TY  - JOUR
AU  - Pearce, Emily Eidenier
AU  - Majid, Alina
AU  - Brown, Toniya
AU  - Shepherd, Rowan Forbes
AU  - Rising, Camella
AU  - Wilsnack, Catherine
AU  - Thompson, Ashley S
AU  - Gilkey, Melissa B
AU  - Ribisl, Kurt M
AU  - Lazard, Allison J
AU  - Han, Paul KJ
AU  - Werner-Lin, Allison
AU  - Hutson, Sadie P
AU  - Savage, Sharon A
PY  - 2024
DA  - 2024/12/16
TI  - “Crying in the Wilderness”—The Use of Web-Based Support in Telomere Biology Disorders: Thematic Analysis
JO  - JMIR Form Res
SP  - e64343
VL  - 8
KW  - social media
KW  - dyskeratosis congenita
KW  - telomere biology disorder
KW  - health communication
KW  - qualitative
KW  - thematic analysis
KW  - web-based information
KW  - web-based support
KW  - telomere
KW  - biology disorder
KW  - social support
KW  - emotional support
KW  - genetic
KW  - internet-based
KW  - information-seeking
KW  - descriptive study
KW  - semistructured interview
KW  - adult
KW  - illness experience
KW  - psychosocial
KW  - digital health
KW  - health intervention
KW  - health informatics
AB  - Background: Web-based information and social support are commonly used in rare disease communities where geographic dispersion and limited provider expertise complicate in-person support. We examined web-based resource use among caregivers of individuals with telomere biology disorders (TBDs), which are rare genetic conditions with long diagnostic odysseys and uncertain prognoses including multiorgan system cancer risk. Objective: This study explored internet-based information-seeking and social support practices and perspectives of patients with TBDs and their caregivers. Methods: Our qualitative descriptive study used semistructured interviews of patients with TBDs and caregivers. Data were transcribed verbatim and thematically analyzed by an interdisciplinary team. Results: A total of 32 adults completed interviews. Participant ages ranged from 27 to 74 years. The majority (n=28, 88%) were female, occupied multiple TBD roles (eg, patient and parent), and had undergone genetic testing. Most engaged in web-based information-seeking (n=29, 91%) and TBD-specific social media (n=26, 81%). Participants found web-based resources useful for information-seeking but reported privacy concerns and frustration with forming supportive relationships. Most participants described ambivalence toward web-based resource use, citing tensions between hunger for information versus distrust, empowerment versus overwhelm, disclosure versus privacy, and accessibility versus connection. Fluctuations in web-based support use arose from perceived harms, information saturation, or decreased relevance over the course of TBD illness experience. Conclusions: Individuals with TBDs and their caregivers reported frequent use of web-based informational and emotional support. However, ambivalence about the benefits and liabilities of web-based resources and persistent medical uncertainty may impact the adoption of and adherence to web-based support among patients with TBD and caregivers. Our findings suggest web-based psychosocial support should target long-term and multifaceted informational and emotional needs, be user-initiated, be offered alongside in-person formats, provide expert-informed information, and be attentive to personal privacy and evolving support needs of the TBD community. This study suggests web-based resources will be most effective in the TBD context when they achieve the following features: (1) offer a variety of ways to engage (eg, active and passive), (2) provide privacy protections in moderated “safe spaces” designed for personal disclosure, (3) offer separate venues for informational versus emotional support, (4) combine web-based relationship formation with opportunities for in-person gathering, (5) provide information that is reliable, easy to access, and informed by medical professionals, (6) remain mindful of user distress, and (7) are responsive to variations in levels and types of engagement. Additionally, advocacy organizations may wish to avoid traditional social media platforms when designing safe spaces for web-based emotional support, instead pivoting to internet-based tools that minimize privacy threats and limit the perpetual public availability of shared information. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2024/1/e64343
UR  - https://doi.org/10.2196/64343
UR  - http://www.ncbi.nlm.nih.gov/pubmed/39680438
DO  - 10.2196/64343
ID  - info:doi/10.2196/64343
ER  -