The individual members (138/182, 75.8%) who represented the majority of members in the #bipolarclub community were individuals from the general public with no health care–related affiliations. The tweets posted by these individual members primarily revolved around their personal lives and thoughts. The second largest category of members was composed of 21.4% (39/182) of persons with health care–related affiliations, including volunteering (mental health advocates); professional (mental health or general practitioners); or academic (researchers, graduates, or students) affiliations. In this category, members were classified into 5 subcategories. The largest subcategory included mental health advocates (33/39, 85%), who mainly tweeted content that reflected their active advocacy activities for promoting mental health care, such as volunteering for mental health organizations, providing motivational and awareness talks, supporting those who are struggling, and fighting stereotypes and stigma of mental health. It is also worth noting that both practitioner types (mental health and general practitioners) in this community tweeted as mental health consumers and peers, not for professional services, despite being identifiable as professionals in the health care–related classification. Their tweets suggested that they were primarily seeking support from the community. However, they were posting informative tweets to help as peers. This shows how the #bipolarclub community as an OMHC stimulated health care providers to engage as mental health consumers, seeking support rather than using it for professional health care service purposes.
The third category involved crew and moderator members, who represented 1.6% (3/182) of the online community. These members had established the community and/or were running its activities. These activities included retweeting supportive tweets, replying to members, monitoring discussions, posting announcements, contributing with helpful resources, and moderating audio conversations held on Twitter Spaces [ 58 ] through the community’s account, which help make the online community a positive outlet for its members [ 5 ]. The next classification was formed of an organizational member (1 peer support foundation), representing 0.5% (1/182) of the community. This foundation was a nonprofit organization that provides peer support services. It was tweeting to share its activities, including peer support groups provided by its team members, and to introduce new team members to the community. The last classification consisted of the Twitter account of the #bipolarclub community, with 0.5% (1/182) representing the community’s members. We considered the community’s account as a member in this categorization because it serves as a digital representative of the online community, tweeting and interacting with its members.
Through the analysis of 547 #bipolarclub tweets, we identified 9 empowerment processes and 4 corresponding subprocesses within the #bipolarclub community. We structured these processes according to the population levels and groups outlined in the WHO’s Strategy 1 (IPCHS framework), along with the substrategy corresponding to each population level and group, as shown in Figure 2 .
As illustrated in Figure 2 , we positioned mental health consumers at the center, with the underserved and marginalized individuals as a subgroup, encircled by 2 tiers: their supporters and informal carers (primarily their families, followed by their friends) in the inner tier and the broader society in the outer tier. This figure suggests that the #bipolaclub community could foster a supportive and empowering environment, with its influence extending beyond individual well-being to a broader societal impact. As indicated by the 3-dotted boxes in Figure 2 , we classified the 9 identified empowerment processes and their 4 associated subprocesses into 3 categories: individual-level processes, informal carer processes, and society-level processes. Individual-level processes support mental health consumers and address the needs of the underserved and marginalized individuals. Informal carer processes extend support to family members and friends, while society-level processes aim to benefit society at large. Our examination revealed that the identified empowerment processes within the #bipolarclub community addressed all the 4 substrategies of Strategy 1. Table 2 provides detailed descriptions, frequencies of tweets, and the contribution proportions of the community members for the identified empowerment processes and subprocesses.
