A critical perspective of engagement in online health communities

Many individuals go to online health communities to obtain emotional and information support. This study employs critical discourse analysis (CDA) to examine the discourse in five online childhood immunization forums to identify online practices related to engagement and emancipation. We identify four online engagement discourse types in online health communities: cognitive, emotional, behavioural, and political. Consistent with our critical perspective, we identify drivers and obstacles to emancipation. The obstacles to emancipation include the adverse consequences of building online knowledge and collective intelligence, shifts in patient–physician relationships, and “Big” institutional power. Members’ suggestions for empowering community members include encouraging members to conduct their own research on childhood immunization and to differentiate between facts and opinions. These findings suggest that sensemaking is one way to emancipate online health community members, while highlighting the challenges of using online communities to promote emancipation.