Sally Sanger

Published 31/1/2021

How do the discussion forums of online alcohol support groups affect users’ understanding of problem drinking?

Sally completed in 2021 (external examiner Jenny Rowley). I co-supervised her research with colleague Peter Bath.

Below is a list of Sally’s publications and the abstract of her thesis.

Abstract

Problem drinking remains a significant problem in British society and internationally (World Health Organisation, 2018), with hospital admissions continuing to rise in the UK, and the cost to the economy estimated at £47 billion in 2016. It has been implicated in many health conditions, such as cancers, heart and liver disease, and strokes and is frequently a factor in accidents and injuries. The human costs of problem drinking to families and individuals are very significant, as it can lead to family disruption and breakdown, domestic violence, neglect of children, unemployment, financial, social and health problems.

Meanwhile, much has been written about the importance of ordinary (non-medical) people’s beliefs about an illness or problem (their ‘representation’ of it). Research has shown that these beliefs can strongly affect what people decide to do about an issue, and therefore its outcome in terms of the achievement of health and social wellbeing. For example, if a person does not see their issue as of concern, they may decide to do nothing, and this may lead to serious health and other problems. It is, therefore, important to understand lay beliefs and where these come from, in order to work well with them. Problem drinking is a particularly interesting area in this regard, as there are many different definitions of it, explanations of what causes it and what should be done to deal with it. Currently there is no one accepted view supported universally. The individual has a choice of meanings, hence the need to explore and understand what may influence their uptake of one or another. This is especially the case as some research has shown that any group or service can work well provided it accords with the user’s value system, and that there is not a one-size-fits-all solution to recovery from problem drinking (e.g., Atkins & Hawdon, 2007, and Best, Manning, Allsop & Lubman, 2020).

This research explores the representations of users of six alcohol online support groups (AOSGs), looking at whether, and how, the discussion forums of these groups have influenced these beliefs. It focuses only on non-12-step groups: those which do not follow the 12-step programme for recovery of Alcoholics Anonymous (AA). These were chosen as they remain comparatively under-researched, despite evidence showing that they can be powerful sources of help to users. The thesis goes on to discuss the information behaviours used in the forums that contribute to creating the impacts.

The research is a cross-sectional, multi-method qualitative study, consisting of thematic analysis of 1500 texts from three purposively chosen non-12-step AOSGs, followed by semi-structured interviews with 22 users of five such groups. Together the two methods yield useful information and address each other’s limitations. The interviews are informed by the outcomes of the text analyses, and the texts in turn were re-coded after the interviews, in the light of the interview findings. The study used Leventhal and colleagues Common Sense Theory of Illness Representations (1984) to analyse user beliefs, finding this to be a helpful tool.

The findings showed that these discussion forums did impact upon user representations. Firstly, they allowed users a space where they could be free to develop their own individual model of problem drinking, rather than having to adopt that of the group as an organisation. Secondly, they could impact on many aspects of beliefs in different ways and the thesis shows examples where the forums provided, changed, challenged or reinforced user beliefs. Thirdly, they had a powerful holistic effect on users’ overall views of problem drinking and themselves-as-drinkers. For many, using the forums meant seeing (perhaps for the first time) someone like themselves leading them to realise that developing a drink problem was not unique, and did not necessarily mean conforming to the cultural stereotype of an ‘alcoholic’.

The findings then explored information behaviours in the forums relating these to the impacts. Users’ overall information journeys in the groups were examined and their information seeking, sharing and avoiding analysed. This work led to development of a new model indicating the role of information behaviours in the development of representations within these discussion forums. The research is also the first to explicitly identify Bates’ theory of ‘berrypicking’ as a key information seeking activity in non-12-step discussion forums, and to show how the four main features of the theory appear in the forums. It also illustrates how the forums acted as sites for other information-related activities (such as planning, celebrating, remembering, and becoming aware of the politics of alcohol).

The study’s empirical findings provide a number of new contributions to knowledge including expanding the literature available on non-12-step groups and on lay representations of problem drinking. It contributes to addressing the gap in knowledge about the relationship of information sources to representations (Katavic et al, 2016), and is the first in-depth study of information behaviours used in non-12-step AOSG discussion forums in the formation of representations. It highlights differences between these groups and the much more widely researched AA, and contributes to the literature and recurrent debate about matching participants to groups, here in terms of matching on the basis of shared beliefs about problem drinking. It suggests that matching a person to a group in terms of the overall approach held to problem drinking is important, but that matching on the basis of detailed representations is not. Finally, the thesis addresses the gap in qualitative studies of user experience of the discussion forums of non-12-step AOSGs and provides a rich picture of their information journeys on the sites. This adds to the limited literature conveying the voices of this hard-to-reach group.