Population level and group, substrategy of Strategy 1 , and empowerment process and subprocess | Description | Sample paraphrased tweet | Tweet frequency, n (%) | Contribution proportions of community members, n (%) | |||||||
Provision of health-related information about mental health conditions and coping strategies, including both objective and fact-based information as well as experiential insights derived from personal experiences | — | 519 (94.9) | : 331 (63.8) : 141 (27.2) : 28 (5.4) : 17 (3.3) : 2 (0.4) | ||||||||
Experiential informational support | Provision of information derived from personal experiences, offering firsthand insights into navigating everyday life with mental health conditions, as well as self-management and coping mechanisms, including medical, therapeutic, and health care system experiences | “I bought myself a new diary... It helped me track my moods and feelings...” | 468 (90.2) | ||||||||
Objective informational support | Provision of information that is impartial and fact based, including mental health–related education materials, advice, and referrals | “...who suffers from bipolar 1 and vestibular migraines, I found this research really interesting...” | 113 (21.8) | ||||||||
Self-disclosing personal feelings, thoughts, daily life experiences, and challenges of living with mental health conditions, as well as self-motivational expressions | “I’ve never had a life. Only surviving...” | 414 (75.7) | |||||||||
Communicating with affiliation to the online community as well as provision of offers to gain access to its members | “...We #bipolarclub, could all collectively help to end your depression...” | 221 (40.4) | |||||||||
Provision of care, love, encouragement, and understanding expressions | “Thank you so much lovely people. Really thanks a lot. I should be dead! But I’m still alive because of you...” | 126 (23) | |||||||||
Provision of affirmation in ability and compliment expressions, as well as expressions of agreement on a situation and alleviating a sense of guilt about a situation | “It’s great for you, me, and the community that you’re open about how you’re managing your disease. I appreciate the content you’re sharing...” | 52 (9.5) | |||||||||
Provision of offers to help and to join activities or events that are needed to cope with the challenges of mental health conditions, including online and offline peer support groups | “Hello #bipolarclub! Come participate in our Twitter Space gathering today! We’ll be discussing communication skills...” | 32 (5.9) | |||||||||
Provision of diverse forms of individual-level support to address the specific needs of individuals from underserved and marginalized populations, including children and individuals from racial and ethnic minority groups (Black population) | “...@ThinkTenacity...join free Black mental health support group by Black therapists who understand us...” | 21 (3.8) | |||||||||
Provision of information that pertains to both mental health– and family-related aspects, including personal experiences with families | “The past couple of days, I was all right, but today I woke up feeling terrible and can’t bring myself to get out of bed. I hope my daughter can understand...” | 39 (7.1) | |||||||||
Provision of information that pertains to both mental health– and friend-related aspects, including personal experiences with friends | “...losing friends from having bipolar...it’s hard...no one can understand...” | 14 (2.6) | |||||||||
Provision of information that pertains to both mental health– and societal-related aspects, addressing social misconceptions and stigmatization of mental health conditions and offering perspectives on the actual experiences and realities associated with mental health conditions | — | 77 (14.1) | |||||||||
Perceptive awareness support | Provision of information that addresses social misconceptions surrounding mental health conditions, including clarifications of these misconceptions, insights into the reality of mental health conditions, and personal experiences in society | “...the most thing I hope people to know about bipolar disorder...that it is not the same thing as mood swings...” | 65 (84.4) | ||||||||
Destigmatization support | Provision of information that addresses the destigmatization of mental health conditions in society, including antistigma expressions and personal experiences with mental health stigma | “...I discuss bipolar disorder because I want to destigmatize it... Stigma is a terrifying thing...” | 18 (23.4) |
a The 4 substrategies of Strategy 1: Strategy 1.1 (empowering and engaging individuals and families), Strategy 1.2 (empowering and engaging communities), Strategy 1.3 (empowering and engaging informal carers), and Strategy 1.4 (reaching the underserved and marginalized).
b Not available.
c IM: individual member.
d HM: health care–related member.
e CM: crew and moderator member.
f CA: the community’s Twitter account.
g OM: organizational member.
Our analysis of empowerment processes that sought to support individuals with mental health conditions in the #bipolarclub community revealed 6 distinct types of processes and 2 associated subprocesses. This individual-level category of processes could benefit a mental health consumer to be empowered. These processes also addressed the specific needs of the underserved and marginalized individuals. Among the 547 eligible tweets, the 6 identified empowerment processes in the #bipolarclub community included informational support (n=519, 94.9%), self-expression support (n=414, 75.7%), network support (n=221, 40.4%), emotional support (n=126, 23%), esteem support (n=52, 9.5%), and tangible support (n=32, 5.9%). Furthermore, 3.8% (n=21) of the tweets in these processes focused on addressing the specific needs of individuals from underserved and marginalized populations. Table 2 illustrates the results of this analysis, descriptions of processes, samples of tweets, and the contribution proportions of the community members.
The most prevalent individual-level empowerment process in the #bipolarclub community was informational support, constituting 94.9% (519/547) of the tweets. In the informational support process, 2 subprocesses emerged, each defined by the type of mental health–related information exchanged through tweets. Experiential insights from personal experiences shaped the experiential informational support subprocess (468/519, 90.2%), while objective and fact-based information formed the objective informational support subprocess (113/519, 21.8%). Tweets in both subprocesses addressed various aspects of mental health conditions and coping strategies. Experiential informational support (468/519, 90.2%) was the predominant subprocess. In this empowerment subprocess, #bipolarclub community members exchanged personal experiences relating to their daily encounters with mental health conditions, as well as self-management and coping strategies, including medical and therapeutic experiences as well as interactions with the health care system:
...have a space for venting...it helps...
...so happy...first...hospitalization...I feel better...
I have been misdiagnosed over 10 times...
I’ve a Zoom appointment with my psychologist...it’s better to be in person, but he only visits my area monthly...
