Computers in Human Behavior 29 (2013) 2072–2080

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Computers in Human Behavior

journal homepage: www.elsevier.com/locate/comphumbeh

Facebooking for health: An examination into the solicitation and effects

of health-related social support on social networking sites
Hyun Jung Oh a,⇑, Carolyn Lauckner b, Jan Boehmer b, Ryan Fewins-Bliss a, Kang Li a
a
Michigan State University, 309 Communication Arts & Sciences, East Lansing, MI 48824, USA
b
Michigan State University, 409 Communication Arts & Sciences, East Lansing, MI 48824, USA

a r t i c l e i n f o a b s t r a c t

Article history: The current study investigates people’s use of social networking sites for health purposes and its impact
Available online 8 May 2013 on their perception of social support and their health self-efficacy. A structural model was fitted to test
hypothesized relationships between having a health concern, seeking online health information, seeking
Keywords: health-related social support on Facebook, perceived social support from Facebook friends, and health-
Health-related social support related self-efficacy. The study also looks at the relative significance of social support dimensions includ-
Facebook ing: emotional, informational, tangible, and esteem dimensions. An analysis of 291 respondents revealed
Online information seeking
a positive relationship between having health concerns and seeking health-related social support. Seek-
Health self-efficacy
ing support was significantly associated with all four social support dimensions. Among the four support
dimensions, emotional support was the only significant predictor of health self-efficacy. Also, emotional
support was the dimension that was most prevalent in Facebook contexts. Health information seeking
was also positively associated with health self-efficacy but was not significantly related to having a
health concern.
Ó 2013 Elsevier Ltd. All rights reserved.

1. Introduction various welfare systems (Bloom, 1990). Importantly, studies have

witnessed positive effects of social support on various health out-
Using the Internet as a tool for health is increasingly common. comes (e.g., Amir, Roziner, Knoll, & Neufeld, 1999; Lakey et al.,
Six in ten U.S. adults have gathered health information online 2002; Solberg & Viliarreal, 1997; Williams & Bond, 2002).
and one in five have gone online to find other individuals that Since the emergence of the Internet, social support has ex-
share similar health concerns (Fox, 2011a). When individuals are panded its scope into an online context. Researchers have docu-
asked about sources for the provision of emotional support for a mented unique benefits of HRSS on the Internet (Walther &
health condition, they prefer fellow patients, friends, and family, Boyd, 2002; Wright & Bell, 2003). With the increased popularity
with findings showing the value individuals place on turning to of social media, studies have investigated ways SNS benefit users
their peers for support in health situations (Fox, 2011a). Within through various types of support (e.g., Ellison, Steinfield, & Lampe,
this context, social networking sites (SNSs) are of growing impor- 2007; Valkenburg, Peter, & Schouten, 2006). However, there is a
tance: With four in five active internet users visiting social net- lack of research examining whether people utilize SNS to seek
works and blogs, Americans spending more time on Facebook HRSS, and whether those seeking HRSS actually end up receiving
than on any other U.S. website (Nielsen, 2011), and the subsequent and benefitting from it.
increased access to one’s peers, it is likely that these websites are The current study seeks to investigate the use of SNS to seek so-
an important tool in helping individuals to acquire health-related cial support for health issues, which has been found to improve
social support (HRSS). health outcomes (as discussed in Wright & Bell, 2003). The study
Social support has been proposed as a central concept for health further looks at the path through which health-related concerns
and well-being. It can be defined as resources or aid exchanged by drive individuals to seek and receive HRSS through their social net-
the members in a community (Cohen & Hoberman, 1983). This work, which in turn enhances health self-efficacy, a significant fac-
concept has been regarded as a key determinant of better food, tor for improving health outcomes. Additionally, using Facebook as
shelter, income, security, social opportunities, and access to the subject of study, this research compares various types of HRSS
that are perceived on SNS and determines which type is the stron-
gest predictor of health self-efficacy. By doing so, this study con-
⇑ Corresponding author. Tel.: +1 517 515 4151; fax: +1 517 432 2589.
tributes to the body of knowledge in social networking and
E-mail addresses: [email protected] (H.J. Oh), [email protected] (C.
Lauckner), [email protected] (J. Boehmer), [email protected] (R. Fewins-Bliss),
online HRSS by revealing the mechanism by which individuals
[email protected] (K. Li). benefit from their use of SNS.

