It is clear that there will be many opportunities to harness the power of social media networks in healthcare. With chronic diseases like diabetes, one-on-one interventions can be expensive and time consuming for patients and physicians alike. Web-based social networks for diabetes have the potential to supplement care and deliver results that are similar to one-on-one interventions, but at a much lower cost. The challenge for providers will be to optimize strategies that encourage patient participation and to integrate the social media components into the existing healthcare infrastructure.

Analysis of Online Interaction

In the December 2010 Journal of Medical Internet Research, my colleagues and I published results of a randomized controlled study examining the impact of adding online interaction to a walking program for patients with type 2 diabetes, coronary artery disease, or obesity. The intervention group had the ability to communicate with other participants and study staff in an online forum. The control group did not have access to the online forum.

“Physicians can play a key role in the advancement of internet-based programs and online communities by leveraging existing online resources and directing patients to appropriate sites.”

We wanted to learn if access to the forum would impact engagement, retention, and step counts. Equal improvement was observed in step counts for both groups. However, adding an interactive online community to the internet-based walking program significantly improved program retention. Nearly eight in 10 participants (79%) who had access to online forums adhered to the 16-week program, compared with two-thirds (66%) of patients randomly assigned to use a version of the website that didn’t have the social components.

Many patients in our analysis had positive social support through non-online contacts. Others, however, had fairly limited social support, were more isolated, and lived in communities where diet and exercise were not highly valued. For these individuals, social online communities may provide an outlet to connect with others and gain the support they need to overcome disease management barriers and meet treatment goals. In our study, patients with lower baseline social support posted more messages and viewed more posts than those with higher levels of social support. The interpretation is that the social connection— established online—helped patients continue their involvement in the walking program.

Physician’s Role in Online Health Programs

Physicians can play a key role in the advancement of internet-based programs and online communities by leveraging existing online resources and directing patients to appropriate sites. The online community tested in our study—“Stepping Up to Health”—is a research platform and is not publically available. However, there are many similar commercial walking programs that use uploading pedometers, automated coaching, and online communities to promote walking for health. Leveraging social media networks may be less expensive than more traditional, face-to-face interventions while providing greater access to strategies that enact behavior changes. Physicians must empower patients with information and long-term support when they’re not in the doctor’s office.

Adding community features to online health programs can be a powerful tool for reducing attrition rates in health programs. The good news is that models of how to change behaviors are being developed and disseminated online. As research demonstrates that these programs help keep patients active and improve health behaviors, outcomes are likely to improve.


Richardson CR, Buis LR, Janney AW, et al. An online community improves adherence in an internet-mediated walking program. Part 1: results of a randomized controlled trial. J Med Internet Res. 2010;12:e71. Available at:

Resnick PJ, Janney AW, Buis LR, Richardson CR. Adding an online community to an internet-mediated walking program. Part 2: strategies for encouraging community participation. J Med Internet Res. 2010;12:e72. Available at:

Richardson CR, Mehari KS, McIntyre LG, et al. A randomized trial comparing structured and lifestyle goals in an internet-mediated walking program for people with type 2 diabetes. Int J Behav Nutr Phys Act. 2007;4:59.

Demiris G. The diffusion of virtual communities in health care: concepts and challenges. Patient Educ Couns. 2006;62:178-188.