...if you need support contact @BipolarUK @IntlBipolar...it’s helpful...
...my insurance doesn’t cover my psych meds $1600 a month...
In the other empowerment subprocess, objective informational support (113/519, 21.8%), #bipolarclub community members exchanged tweets involving mental health–related education content, advice, and referrals:
... This article discusses a type of delusion called pseudocyesis, which refers to the false belief of being pregnant...
Take a cozy day off (or three) to recharge...
... Listening to “This Is Bipolar” podcast...
The second individual-level empowerment process was self-expression support. It constituted 75.7% (414/547) of the tweets. Tweets involved in this process show that #bipolarclub community members used it as an outlet for venting and sharing their emotions, thoughts, and challenges of living with mental health conditions, as well as self-motivational expressions:
I am in an absolutely fantastic mood today!...
I feel like I’m losing my fight with my disorder. I feel like my mind is taken a walk off the map...
This week, I’m actively searching for a job. Just last week, I was filling out disability papers. It feels like every week is a guessing game...
I will be okay, it’s not the first time, just like the previous time...
Network support was the third empowerment process in the mental health consumer category, comprising 40.4% (221/547) of the tweets. Members of the #bipolarclub community in this process tweeted expressions of belonging to the online community and exchanged offers to contact one another:
Fellow #bipolarclub...
If you’re up for a chat, please message me. 11:53 PM. I would like a chat with a Peer about right now...
The fourth individual-level empowerment process was emotional support, representing 23% (126/547) of the tweets. This process consisted of tweets among #bipolarclub community members expressing their care, love, encouragement, and understanding to one another:
... To all my #bipolarclub friends and family! Wishing you joyous holidays and hope everyone enjoyed a peaceful day!...
... Thanks #bipolarclub for making this year easier to handle...
... I wish you a wonderful day. If you’re feeling a bit low, just remember you woke up and faced life today. That’s a victory!...
...holidays...I know this time of year can be challenging...
The fifth empowerment process, esteem support, constituted 9.5% (52/547) of the tweets. Tweets in this process revealed that #bipolarclub community members were supporting one another through expressions of positive affirmations regarding capabilities, compliments, agreement on a situation, and alleviation of any feelings of guilt about a situation:
Living with bipolar doesn’t mean you’re broken; it means you are strong and brave for battling your mind every single day...
Yes. I’ve experienced... It’s exhausting...
Completely agree. I’m unable to get help... My general practitioner referrals have been denied twice, and I don’t have the funds for private help...
... If you’re facing depression, know that you’re not alone, millions of people worldwide understand what you’re going through...
The least prominent empowerment process identified in the individual-level category was tangible support, comprising 5.9% (32/547) of the tweets. These tweets demonstrate that the #bipolarclub community was used by its members to offer help to one another and announce activities or events crucial for coping with the challenges of mental health conditions, such as participation in peer support groups:
...I’m here if needed...
Hello #bipolarclub! Join our Twitter Space this Sunday as we delve into a discussion about establishing healthy boundaries in your relationships...
Our analysis also revealed that 3.8% (21/547) of the tweets in the identified empowerment processes at the individual level addressed the specific needs of individuals from underserved and marginalized populations. This formed a distinct subcategory of individual-level empowerment in the #bipolarclub community, as illustrated in Figure 2 . The content of tweets in this subcategory was particularly relevant to 2 groups, children and individuals from racial and ethnic minority groups (Black population):
The ACEs (adverse childhood experiences) score is important... Watch this video about childhood trauma!...
...free access to Black therapists...a group support via zoom...meet real Black therapists... Date of event...
As shown in Table 2 , #bipolarclub community members from all classifications contributed to the individual-level empowerment processes, with proportions reflecting their representation ratios and classifications within the community. Notably, among the 6 identified empowerment processes, health care–related members were the predominant contributors of tangible support content, in contrast to the other 5 processes with the largest proportion of posts by individual members.
Furthermore, health care–related members made their most substantial contribution to the empowerment process of tangible support, with 66% (21/32) of the tweets. By contrast, both individual members and crew and moderator members demonstrated their highest contribution ratios in self-expression support, with 68.8% (285/414) and 5.6% (23/414) of the tweets, respectively. The community’s account had its most significant contribution rate in the network support process (17/221, 7.7%), whereas the organizational member had it in the tangible support process (1/32, 3%).
The examination of empowerment processes dedicated to supporting informal carers in the #bipolarclub community unveiled 2 processes, one tailored to family members and another to friends. We identified these 2 processes as family awareness support and friend awareness support. Of the 547 tweets, family awareness support comprised 7.1% (n=39) of the tweets, and friend awareness support included 2.6% (n=14) of the tweets. Table 2 shows descriptions of these processes, tweet samples, and the contribution proportions of the community members.