0747-5632/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.chb.2013.04.017
 H.J. Oh et al. / Computers in Human Behavior 29 (2013) 2072–2080 2073

2. Literature review Hawkins, & Pingree, 2008, p. 362). While it is broadly based on
the theoretical work of Bandura (1977), it closely follows a later
2.1. Health information seeking adaptation of his original definition, which defines self-efficacy as
‘‘a belief in one’s capabilities to organize and execute the course
Seeking for health related information online is a common prac- of action required to produce given attainment’’ (Bandura, 1997,
tice among Internet users in the United States. Eight in ten Internet p. 3). The idea behind the concept of self-efficacy is the principle
users look online for health information, making it the third most that an individual’s beliefs about his or her capabilities affect the
popular online pursuit among all those tracked by the Pew Internet way he or she reacts to a given situation. In the health realm, re-
Project (Fox, 2011a). And, with the rise of SNS, defined as web- search has demonstrated that self-efficacy can play a significant
based sites that allow users to ‘‘present themselves in an online role for different desirable outcomes.
profile, accumulate friends who can post comments on each other’s In a study of women with heart disease, self-efficacy was found
pages, and view each other’s profiles’’ (Ellison et al., 2007), individ- to be a significant predictor of several disease management behav-
uals’ networks for seeking health related information are expand- iors, including medication use, exercise and diet behaviors, and
ing to include online peers. One in four Internet users who have stress management (Clark & Dodge, 1999). Overall, several studies
chronic conditions indicated that they go online to seek for others have concluded that perceived self-efficacy is closely linked to
who have similar issues (Fox, 2011b). health-promoting and health-impairing behavior (Bandura, 1986;
The motivations for seeking health related information online O’Leary, 1985). More specifically, Bandura (1990) finds that per-
are widespread. Tu and Cohen (2008) suggest that people go to ceived efficacy potentially affects ‘‘every phase of personal change
the Internet to find out costs associated with health care and look – whether people even consider changing their health habits, how
for cheaper treatment options. In addition, Tai-Seale, McGuire, hard they try should they choose to do so, how much they change,
and Zhang (2007), as well as Yawn, Goodwin, Zyzanski, and Stange and how well they maintain the changes they have achieved’’ (p.
(2003), have found that patients are concerned about the limited 10). Self-efficacy has also been shown to have an effect on health
time given during a regular doctor’s office visit to discuss all of their information seeking behaviors (Lee et al., 2008), number of hospi-
health related questions. Consistent with those findings, Nicholas, talizations (Sarkar, Ali, & Whooley, 2009), and lower health costs
Huntington, Gunter, Withey, and Russell (2003) found that people (Cross, March, Lapsley, Byrne, & Brooks, 2006), among many other
went online after seeing a health professional to confirm the infor- outcomes.
mation given during a visit and to gather additional insight. Further- Importantly, health self-efficacy has also been found to be re-
more, satisfaction with a health care provider also seems to play a lated to an individual’s health status and/or health behaviors. Pals-
role in patients’ motivations for seeking health related information dottir (2008) found that individuals with high health self-efficacy
online. Tustin (2010) also found that patients who were dissatisfied were more likely to exercise than those with moderate or low
with their healthcare service tend to evaluate the Internet as a bet- self-efficacy, while Jackson, Tucker, and Herman (2007) found that
ter information source than their doctor. Summarizing, Caiata- health self-efficacy was positively correlated with engaging in a
Zufferey, Abraham, Sommerhalder, and Schulz (2010) found that health-promoting lifestyle. Furthermore, in his social cognitive
patients searched for health information online to achieve the goals theory, Bandura (1977) originally posited a negative relationship
of preparing for, complementing, validating, and/or challenging the between self-efficacy and anxiety. Having a health concern is likely
outcome of consultations. As of today, online health information to increase anxiety, which should then reduce one’s self-efficacy.
seeking has been associated with various positive outcomes. Bass Based on the discussion above, this study proposes a negative rela-
et al. (2006) showed cancer patients found the Internet as a useful tionship between health concerns and health self-efficacy, as expli-
channel for getting necessary health information and increasing cated in the following hypothesis:
their competence for making the right decision. In another study,
Samal et al. (2011) found that online information seeking is posi- H3. Having a health concern is negatively related to health self-
tively associated with adherence to treatments, even after control- efficacy.
ling for potentially confounding variables. Cline and Haynes
(2001) and Rice (2006) pointed out that online health information Especially relevant to this study, social support and self-efficacy
seeking can serve as a source for support and interaction. In addi- have been found to be joint predictors of exercise and nutrition in
tion, Ghaddar, Valerio, Garcia, and Hansen (2012) established a po- both general (Anderson-Bill, Winett, & Wojcik, 2011) and diabetic
sitive association between seeking health information online, populations (King et al., 2010). Additionally, use of available social
health literacy, and self-efficacy. This relationship between online support has been found to be an indicator of self-care self-efficacy
health information seeking, social support, and self-efficacy is of among cancer patients (Qian & Yuan, 2012). Clearly, there is a rela-
special interest to this research. Specifically, based on the research tionship between social support and self-efficacy within the health
reviewed, this study examines the following hypotheses: realm.

