More threads by David Baxter PhD

David Baxter PhD

Late Founder
The Quality of Online Support Communities: People not Posts
by John M. Grohol, Psy.D.
December 29, 2006

As online communities continue to grow with virtually everyone who is online belonging to at least one such community, communities start competing with one another for the same people. Like to talk about the latest technologies and gadgets? You have dozens of large, thriving online communities to choose from. Suffer from depression and want to find an online support group? Dozens of depression support groups are vying for your attention.

Online Support Communities Are Different
But an online health or mental health support community is qualitatively different than other types of online communities. In a mainstream, non-support community, there are more often than not a large number of replies to a post, video, or news item that are short in length. And while there are some non-support communities that are exceptions to this rule, sites such as Digg, YouTube and Slashdot chase the norm ? there are far more quantities of replies than there are quality replies. (Which is not to say there aren?t quality replies, just that you often have to read many ? or use their built-in reputation systems ? to find them.)

Support communities for health and mental health concerns, however, usually have a distinct purpose and an additional emotional connection amongst its members. They are all grappling with a similar serious issue in their lives, such as cancer, a medical disease, or a mental health issue. These communities usually foster a greater social connectedness amongst their members because of their focused subject matter and the seriousness of the concern. Reputation systems don?t make as much sense in these kinds of communities because users can be emotionally vulnerable ? reputation systems are seen as just another judgment of their abilities. Such systems are usually inappropriate for a support community.

What Makes a Quality Support Community?
So what differentiates a vibrant, quality support community from one that may be large, but lacking in real social connections?


Some online communities rely on the top numbers (number of users or total posts in the system) to suggest they are a large, vibrant community. Only by digging deeper can a person determine whether the community actually is a robust community that encourages social connections.

Social connections are weaker when people are rewarded for their community contributions via external, versus internal, rewards. An external reward is something like a prize for ?best reply? or ?most replies,? or a community reputation system. An internal reward is something a person feels inside for helping others out because they feel a social connection of some type to the person asking a question, or providing advice or support or information in their post. External rewards are often (but not exclusively) given to compensate for the lack of social connectedness within a community.

Unintentionally, such external rewards may reinforce a shallow, lower-quality community. If a community reinforces quantity over quality, its users learn how to ?game the system? by replying in large numbers to increase their standing (or reputation). Even when such communities make an effort to balance such rewards with rewards for quality replies as well, users learn that the more replies one makes, the more likely any given reply will be seen and considered for a ?quality? indicator. With billions of web pages online, it?s also far easier to plagiarize a ?reply? from an external source, with little worry of being caught (since most such Q&A online communities don?t have the resources to police the community properly).

A set of clearly defined community ground rules are also important to a strong, cohesive online community. While in many online communities, ?anything goes? because there are things like reputation systems that are supposed to take care of troublemakers, an online support community is different. Users of a health community expect a higher level of discourse and emotional support, and don?t want to be judged for their posts or opinions (as reputation systems do). Therefore a set of community guidelines ? of acceptable and unacceptable community behavior ? helps to resolve this issue. Such guidelines also need to be administered by a fair, impartial team of transparent (e.g., known to the users) community moderators. Quality online support communities have both.

Quality support communities differ from their shallow counterparts simply because they emphasize people over posts. It?s not chasing a numbers game of how many ?friends? you have in the community.

Replies generally aren?t just information-oriented in nature (You asked Question A, I reply with Answer B). They are support-oriented, and tend to involve the individual?s own personal experiences with the issue or health concern in a narrative form. Such communities also emphasize an individual?s own personal experiences and not as a substitute for a search engine, so the community isn?t treated as an unlimited human resource (such as Yahoo! Answers).

Informational questions that have been asked and answered in the past are often stored in the form of a FAQ or ?sticky? thread so people don?t expend time asking and answering the same questions over and over again. After all, that?s one of the powerful uses of computers ? to organize information that is known. There is a simple, factual answer to ?I think I may have depression? What are the symptoms of depression?? that doesn?t require a human being to copy and paste the answer from another website. Yet this is exactly the kind of behavior some online communities endorse and reinforce.

In the same vein, communities that emphasize a social networking component for health or mental health support are simply latching onto the latest online phenomenom. ?Friends? are not defined by a simple online connection to someone who has the same issue as you. And the number of such ?friends? a person has doesn?t help the individual with their health issue. It has to go deeper than that. So while such components have the potential to help people, nobody has yet deployed them in a manner that actually does.

Experts Help Guide Support Communities
Strong, thriving online communities are not numbers games. In addition to emphasizing a person?s own personal experiences over that of informational posts, quality online communities are focused and overseen by people who understand the unique needs of their users. Similar to how editors work at large news-oriented community sites such as Digg, Engadget or Slashdot, community administrators and editors should have a background, knowledge and deep understanding of the topics their community covers. Since setting up community software is as simple as clicking a signup button, a quality community differentiates itself by having topical experts who can help tailor the community?s growth and development over time. Each community has unique needs, so such experts become important guides that help foster the community?s users own personal growth, learning, and support.

Expert community guides and editors have a grounded educational background in the topics they are covering, and be readily available to the community on a regular basis to be most effective. Such people should also understand that their role is to help foster the community?s growth along a positive path of support and help, not to expound their own personal or professional theories on the health or mental health topic. Experts and professionals are there to serve the community, not the other way around.

Beyond the Numbers
In summary, online health and mental health support communities:

  • Emphasize and reinforce internal rewards (not external rewards)
  • Have community ground rules that are enforced by a transparent team of impartial, fair moderators
  • Emphasize quality over quantity
  • Emphasize personal experiences and sharing over information re-publication (and duplicate posts)
  • Foster personal growth, learning and support through expert guides and editors
Online health and mental health support communities have unique requirements over a typical online community. Sites that recognize these needs and foster their users? growth and development offer a more vibrant, higher quality experience than sites that don?t understand their users and treat them just like another social network. Discerning users know the difference and vote with their mouse.


Good overview to describe what we do. Should be required reading for all who participate in a health support forum.

Thanks for posting this!


Good overview to describe what we do. Should be required reading for all who participate in a health support forum.

I agree, TSOW.

Thanks for posting it David. Definitely a great article especially the part of quality over quantity of posts :)
Replying is not possible. This forum is only available as an archive.