The most prominent empowerment process identified in the informal carer category was family awareness support, constituting 7.1% (39/547) of the tweets. Tweets in this process were composed of information that could support the engagement of families in mental health care, raise their awareness, and allow them to understand their crucial role in the well-being of individuals in their families with mental health conditions. The content of these tweets was related to both mental health conditions and family-related aspects. It involved mental health education materials relevant to families as well as personal experiences shared by #bipolarclub community members. These experiences covered interactions with families in general and specific family members, including parents, children, siblings, and partners:
... Some reading from the Bipolar Disorder Survival Guide “What You and Your Family Need to Know”...
It really hurts being the bipolar child who never gets invited to family gatherings, again...
I find it not easy to discuss my condition with others...especially...my parents...for fear of being blamed; that’s why I can’t be positive, there’re lots of people have rougher lives than you, so on...
My brother led me to a really dark place that I haven’t been in for a very long time, he doesn’t realize how much his words hurt all the time...
I was feeling scattered mentally yesterday, and I was terrible to my partner. I’m so relieved today, and he seems to have forgiven me...
In the informal carer category, the other empowerment process that we identified was friend awareness support (14/547, 2.6%). This process included tweets containing valuable information that could help involve friends in mental health care, enhance their awareness, and help them recognize their significant role in supporting and understanding their friends with mental health conditions. The content in these tweets was relevant to both mental health conditions and friend-related perspectives. It mainly consisted of personal experiences shared by #bipolarclub community members in relation to their friends:
My friend gifted me this wonderful book...it is really helpful during challenging days of depression…
...losing friends from having bipolar...it’s hard...no one can understand...
From the overall contributions of #bipolarclub community members to the 2 empowerment processes of the informal carer category, individual members contributed the most in both processes, family awareness support and friend awareness support. However, the contribution ratio of individual members in family awareness support (27/39, 69%) was higher than in friend awareness support (9/14, 64%). Furthermore, individual members and health care–related members were the only contributors to family awareness support. In addition, health care–related members made their strongest contribution in this category of processes in family awareness support (12/39, 31%). In contrast, the organizational member did not contribute to any process in the informal carer category, while crew and moderator members (1/14, 7%) and the community’s account (1/14, 7%) contributed solely to the friend awareness support process at the same percentage.
Our analysis of empowerment processes in the #bipolarclub community, aimed at supporting society, indicated that this online community involved 1 overarching process and 2 associated subprocesses. We identified the overarching process as social awareness support and the associated subprocesses as perceptive awareness support and destigmatization support. The findings revealed that of the 547 eligible tweets, social awareness support constituted 14.1% (n=77), wherein perceptive awareness support and destigmatization support accounted for 84% (65/77) and 23% (18/77), respectively. Table 2 describes the processes, samples of tweets, and the contribution proportions of the community members in each process.
The empowerment process of social awareness support (77/547, 14.1%) and its subprocesses, perceptive awareness support (65/77, 84%) and destigmatization support (18/77, 23%), emerged from tweets involving information that could inform and educate the public about mental health conditions and raise their awareness, as well as support to counter stigmatizing attitudes and engage society in mental health care. The provided information pertained to both mental health conditions and aspects associated with society. In addition, notably, tweets in the society-level empowerment processes often featured relevant hashtags such as #MentalHealthAwareness, #BipolarAwareness, #RaiseAwareness, #DepressionIsReal, #MentalHealthMatters, and #BreakTheStigma. This demonstrated that #bipolarclub community members were using their collective voice to reach the public.
The most prevalent subprocess in the social awareness support process was perceptive awareness support (65/77, 84%). This subprocess was composed of tweets containing explanations of misunderstandings regarding mental health conditions, glimpses into the actuality of mental health conditions, and lived experiences of mental health conditions in society:
... Stop saying it’s “their” FAULT to mental patients! The meds disrupt metabolism!...
I’ve been physically fit with a six-pack but still battled major depression and panic attacks...looking good on the outside doesn’t necessarily mean you’re mentally “healthy” on the inside...
I don’t like when people say they’re “so bipolar today” just because they can’t make up their minds...dear, it doesn’t work that way...
I don’t want anyone passing judgment on me during my episodes... Mental health challenges come in various ways. May we all learn to support each other with love, understanding, and compassion...
It seems I have got tardive dyskinesia from my antipsychotics...so embarrassed my twitching is pointed out by my coworker...