H1. Having a health concern is positively related to online health 2.3. Health-related social support on social networking sites
information seeking.
Social support, broadly defined as resources exchanged with
H2. Online health information seeking is positively related to others through one’s social ties (Cohen & Hoberman, 1983), has
health self-efficacy. been widely studied as one of the key determinants influencing
individuals’ health. Studies have witnessed positive impacts of so-
This concept of health self-efficacy, the primary outcome vari- cial support on various health outcomes (e.g., Arora, Finney Rutten,
able of this research, will be discussed in more detail in the follow- Gustafson, Moser, & Hawkins, 2007; Cobb, 1976; Kaplan, Cassel, &
ing section. Gore, 1977), though early research found it to be more strongly re-
lated to psychological health than physical health (Schaefer, Coyne,
2.2. Health self-efficacy & Lazarus, 1981). In the past, social support has been studied as a
moderator that reduces negative impacts of stressful situations on
Health self-efficacy is a construct that refers to ‘‘individuals’ be- health (Arora et al., 2007; Cobb, 1976; Cohen & Wills, 1985) or as a
liefs about their ability to manage their health’’ (Lee, Hwang, direct agent that improves health by increasing health-related
2074 H.J. Oh et al. / Computers in Human Behavior 29 (2013) 2072–2080

self-efficacy or perceived availability of supportive resources (Amir mechanism through which having a health concern leads to seek-
et al., 1999; Lakey et al., 2002; Solberg & Viliarreal, 1997; Williams ing for and getting HRSS, which then enhances people’s health self-
& Bond, 2002). efficacy. However, as discussed, research has documented that so-
Since the emergence of the Internet, computer-mediated com- cial support contributes to self-efficacy, which provides the basis
munication has proven its capability of facilitating supportive for the final hypothesis:
interaction among users (e.g., Coursaris & Liu, 2009; Oh & Lee,
2012; Xie, 2008; for in-depth discussion see Wright & Bell, H6. Perceived HRSS on SNS is positively related to health self-
2003). Similar to traditional ‘‘face-to-face’’ social support, com- efficacy.
puter-mediated social support has benefitted those dealing with Finally, the current study attempts to examine whether individ-
health concerns and other stressful situations (Rains & Young, uals seek for certain types of HRSS on SNS, and whether perceiving
2009; Wright & Bell, 2003). Computer-mediated social support different types of HRSS from SNS friends produces different health
can complement face-to-face support such that people can seek outcomes. Acknowledging the multidimensional characteristics of
for the type of support they need through the Internet if it is not social support (Cutrona & Russell, 1990), communication scholars
available face-to-face (Turner, Grube, & Meyers, 2001). Based on have looked at the types of supportive messages that are actually
this line of reasoning, the next hypothesis for this research is put being exchanged among individuals. For example, Braithwaite,
forth: Waldron, and Finn (1999) analyzed supportive messages on an on-
line support group to see whether traditional categorization of so-
H4. Having a health concern is positively related to HRSS seeking cial support can be applied to the online HRSS context. Following
on SNS. earlier classifications of informational, emotional, esteem, tangible,
Building off of previous HRSS research, this study examines the and network support, the study compared frequencies of messages
various types of social support provided through Facebook, the conveying each type of support on the board. Messages conveying
most popular SNS, as well as the effects of receiving this support. informational and emotional support appeared more frequently
Although Facebook studies have not explicitly looked at supportive than other types of support. Informational support included prac-
interactions on Facebook, there has been evidence that SNS have tical resources such as objective information, suggestions, advice,
great potential to benefit users who seek support from others. and appraisals of situations that helped receivers reduce uncer-
For example, Hampton, Goulet, Rainie, and Purcell (2011) found tainty and cope with illness. Emotional support included encour-
