Date of Award

2009

Document Type

Thesis - ECU Access Only

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy

Faculty

Faculty of Education and Arts

First Supervisor

Lelia Green

Second Supervisor

Arshad Omari

Third Supervisor

Maurice Swanson

Abstract

This research was motivated by several important communication and public health issues. In terms of communication, the issue at hand was whether an authentic online health-related service could be started from scratch that would exhibit the hallmarks of community. If so, could the community offer effective support to its members? Would such a community help reduce the disadvantage experienced by some people who live outside the metropolitan area and away from health-related face to face support groups? If the on line community were supported by a charity, would community members feel more inclined to support the charity themselves, through donations, for example?

In terms of the public health agenda, heart-related diseases are a national concern in Australia and throughout many (predominantly) westernised countries. While preventing heart disease, in particular, must remain the primary focus for public health initiatives; for those already affected, the National Heart Foundation (WA) has recognised that social support is a significant protective factor along with other healthy lifestyle behaviours. Social support or access to support programs has been positioned as particularly lacking for those who reside in rural or remote areas of Australia. Therefore, finding ways to provide mechanisms and avenues for the delivery of support and rehabilitation have been identified as critical if the secondary prevention (i.e., recovery) of heart disease is to be achieved. An online community is one response to this challenge.

Given that the prevalence of heart disease increases with age, Australia's baby boomer generation is moving into a vulnerable life stage. If this large cohort is not provided for, a myriad of social and economic ramifications will follow. The National Heart Foundation has also expressed concern that baby boomers are less concerned about making donations to support their work than predecessor generations; and this may ultimately reduce the types of public health programs which are made available as more of this generation encounters heart conditions.

This research, funded by an ARC Linkage grant with the National Heart Foundation (WA) as the Industry Partner, set out to respond to these challenges through the provision of a best practice website to support heart patients in Western Australia. My role, as the PhD Candidate, was to oversee all aspects of the project's design, implementation and evaluation in order to achieve the research goals. Although I was supported by specialist supervisors and technicians, all aspects of the research were undertaken as part of my PhD journey.

The website that was developed, HeartNET, provided the mechanism to determine if a sense of community among heart patients could be fostered online, not only to produce therapeutic outcomes but to support the healthy behaviours which reduce the recurrence of heart disease or illnesses. Given the challenges with rural and remote access to support services, the building of a 'community' was aptly positioned to deliver support and rehabilitation regardless of location.

The research utilised an intervention-approach which relied upon the development of a successful website from the grassroots. That is, although research into the hallmarks of what patients consider to be community was the primary research objective, this could not be undertaken unless the website were deemed successful. Achieving the 'right' website was eventually delivered after two iterations; when it had reached a critical mass of participants, having undertaken substantial marketing and public relations activities, and after interactive tools had been fine-tuned. With the website running smoothly, utilising a netnographic methodology provided the best way to investigate the notion of community. In order to ensure rigour and trustworthiness, the research utilised two groups of participants - those who accessed the website, and those who acted as comparison, and therefore did not have access. The netnography, similar to ethnography but with unique markers for online research, utilised a number of qualitative data collection techniques - a focus group, in-depth interviews, online transcripts, and other observational techniques - along with questionnaires for quantitative data collection at the commencement of the research and after 12 months of participation.

The netnography revealed that a strong sense of community developed on the HeartNET website over a 12 month duration. The community began when members started forming relationships with each other, which resulted in a sense of bonding and belonging. Members were also identified as offering mutual support as part of a 'gift economy' which led to revelations about a reduced sense of isolation or aloneness. Having identified community features, the analysis turned to issues of identity and culture which resulted in a sense of community ownership and reinforcement of community values. The analysis then revealed some positive signs of an improvement in healthy lifestyle choices for healthy diet, physical activity and smoking cessation. The questionnaire data adds some additional weight to, and provides triangulation for, what was observed online in relation to health outcomes. The final stage analysis revealed that, although methodological issues would not allow for an in-depth interrogation of philanthropic support in terms of attitudes and behaviours to do with donations, it did reveal a new philanthropic currency in that HeartNET members were willing to donate their time, stories, and experiences to support Heart Foundation events and activities.

This thesis offers an innovative application of communications theory within a health context by providing a detailed roadmap for the development of other online health-related communities.

LCSH Subject Headings

Health promotion -- Computer network resources -- Western Australia.

Heart -- Diseases -- Patients -- Western Australia.

Therapeutic communities -- Western Australia.

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