The other subprocess, destigmatization support (18/77, 23%), included expressions aimed at destigmatizing mental health conditions as well as personal experiences with mental health stigma:
It isn’t acceptable to use disrespectful, stigmatizing words describing any situation...bipolar is a real mental condition...
...I really want to appear with my real identity to #bipolarclub. But I am scared of the potential of someone from real life finding me. I wouldn’t be able to survive the shame & humiliation again...
While the major contributors in the empowerment processes of the individual-level category and the informal carer category were individual members, health care–related members were the major contributors in the society-level category. Health care–related members contributed to the social awareness support process by 47% (36/77) of the tweets, while individual members participated by 43% (33/77). Furthermore, health care–related members and individual members were the only contributors to the subprocess destigmatization support. In alignment with the informal carer category, the organizational member did not contribute to the society-level category. Crew and moderator members and the community’s account participated in the social awareness support process by 6% (5/77) and 4% (3/77) of the tweets, respectively.
In this study, we have investigated an OMHC on Twitter called #bipolarclub by conducting a qualitative content analysis of tweets containing this hashtag circulated between December 19, 2022, and January 15, 2023. Through this analysis, we provided profound insights into three key aspects: (1) the members shaping the online community; (2) the various types of empowerment processes in it, aligned with the population levels and groups outlined in Strategy 1 of the WHO’s IPCHS framework; and (3) the contributions made by its members to these empowerment processes, elucidating their tendencies of involvement.
Overall, we have demonstrated that OMHCs such as #biplolarclub involve health professional members who have dual roles as both professionals and individuals coping with mental health conditions, which highlights the valuable insights and expertise they contribute to the community. We have also revealed that the #bipolarclub community includes empowerment processes catering to all the population levels and groups outlined in Strategy 1 of the WHO’s IPCHS framework. The online community contains processes for mental health consumers, including those from the underserved and marginalized populations, their informal carers (families and friends), and society at large. This finding indicates that an OMHC on Twitter holds promise for empowering diverse populations and supporting global empowerment objectives. Furthermore, our analysis has unveiled distinct contribution tendencies among the members to the empowerment processes in the #bipolarclub community. These tendencies showed diverse patterns of involvement in these processes. In the following sections, we thoroughly discuss our findings and provide suggestions on how these findings can be leveraged to promote consumer empowerment in OMHCs and mental health care.
The #bipolarclub community is formed of 5 primary types of members: individual member, health care–related member, crew and moderator member, organizational member, and the community’s account. This categorization is generally aligned with a previous study that broadly discussed the identities of those who use OMHCs for peer support and the role of moderators in managing the communities [ 5 ]. However, our categorization provides deeper insights into the members who form OMHCs on Twitter. All #bipolarclub community members identified with a mental health condition, including practitioner members with health care–related affiliations. However, they used the community as consumers and peers, not for professional service purposes. This finding indicates that the #bipolarclub community involves a unique type of peers that could be identified as “professional peers.” These peers share similar features with those noted in previous studies as formal peers [ 59 ] and peer specialists [ 60 ]. This peer type in the community provides health-related information based not only on a similar personal experience but also on a professional one. They also serve as linkages with the health system [ 60 ].
Furthermore, these peers add value to the #bipolarclub community, as they can bring reliability and credibility to the health-related information provided therein. Compared with a previous study on Reddit, which reported that mental health professionals joined OMHCs solely to offer expert assistance [ 26 ], our study shows that professionals may also seek support for themselves as individuals affected by mental health conditions. Thus, we have introduced the concept of “professional peers” as a novel member category in OMHCs on social media that has not been previously documented.
The identified empowerment processes in the #bipolarclub community imply that an OMHC on Twitter has the potential to achieve the empowerment objectives of Strategy 1 of the WHO’s IPCHS framework, along with all its substrategies. This includes empowering mental health consumers as well as addressing the specific needs of the underserved and marginalized individuals, their informal carers (families and friends), and society. The #bipolarclub community comprises 3 categories of empowerment processes, each supporting a specific population level and/or group: the individual-level category (mental health consumers including those from underserved and marginalized populations), the informal carer category (families and friends), and the society-level category.