that those who use SNS perceived greater levels of social support agement, empathy, and sympathy aimed at reducing stress or
including emotional, companionship, and tangible support, than negative affect. Messages carrying network support, which in-
did general Internet users or cell phone users. Valkenburg et al. volves broadening recipients’ social networks, were more fre-
(2006) found out that the tone of interactions in social networking quently found in the online board compared to traditional forms
sites influenced adolescents’ self-esteem and well-being such that of social support. Esteem support included messages that helped
positive feedback from other users enhanced self-esteem and sat- recipients restore self-concept or self-validation, and tangible
isfaction with life, whereas negative reactions from other users de- assistance included expressions of willingness to give direct phys-
creased self-esteem and satisfaction. Although the study did not ical assistance, which was the least frequently occurring type. Gi-
conceptualize giving feedback as supportive interaction, their ven the distinctive nature of each support dimension, it is
model indirectly explains the supportive mechanism, especially important to understand which type of social support is more pre-
the esteem dimension of social support. valent on SNS, and whether and how each support dimension
In the context of health communication, SNS can be a useful influences various health outcomes. As an initial step to address
channel for sharing health information and building a sense of such needs, the current study poses two research questions, using
community among people with similar health issues. Like online the categorization presented by Braithwaite et al. (1999):
communities, users in SNS can create a group based on different
health topics, identify with others in the group, and share health RQ1. Which type of HRSS do individuals perceive more on SNS?
information with them (Kamel Boulos & Wheeler, 2007). However, RQ2. Which type of HRSS on SNS is the strongest predictor of
unlike general support, which can be internalized through daily health self-efficacy?
interaction through SNS, HRSS can only be acquired through active
and intentional seeking of it because of its specificity and relation- A path model addressing all of the aforementioned hypotheses
ship to certain situations. Users must express a need for HRSS or will be examined (see Fig. 1). In particular, the model tests the cau-
disclose health concerns in order to receive HRSS from others with- sal chain between having a health concern, viewing online infor-
in their social network. For example, one study examined social mation, seeking HRSS on SNS, receiving HRSS, and health self-
support in a weight loss Facebook page and found a relationship efficacy. Overall, the goal of this research is to determine if people
between perceived support and sought support, such that those are seeking out social support for health issues on Facebook, and if
who actively communicated with others perceived greater infor- so, to understand which type of support they seek out more. Fur-
mational and emotional support than those who simply browsed thermore, this study will examine contributing factors and the
the page (Ballantine & Stephenson, 2011). Another study found resulting consequences of this behavior.
that HRSS received through Facebook was determined by how well
a users’ network was developed and how effectively users sought
3. Methods
for it within the network (Newman et al., 2011). Based on this re-
search, the following hypothesis is put forward:
3.1. Subjects
H5. HRSS seeking on SNS is positively related to perceived HRSS on
The subject population was undergraduate college students at a
SNS.
large Midwestern university and individuals recruited through
Although there has been indirect evidence that HRSS can be ac- Facebook in a convenience sampling procedure. An online survey
tively exchanged in SNS and that users can possibly benefit from was utilized to collect data, and college students were offered
their supportive network (Ballantine & Stephenson, 2011; New- course credit in exchange for their participation. From those who
man et al., 2011), few studies have empirically examined the responded, 291 responses were usable and comprised the final
 H.J. Oh et al. / Computers in Human Behavior 29 (2013) 2072–2080 2075

Online Health
Health Concern H1 Information
Seeking

H2
H4 H3

Health Self-
HRSS Seeking Efficacy
on Facebook

H5-5 H6-1 H6-2 H6-3 H6-4 H6-5

H5-1 H5-2 H5-3 H5-4

Perceived Perceived Perceived Perceived Perceived

Appraisal Network Esteem Emotional Tangible
Support Support Support Support Support

Fig. 1. 1 Proposed model and hypotheses.

sample. Participants’ age ranged from 19 to 75 years, with a mean emotional support, and tangible support. One dimension, network
of 29 years (median 23). Thirty-two percent were male, while 68% support, was excluded from analysis because all the items in this
were female. dimension were cross-loaded to other dimensions. After removing
one item from the appraisal support dimension, ‘‘If I have a health-
related problem, my Facebook friends will give me advice that I
3.2. Measures
really trust,’’ which was highly correlated with other items, each
dimension showed high reliability and acceptable construct valid-
The survey included measures assessing health status, HRSS
ity. For the full scale, factor loadings, and reliability scores, see Ta-
seeking on Facebook, online health information seeking, perceived
ble 1. Each item was weighed based on its loading for its
HRSS from Facebook friends, and health self-efficacy. Health con-
corresponding dimension, and the loaded scores within each
cern was measured using one item asking respondents ‘‘How
dimension were summed up to create a composite score for each
would you rate your personal health?’’ It was measured using a
of the four HRSS dimensions.
5-point Likert scale ranging from ‘‘excellent’’ to ‘‘poor.’’Online
A five-item scale taken from Lee et al. (2008) was used to mea-
health information seeking was measured with 11 dichotomous
sure health self-efficacy. While this measure does not tap into all the
items asking whether or not individuals had searched for different
dimensions Bandura (1977) originally suggested, it closely follows
types of health information online, such as ‘‘a specific disease or
his later definition for self-efficacy in the health realm, measuring
medical problem,’’ ‘‘environmental health hazards,’’ and ‘‘doctors
the ‘‘capabilities to organize and execute the course of action re-
or other health professionals.’’ These questions were taken from re-
quired to produce given attainment’’ (Bandura, 1997, p.3). Re-
search done by Fox (2011b). The only changes made were eliminat-
sponses were provided using a 5-point Likert scale ranging from
ing a few types of health information that were uncommon among
‘‘disagree very much’’ to ‘‘agree very much.’’ After removing the
Fox’s respondents in an effort to cut down the length of the survey.
item ‘‘I feel that I am in control of how and what I learn about
HRSS seeking on Facebook was measured with six items using a
my health,’’ the remaining four items in the scale, viewable in Ta-
7-point scale ranging from ‘‘definitely false’’ to ‘‘definitely true.’’
ble 1, indicated acceptable construct validity as well as high inter-
The items demonstrated acceptable construct validity and high
nal consistency, as the Cronbach’s alpha score was .87.
internal consistency (a = .92) after removing two bad items, ‘‘I
would never disclose anything related to health on Facebook’’
and ‘‘Facebook is the best method for getting health information
I need.’’ The final set of questions including their mean, standard 3.3. Analyses
deviation, and factor loading can be viewed in Table 1. For analysis,
individual items were weighed based on their loading scores (i.e., A path analysis, a statistical method of structural equation mod-
unstandardized coefficient) and summed up to create a composite eling (SEM), was used to test the hypothesized model. The AMOS
score of HRSS seeking on Facebook. Those who indicated that they 19.0 program was employed to obtain maximum-likelihood (ML)
have never sought HRSS on Facebook were assigned the lowest estimates of the model parameters (Arbuckle, 2010). Table 2 shows
score of the scale for all the items. the correlation matrix for estimating the recursive model hypoth-
To measure perceived HRSS from Facebook friends, an 18-item esized in this study. Health concern was treated as an exogenous
measure of online social support was developed by consulting Co- variable, and the other seven variables— seeking HRSS on Face-
hen and Hoberman (1983) as well as LaRose, Eastin, and Gregg book, seeking online health information, the four types of per-
(2001). In this study, the items from these scales were adapted ceived HRSS (appraisal, esteem, emotional, and tangible support)
by phrasing them in terms of perceived HRSS on Facebook. A 7- on Facebook, and health self-efficacy were treated as endogenous
point Likert scale was used ranging from ‘‘definitely false’’ to ‘‘def- variables. Missing values were replaced with means and incom-
initely true.’’ This scale measured five dimensions of social plete survey responses were deleted, which resulted in the final
support: appraisal support, network support, esteem support, sample size of 291.
2076 H.J. Oh et al. / Computers in Human Behavior 29 (2013) 2072–2080

Table 1
Descriptives, reliability and validity of the key variables.

Mean SD Factor loading Alpha

Health Concern 2.04 .85
Online Health Information Seeking 7.07 2.78
HRSS Seeking on Facebookabc 3.21 1.48 .92
I have used Facebook to get health-related information from others 4.57 1.97 .90
I have used Facebook to seek out people who have experienced similar health problems as I have 3.56 2.16 .90
If I have a health question, I often go to Facebook to seek out advice from others. 2.87 1.85 .84
I have used Facebook to update others on my health 4.30 2.01 .82
Perceived HRSS from Facebook Friends
If I have a health-related problem, my Facebook friends will. . .
Appraisalbc 3.21 1.48 .89
Give objective feedback to me about how I’m handling my problem 3.66 1.57 .71
Make me feel comfortable discussing sensitive health issues 3.10 1.63 .95
Make me feel comfortable sharing my private worries and fears about health 3.00 1.66 .93
Esteembc 4.27 1.48 .93
Show confidence in my ability to deal with my health concern 4.20 1.63 .83
Make me feel that I am good at making healthy decisions 4.26 1.54 .94
Make me feel as though I am capable of handling my health problem 4.35 1.58 .95
Emotionalbc 4.80 1.46 .91
Provide encouragement to me 5.04 1.58 .92
Show me empathy 4.94 1.52 .92
Make me feel relieved. 4.39 1.66 .82
Tangiblebc 3.54 1.69 .91
Drive me to the doctor if I ask for a ride 4.13 1.87 .79
Provide a quick emergency loan if I need it for my health issue 3.25 1.78 .95
Buy me medicine if I ask for it 3.31 1.85 .91
Health Self-Efficacybc 3.21 1.48 .87
I am confident I can have a positive effect on my health 4.41 .98 .68
I have set some definite goals to improve my health 3.98 1.03 .88
I have been able to meet the goals I set for myself to improve my health 3.54 1.05 .76
I am actively working to improve my health 3.85 1.05 .85

Note: Deleted items are not shown here.

a
N = 116.
b
Dimensions were validated through confirmatory factor analysis with an acceptable fit, v2 (155) = 414.50, RMSEA = .08, NNFI = .92, CFI = .95, and SRMR = .07.
c
Composite score.