Regarding the individual-level empowerment processes, the #bipolarclub community involved informational support and its subprocesses, experiential informational support and objective informational support, self-expression support, network support, emotional support, esteem support, and tangible support. Although previous studies indicated that informational and emotional support are the predominant social support types in OHCs [ 57 , 61 ] and are the 2 most common types sought by mental health consumers in online communities [ 5 ], our results indicate that the most exchanged social support types in the #bipolarclub community were informational and network support. This finding may be attributed to the networking mechanisms unique to Twitter, such as #hashtags, @username mentions, retweeting, and the following function [ 40 ], enabling #bipolarclub community members to engage in more interconnected communication compared with those connected in OHCs on other social media platforms [ 62 ]. A prior study that analyzed Twitter hashtags relating to bipolar disorder highlighted emotional support as the predominant social support type [ 63 ]. By considering a specific community and the types of members involved therein, we point toward network support as a key aspect. In addition, in a recent study that delved into empowerment processes, “finding recognition” was identified as a process in OMHCs [ 15 ]. This process aligns with the network support process in our study, emphasizing the idea that being connected in OMHCs with fellow community members who share similar illnesses and potentially have comparable life experiences can alleviate feelings of loneliness.
Our analysis also unveiled that the experiential informational support subprocess constitutes the majority of its main empowerment process informational support in the #bipolarclub community. This finding suggests that members could primarily use the community to learn from one another their personal experiences of dealing with mental health challenges, which aligns with one of the 5 motivations for establishing the #bipolarclub community (learning from one another) [ 47 ]. Although these firsthand experiences can help them in their management and coping strategies [ 61 ], they may also lead them to overlook professional guidance. In addition, #bipolarclub community members actively shared information and provided feedback on their experiences with the health care system. This finding indicates that the community could serve a dual function, helping its members to navigate the health care system more effectively [ 9 ], as well as offering valuable feedback to health care providers, thereby providing opportunities to enhance health care services [ 11 ]. This is particularly relevant in the #bipolarclub community, in which some members have dual roles as both mental health consumers and practitioners.
Our analysis also demonstrated that self-expression support emerged as a frequently practiced empowerment process among #bipolarclub community members. This implies that self-expression may represent a significant need among members, which could be met in the OMHC. Our finding supports previous assertions that mental health consumers commonly use OMHCs on social media [ 5 , 9 ] and Twitter [ 4 ] to self-express and vent, reaffirming the notion that OMHCs offer a conducive environment for expressing one’s true self owing to the anonymity afforded by social media [ 9 ]. The findings also showed that #bipolarclub community members were expressing their current emotions, thoughts, and challenges instantly, indicating that the real-time nature of Twitter could be a valuable tool for immediate release and a sense of catharsis for those struggling with mental health conditions.
Although the #bipolarclub community generally serves underserved and marginalized individuals (mental health consumers) [ 64 ], the content of its tweets addresses the needs of individuals who belong to 2 additional underserved and marginalized populations: children and racial and ethnic minority groups (Black population) [ 13 , 55 ]. The fact that Twitter can support consumers with dual underserved and marginalized status toward empowerment is not novel. An earlier study highlighted the creation of the hashtag #YouGoodMan on Twitter, which is specifically tailored for Black men to share their experiences with mental health conditions, exchange support, and navigate challenges stemming from cultural and social factors in the Black community [ 8 ].
Regarding the informal carer empowerment processes, the existence of family awareness support and friend awareness support processes in the #bipolarclub community signifies its potential to empower family members and friends of mental health consumers. The dissemination of mental health–related information linked to families and friends could serve as a valuable resource for enhancing their understanding of the challenges faced by those they are caring for [ 65 , 66 ] and their significant role in their well-being, which could facilitate their active engagement in mental health care practices. In addition, the public nature of Twitter allows users to access a diverse range of perspectives and information. With these findings, we underscore the pivotal role of firsthand information in OMHCs for informal carers, which is sourced directly from individuals who have experienced the situation themselves rather than from other informal carers. This aspect of firsthand information has been overlooked in the existing literature on informal carer empowerment in OMHCs.
Regarding the society-level empowerment processes, the presence of social awareness support and its subprocesses, perceptive awareness support and destigmatization support, highlights the capability of the #bipolarclub community to empower society. The community’s potential role as a facilitator of societal education is apparent through clarifications about social misconceptions regarding mental health conditions, personal experiences in the broader societal context, and antistigma posts. This content could enhance societal understanding and awareness of mental health conditions and could foster societal engagement in mental health care. The destigmatization support subprocess in the #bipolarclub community, aligned with the community’s core objective of fighting stigma [ 47 ], could address the stigmatizing challenges encountered by those dealing with mental health conditions in their daily lives in society [ 67 ]. Using the #bipolarclub community to combat stigma resonates with previous studies on Twitter [ 4 , 68 ], emphasizing Twitter’s key role in supporting mental health antistigma efforts. In addition, most tweets in the #bipolarclub community centered on raising awareness rather than directly addressing stigmatization. This finding indicates that the community could be adopting a proactive approach to building understanding and empathy with a more inclusive discourse around mental health issues.