Table 2
Correlation matrix between the key variables.

1 2 3 4 5 6 7 8
Health concern 1
HRSS seeking on Facebook .12* 1
Online health information seeking .01 .16** 1
Perceived appraisal support .01 .33*** .01 1
Perceived esteem support .04 .34*** .03 .61*** 1
Perceived emotional support .12* .36*** .02 .55*** .79*** 1
Perceived tangible support .01 .23*** .06 .54*** .48*** .47*** 1
Health self-efficacy .22*** .21** .22** .13* .21*** .28** .14* 1
*
p < .05.
**
p < .01.
***
p < .001.

4. Results who had sought health information on the Internet reported a

higher level of health self-efficacy. Thus, hypothesis 2 was sup-
Overall, 39.18% of individuals had sought HRSS on Facebook. ported whereas hypothesis 1 was rejected.
The proposed model, based on the study hypotheses and edited Hypotheses 3 through 6 were proposed to test the relationships
to account for the removal of network support from analysis, indi- among health concern, seeking out and perceiving HRSS on SNS,
cates an acceptable fit based on multiple goodness of fit indices, v2 and health self-efficacy. First, having a health concern was signifi-
(10) = 29.01, RMSEA = .08, NNFI = .96, CFI = .97, and SRMR = .05. cantly associated with health self-efficacy. Those who reported
From this model, 15% of the variance in health self-efficacy was ex- having poorer health status also had lower perceived self-efficacy
plained. Fig. 2 presents the final model with standardized coeffi- (b = .19, p < .001), supporting hypothesis 3. On the other hand,
cients and their statistical significance. More details regarding individuals with health concerns were more likely to seek out HRSS
the hypothesis tests are provided in the sections that follow. on SNS (b = .23, p < .05), and those who had sought more HRSS on
Hypotheses 1 and 2 were proposed to test the relationships Facebook perceived greater appraisal (b = .33, p < .001), esteem
among health concern, online health information seeking, and (b = .34, p < .001), emotional (b = .36, p < .001), and tangible sup-
health self-efficacy. As shown in Fig. 2, having a health concern port (b = .23, p < .001) from their Facebook friends. Therefore,
was not significantly associated with seeking online health infor- hypotheses 4 and 5 were also supported. Hypothesis 6 predicted
mation, but seeking online health information was positively re- a positive association between perceived HRSS from SNS friends
lated to health self-efficacy (b = .27, p < .01), such that individuals and health self-efficacy. As shown in Fig. 2, this hypothesis was
 H.J. Oh et al. / Computers in Human Behavior 29 (2013) 2072–2080 2077

Online Health
Health Concern Information
Seeking (.00)

***
.23
*
.23 ***
-.20

Health Self-
HRSS Seeking on Efficacy (.15)
Facebook (.01)

*** *** ***

*** *** .22
.28 .30 .30 .27

Perceived Perceived Perceived Perceived

Appraisal Esteem Emotional Tangible
Support (.11) Support (.12) Support (.13) Support (.05)

Fig. 2. Hypothesized model and significance testing. Note: Only significant coefficients are presented. All the coefficients are standardized. The error terms of four perceived
HRSS dimensions are correlated, but not shown here. R2 for each endogenous variable is reported in the parentheses. ⁄p < .05, ⁄⁄p < .01, ⁄⁄⁄p < .001.