When examining members’ contributions to the 3 categories of empowerment processes in the #bipolarclub community, distinct patterns emerged regarding their involvement tendencies, reflecting their identities. Health care–related members were inclined to support societal awareness, mirroring their role as influencers and educators. In contrast, individual members were actively engaged in self-expression and significantly contributed to family awareness, reflecting the importance of personal expression and familial support in this group. In addition, the peer support foundation (organizational member) focused solely on supporting mental health consumers through tangible support, aligning with the core mission of such foundations in providing practical assistance to individuals in need. Akin to individual members, crew and moderator members used the #bipolarclub community as an outlet for personal expression. This tendency conforms with their primary role as individuals coping with mental health conditions, preceding their roles as crew and moderator members. The community’s account stood out for its active role in connecting with members and providing network support, aligning with its identity as a facilitator of community cohesion. These nuanced tendencies underscore the collaborative efforts of different member types, each bringing unique perspectives to the community’s empowerment processes. Notably, our findings differ from those of a study that examined tweets during Mental Health Awareness Week [ 16 ], which found similar contribution tendencies to the discourse among diverse users. However, our analysis focused on an OMHC’s tweets, which are not based on a trendy mental health–related hashtag, and we used different criteria for analyzing community members and tweets. Despite differing research goals, these findings suggest that Twitter users’ contribution tendencies in engaging in mental health discussions may vary depending on the context of use.
Our study has extended the research on the role of OMHCs in empowering people in significant ways. The key findings are as follows: (1) we identified the diverse members within an OMHC, clarifying their tendencies for engaging in empowerment processes; (2) while health care practitioners use OMHCs to support consumers, we revealed their multifaceted engagement to fulfill various roles simultaneously, acting as mental health consumers, peers, and providers of health information, sometimes disclosing their professional identities; and (3) we proved that an OMHC not only could facilitate empowerment processes for mental health consumers but could also extend their impacts to individuals from underserved and marginalized populations, informal carers (family and friends), and society at large, aligning with the WHO’s empowerment agenda (Strategy 1 of the IPCHS framework). In addition, we have proposed a structured framework for classifying the empowerment processes within OMHCs based on Strategy 1 of the WHO’s IPCHS framework, which embraces individual-level, informal carer, and society-level processes.
The study findings hold significant implications for various health care stakeholders, such as national and international health care organizations, health care professionals, and OMHC moderators. For instance, the WHO and other health care institutions can benefit by learning about the potential of OMHCs for empowering not only mental health consumers but also their families and friends as well as society. Thus, they could consider integrating these communities into standards, acknowledge their important roles in guidelines, and effectively support their development as an element in holistic approaches to mental health care. Our findings can also guide health care organizations and professionals to tailor their interventions and outreach strategies using these communities, ensuring more effective and targeted approaches for diverse population levels and groups to foster empowerment in mental health. Furthermore, moderators of OMHCs can leverage insights from our findings to provide dedicated support for diverse empowerment processes. We speculate that they could explore various uses for initiatives, such as motivating mental health consumers to tell their stories (eg, “tell-your-story” week) to express themselves and raise awareness among others.
This study had several strengths. First, our examination of the #bipolarclub community forms part of a larger study to investigate the concept of consumer empowerment in the community following the netnography methodology that focuses on studying online communities’ behaviors [ 69 ]. Therefore, the findings of our analysis were based on in-depth immersion in the community. Second, by investigating empowerment processes supporting various population levels and groups, we offer a comprehensive and nuanced view of the empowerment concept within the community. Third, examining empowerment processes aligned with Strategy 1 of the WHO’s IPCHS framework has yielded profound insights into the types of processes that adhere to global standards within OMHCs. Often overlooked in prior studies, this aspect contributes a valuable perspective on the empowerment processes within OMHCs to the existing body of research. Thus, our proposed structured framework of empowerment processes’ classifications within OMHCs, based on Strategy 1, can serve as a novel foundation for future investigations of various OMHCs.
A possible limitation of this study is the classification of #bipolarclub community members based on their personal bios and the tweets posted on their profiles. This content may not necessarily represent their real-life identity and activities, potentially leading to inaccuracies. However, our passive data collection approach provides real and bias-free insights into how empowerment processes are conducted in the online community [ 70 ]. In addition, this approach precluded the examination of a member type in online communities, known as passive members and “lurkers” [ 71 ], who may be using the community. Further research could build on our study and explore this member type.