partially supported. Among the four HRSS dimensions, only emo- perceived on SNS, and which type of HRSS is the strongest predic-
tional support was significantly related to perceived health self- tor of health self-efficacy.
efficacy (b = .27, p < .01). The current study bolsters existing social support literature by
Research question 1 examined whether certain types of HRSS confirming the positive associations between having a health con-
were more predominant among Facebook users. A repeated-mea- cern, seeking HRSS, and perceiving HRSS. The relationship between
sures ANOVA was conducted to compare the means of the different HRSS sought and perceived suggests that SNS may be an effective
types of HRSS: appraisal, esteem, emotional, and tangible. Mau- method of gathering needed social support, as respondents seemed
chly’s Test of Sphericity yielded a significant result (p < .001), to find what they were looking for. Previous literature on online
meaning that sphericity could not be assumed, so the Green- HRSS has documented the greater needs of social support among
house–Geisser test was utilized. The overall analysis was signifi- people who suffer from health issues (Cutrona & Russell, 1990)
cant, F (2.47, 716.65) = 145.53, p < .001, partial g2 = .33, indicating and has suggested that computer-mediated interaction benefits
differences between the types of support. A post hoc Bonferroni those people by allowing them to exchange necessary support
analysis was completed to determine which dimensions of support and build in-depth relationships (Turner et al., 2001; Wright & Bell,
were significantly different from one another. Results showed that 2003). This study found another benefit of seeking support online –
the means of emotional (M = 4.79, SD = 1.46), esteem (M = 4.27, improved health self-efficacy, which is a significant factor influenc-
SD = 1.48), tangible (M = 3.54 SD = 1.68), and appraisal (M = 3.21, ing health behaviors and health outcomes (e.g., Clark & Dodge,
SD = 1.48) support were all significantly different from one an- 1999; Cross et al., 2006; Sarkar et al., 2009). This study suggests
other. Thus, it can be concluded that emotional support was statis- that using Facebook to seek HRSS may have real-world health
tically the most predominant among Facebook users, followed by implications, which warrants further research on the role that this
esteem and tangible support. Appraisal support was the least technology can play in individuals’ health. If researchers could
common. determine specific Facebook functions that are more likely to lead
Research question 2 was formulated to examine which type of to benefits, or use social media-based interactions as an interven-
HRSS perceived from Facebook friends would be the most strongly tion technology for patients, then the knowledge of this technol-
associated with health self-efficacy. As discussed above, emotional ogy’s effects would be bolstered.
support was the only dimension significantly associated with Further, the positive relationship between perceived social sup-
health self-efficacy, suggesting that among the four social support port and health self-efficacy was not surprising, given a wealth of
dimensions perceived from Facebook friends, emotional support is studies that documented the significant role of social support in
the strongest predictor of health self-efficacy. enhancing self-efficacy (King et al., 2010; Qian & Yuan, 2012).
The differential impact of each support dimension that was found,
however, deserves special attention and should be one of the key
contributions of this study to the online social support literature.
5. Discussion Among the four dimensions, emotional support was the only sig-
nificant predictor of health self-efficacy. This finding bolsters the
The purpose of the current study was to investigate whether so- key proposition of optimal matching theory (Cutrona & Russell,
cial networking sites can serve as an effective venue for HRSS ex- 1990), which posits that the effectiveness of social support will
change among users. Using Facebook as the topic of interest, the be maximized when the type of support one receives matches
study looked at relationships between having a health concern, the type of support one needs. The current study supports optimal
seeking HRSS from Facebook, seeking health information online, matching theory such that emotional support was the most fre-
perceived HRSS from Facebook, and health-related self-efficacy. quently sought dimension among four types of support and was
The study also examined the types of social support that are most the only predictor of enhanced health self-efficacy. According to
2078 H.J. Oh et al. / Computers in Human Behavior 29 (2013) 2072–2080