Another limitation of using a passive investigation is the challenge of demonstrating that the #bipolarclub community includes members beyond those who directly experience mental health conditions, such as family members, friends, and the public. However, since our analysis did not include passive members, it is important to acknowledge that merely lurking constitutes a form of engagement in empowerment processes. This implies that these populations still have considerable potential for being involved in the online community. In addition, Twitter’s open-access nature allows not only #bipolarclub community members but also other Twitter users to engage in these processes without restrictions, such as account following [ 39 ] or registration requirements such as private groups on Facebook. Furthermore, tweets using the #bipolarclub hashtag were often blended with other hashtags, expanding the community’s reach to a wider audience of Twitter users outside the scope of the community’s members [ 40 ], advertently and inadvertently engaging them in the empowerment processes. Future research endeavors could leverage our findings by examining the passive involvement of various population levels and groups within the #bipolarclub community.
We have also primarily focused on one aspect of the consumer empowerment concept, the processes (empowering activities), without considering its other aspect, the outcomes (states of being empowered), which may have limited our findings to provide a comprehensive understanding of the empowerment phenomenon in the online community. However, our study provides in-depth insights into these processes. Future research could investigate the empowerment outcomes in alignment with the empowerment processes we have identified.
Our analysis of members and empowerment processes in the #bipolarclub community highlights the capability of Twitter-based OMHCs to empower mental health consumers, including those from underserved and marginalized populations, along with their families and friends as well as society. Our study demonstrates the ability of a Twitter-based OMHC to facilitate empowerment processes for diverse population levels and groups aligning with the WHO’s empowerment agenda (Strategy 1 of the IPCHS framework), highlighting the potential advantages of using Twitter for such empowerment objectives. These findings also acknowledge the relevance of Twitter-based OMHCs in advancing global empowerment goals. As the use of OMHCs and Twitter continues to rapidly grow, exploring their potential holds promise for informing various health care stakeholders. This is particularly relevant for health care organizations, professionals, and OMHC moderators, as these insights could pave the way for developing consumer-oriented services and empowerment programs for different population levels and groups.
HA, a doctoral researcher, has been awarded a Swiss Government Excellence Scholarship from the Federal Commission for Scholarships for Foreign Students (FCS). We would like to acknowledge the FCS for supporting this research.
None declared.
Sample paraphrased personal descriptions (bios) and posted tweets on Twitter profiles of the #bipolarclub community’s members.
application programming interface |
Connectedness, Hope and Optimism, Identity, Meaning and Purpose, Empowerment |
graphics interchange formats |
Integrated People-Centred Health Services |
online health community |
online mental health community |
Purpose and Meaning, Optimism and Hope, Empowerment, Tensions, Identity, Connectedness |
World Health Organization |
Edited by K Williams; submitted 31.12.23; peer-reviewed by F Lobban, P Marshall; comments to author 09.03.24; revised version received 02.05.24; accepted 10.06.24; published 19.08.24.
©Horeya AbouWarda, Mateusz Dolata, Gerhard Schwabe. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 19.08.2024.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
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Title: the ai scientist: towards fully automated open-ended scientific discovery.
Abstract: One of the grand challenges of artificial general intelligence is developing agents capable of conducting scientific research and discovering new knowledge. While frontier models have already been used as aides to human scientists, e.g. for brainstorming ideas, writing code, or prediction tasks, they still conduct only a small part of the scientific process. This paper presents the first comprehensive framework for fully automatic scientific discovery, enabling frontier large language models to perform research independently and communicate their findings. We introduce The AI Scientist, which generates novel research ideas, writes code, executes experiments, visualizes results, describes its findings by writing a full scientific paper, and then runs a simulated review process for evaluation. In principle, this process can be repeated to iteratively develop ideas in an open-ended fashion, acting like the human scientific community. We demonstrate its versatility by applying it to three distinct subfields of machine learning: diffusion modeling, transformer-based language modeling, and learning dynamics. Each idea is implemented and developed into a full paper at a cost of less than $15 per paper. To evaluate the generated papers, we design and validate an automated reviewer, which we show achieves near-human performance in evaluating paper scores. The AI Scientist can produce papers that exceed the acceptance threshold at a top machine learning conference as judged by our automated reviewer. This approach signifies the beginning of a new era in scientific discovery in machine learning: bringing the transformative benefits of AI agents to the entire research process of AI itself, and taking us closer to a world where endless affordable creativity and innovation can be unleashed on the world's most challenging problems. Our code is open-sourced at this https URL
Subjects: | Artificial Intelligence (cs.AI); Computation and Language (cs.CL); Machine Learning (cs.LG) |
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