Cutrona and Russell (1990), having a health issue requires emo- either by looking at actual messages communicated through SNS
tional support, and this study supports this claim by showing the or characteristics of supportive networks on SNS. Diverse ap-
prevalence of emotional support exchange on Facebook and its sig- proaches combined will contribute to the advancement of existing
nificant role in improving a health-related outcome. knowledge on social support, especially in regards to how the sup-
Existing SNS studies demonstrate that users exchange practical portive functions of SNS can be maximized.
resources through SNS such as information, resources, or networks
(Ellison et al., 2007). It is unclear why, in this study, emotional sup-
port was more prevalent than the other dimensions. It may simply
5.1. Limitations
be that SNS facilitate more personal communication due to the
peer-based nature of one’s network, which is more likely to lead
One dimension of HRSS, network support, was removed from
to the exchange of emotional support. These findings suggest that
analysis due to indications of poor reliability and loadings in the
the type of resources exchanged on Facebook must be understood
factor analysis. This did not affect the other dimensions, but did de-
in terms of specific purposes or outcomes users expect. In this case,
crease the ability to compare this research to past studies using the
emotional support was most often sought for health-related issues,
five dimensions of social support. Additionally, the removal of this
but this does not necessarily imply that emotional support will be
dimension could have negatively affected the predictive power of
the only type of support to be exchanged on Facebook. Depending
our proposed model.
on the type of issue and outcome, different dimensions may arise
Another limitation is that the number of respondents who had
and play significant roles. Further research in this area is warranted
sought HRSS on Facebook was low (39.18%) and answers from the
to capitalize upon these technologies in order to facilitate social
participants who had not sought HRSS on Facebook decreased the
support and, in turn, better health outcomes.
composite scores created for the path analysis. Future work should
The lack of association between having a health concern and
seek to utilize a larger sample to account for the fact that seeking
online health information seeking suggests that individuals go to
HRSS on Facebook is still not a common activity among users.
their friends on Facebook to discuss health issues with networked
Given high correlations among sub-dimensions of perceived so-
others and get more personalized information or reactions, rather
cial support, one might attribute insignificant relationships be-
than seeking for information online through search engines or
tween the three support dimensions (i.e., informational, esteem,
blogs. This result further highlights the potential role of social net-
and tangible) and health self-efficacy to the multicollinearity
working sites as a source of health information (Kamel Boulos &
among those dimensions. Although no multicollinearity issues
Wheeler, 2007). It is, however, also possible that the insignificant
were found that were large enough to influence tested relation-
relationship was due to the items used for measuring health infor-
ships, it is plausible that high correlations among the sub-dimen-
mation seeking. Because health information seeking was measured
sions suppressed the relationships between each support
by asking respondents whether they had sought information
dimension and self-efficacy.
regarding different health topics (i.e., a specific disease or medical
Finally, this research utilizes correlational data, preventing
problem, environmental health hazards), it is also likely that one
inference of cause. Future work should seek to use more longitudi-
who has a health concern is more likely to seek information spe-
nal data in order to examine this phenomenon. Although the good-
cific to the disease but not across different issues. Thus, if questions
ness of fit indices suggest that the data are in favor of the model
had addressed frequency or duration of information seeking, rather
proposed here, this is only one of many possible iterations, and riv-
than the number of topics sought online, the study may have
al models could also fit the data. With a path model, the goal of this
yielded different responses.
research was to test the influence of HRSS and health information
The study’s findings on health self-efficacy support the original
seeking on enhancing health-related self-efficacy, but given the re-
claim of Bandura’s (1977) social cognitive theory, which links self-
ciprocal characteristics of self-efficacy and behavioral experiences
efficacy with perceived anxiety. In the current study, self-efficacy
(Bandura, 1977), it is also plausible that self-efficacy can become
was reduced by having a health concern, which likely increases
a predictor of seeking social support and health information. Fu-
anxiety, as demonstrated by the negative relationship found. How-
ture studies can test alternative models and examine different
ever, this negative relationship was mediated by social support
directions of relationships among the key constructs proposed
such that having a health concern encouraged people to seek more
here. Additionally, the presence of third variables not incorporated
support, leading to greater perception of emotional support, which
in this research, such as health or computer literacy, extraversion/
then enhanced health-related self-efficacy. Although the mecha-
introversion, or health history, could have affected the relation-
nism of how or why social support enhances self-efficacy is not
ships proposed here and should also be considered in future
in the scope of this paper, it is likely that increased level of self-effi-
studies.
cacy can be in part explained by a reduced level of anxiety result-
ing from emotional support and information.
Since its introduction, social support has been approached from
many different perspectives. Network approaches highlight the 6. Conclusion
significance of a supportive network and interpersonal ties on indi-
vidual health or life satisfaction (House, Umberson, & Landis, 1988; The current study examined how individuals utilize their online
Seeman & Berkman, 1988; Stokes, 1983), whereas psychological social networks to seek HRSS, how their social networks provide
approaches focus more on internalization of support and the HRSS, and how perceived HRSS is related to health outcomes with-
mechanism through which perceived social support benefits peo- in the context of Facebook. The result reveals the significance of
ple (Cohen & Wills, 1985; Lakey & Cassady, 1990; Valkenburg perceived social support from SNS, especially emotional support,
et al., 2006). Communication scholars take a closer look at the ac- in enhancing one’s self-efficacy. Given the prevalence of SNS, the
tual supportive content exchanged via face-to-face (Burleson & positive associations between health concerns, seeking as well as
MacGeorge, 2002; Goldsmith, 2004) or computer-mediated com- perceiving HRSS from Facebook, and enhanced health self-efficacy,
munication (Braithwaite et al., 1999). The current study is in line lead to an optimistic conclusion that Facebook can become an
with the psychological approach, as it examines outcomes and effective space for supportive interaction. In turn, these supportive
mechanisms of social support on SNS. Future studies should ap- interactions on Facebook can indeed benefit users by enhancing
proach supportive functions of SNS from different perspectives, their confidence in managing their own health.
 H.J. Oh et al. / Computers in Human Behavior 29 (2013) 2072–2080 2079

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