Untitled

Original Paper

Examining the Supports and Advice That Women With Intimate

Partner Violence Experience Received in Online Health

Communities: Text Mining Approach

Vivian Hui

1,2

, RN, BSN, PhD; Malavika Eby

; Rose Eva Constantino

, RN, PhD, JD; Heeyoung Lee

, PMHNP-BC,

PhD; Jamie Zelazny

, RN, MPH, PhD; Judy C Chang

, MD, MPH; Daqing He

, PhD; Young Ji Lee

2,6

, RN, MS, PhD

Center for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)

Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States

Department of Psychology, Swarthmore College, Swarthmore, PA, United States

Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States

Department of Informatics and Networked Systems, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States

Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States

Corresponding Author:

Vivian Hui, RN, BSN, PhD

Center for Smart Health, School of Nursing

The Hong Kong Polytechnic University

HJ 544, Hung Hom, Kowloon

Hong Kong

China (Hong Kong)

Phone: 852 27664691

Email: vi[email protected]

Abstract

Background: Intimate partner violence (IPV) is an underreported public health crisis primarily affecting women associated

with severe health conditions and can lead to a high rate of homicide. Owing to the COVID-19 pandemic, more women with IPV

experiences visited online health communities (OHCs) to seek help because of anonymity. However, little is known regarding

whether their help requests were answered and whether the information provided was delivered in an appropriate manner. To

understand the help-seeking information sought and given in OHCs, extraction of postings and linguistic features could be helpful

to develop automated models to improve future help-seeking experiences.

Objective: The objective of this study was to examine the types and patterns (ie, communication styles) of the advice offered

by OHC members and whether the information received from women matched their expressed needs in their initial postings.

Methods: We examined data from Reddit using data from subreddit community r/domesticviolence posts from November 14,

2020, through November 14, 2021, during the COVID-19 pandemic. We included posts from women aged ≥18 years who

self-identified or described experiencing IPV and requested advice or help in this subreddit community. Posts from nonabused

women and women aged <18 years, non-English posts, good news announcements, gratitude posts without any advice seeking,

and posts related to advertisements were excluded. We developed a codebook and annotated the postings in an iterative manner.

Initial posts were also quantified using Linguistic Inquiry and Word Count to categorize linguistic and posting features. Postings

were then classified into 2 categories (ie, matched needs and unmatched needs) according to the types of help sought and received

in OHCs to capture the help-seeking result. Nonparametric statistical analysis (ie, 2-tailed t test or Mann-Whitney U test) was

used to compare the linguistic and posting features between matched and unmatched needs.

Results: Overall, 250 postings were included, and 200 (80%) posting response comments matched with the type of help requested

in initial postings, with legal advice and IPV knowledge achieving the highest matching rate. Overall, 17 linguistic or posting

features were found to be significantly different between the 2 groups (ie, matched help and unmatched help). Positive title

sentiment and linguistic features in postings containing health and wellness wordings were associated with unmatched needs

postings, whereas the other 14 features were associated with postings with matched needs.

Conclusions: OHCs can extract the linguistic and posting features to understand the help-seeking result among women with

IPV experiences. Features identified in this corpus reflected the differences found between the 2 groups. This is the first study

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that leveraged Linguistic Inquiry and Word Count to shed light on generating predictive features from unstructured text in OHCs,

which could guide future algorithm development to detect help-seeking results within OHCs effectively.

(J Med Internet Res 2023;25:e48607) doi: 10.2196/48607

KEYWORDS

intimate partner violence; text mining; social media; online health communities; linguistic features

Introduction

Intimate partner violence (IPV) is one of the most traumatic,

multifaceted, and widespread public health challenges that

jeopardizes women’s health in a life span. Statistics show that

1 in 3 women have experienced some form of physical violence

from their intimate partner in their lifetime [1]. Inequitably,

women who have experienced IPV face more severe challenges

owing to child-rearing obligations, financial dependence, and

IPV-related mental health problems [2-4]. These women can

be more difficult to treat compared with those experiencing

other health issues, as great societal pressure to protect the peace

and reputation of their families is exerted on women. Owing to

shame and guilt, women refrain from asking for formal

assistance because they believe that reporting IPV could put

their family’s stability and privacy at risk. Therefore, the

magnitude of IPV cases is consistently underreported in public

data.

Successful help seeking could promote mental healing and

improve the coping mechanisms, quality of life, and resilience

of these women following traumatic and abusive experiences

[5-8]. According to a previous study, women with IPV

experience requested assistance with safety planning, financial

aspects, childbearing issues, and health issues related to physical

and emotional abuse [9]. Notably, they tended to seek assistance

from close friends and family members rather than from

institutional agencies such as health care agencies and the police

[10].

Given the proliferation of computer literacy, it is convenient

for those women to share their struggles and ask for guidance

by using an anonymous web-based account. Online health

communities (OHCs), which are web-based platforms created

for a particular group of individuals dealing with a specific

illness or public health issue, may help eliminate shameful and

guilty feelings from in-person help-seeking processes. Tanis

[11] delineated that the anonymity and deinhibiting effects of

OHCs are beneficial to the self-disclosure of women with IPV

experiences. According to Moors and Webber [12], OHCs

provide a secure, easily accessible, and prompt response

environment where these women could openly discuss sensitive

family matters and traumatic experiences.

Nevertheless, not all attempts and outcomes of help seeking are

desirable. As shown in previous studies, women with IPV

experiences are at risk of secondary exposure to violence. For

example, survivor-blaming and critical comments from friends

or police officers are the main catalysts reported in recent

literature [13,14]. Web-based platforms have been criticized

for misinformation and selfish responses to individuals who

disclose their abusive experiences. Moreover, OHC members

may misuse the freedom offered by flexible OHC guidelines to

make careless responses or offer unsolicited advice, including

recommendations for women to leave their abusive relationships

or call law enforcement agency without cautious and thorough

planning, which may lead to far-reaching repercussions such

as homicide [15]. As such, providing constructive and

empowering responses in a nonjudgmental manner is the

backbone of facilitating help-seeking initiatives among women

with IPV experience.

During the COVID-19 pandemic, IPV cases surged to alarming

levels as a result of the quarantine orders and strict social

distancing policy [16]. López et al [17] reported the increased

use of social networking sites, such as Twitter. Lyons and

Brewer [18] specifically examined the contents of a particular

OHC on Reddit and reported IPV survivors’experience during

the lockdown, including service disruption and preparation to

leave their abusers. As a result of these unprecedented responses

on OHCs, it is critical to examine whether these responses made

by OHC members are helpful to women with traumatic IPV

experiences. However, little is known about the types of advice

provided and the manners in which OHC members offer

guidance to women with IPV experience. There is also a lack

of clear understanding of the number of women in OHCs who

successfully received relevant responses from OHC members

or what types of assistance are most frequently provided.

Without bridging this knowledge gap, it will be challenging to

evaluate the value of OHCs for women who worry about

privacy, self-doubt, and shame in help seeking. Therefore, this

study aimed to examine the types and patterns (ie,

communication styles such as directive, assertive, and

supportive) of the advice offered by OHC members and whether

the information received by women matched their expressed

needs in their initial postings. The research questions of this

study included the following:

What types of advice do OHCs give to women with IPV

experiences?

What patterns of communication were presented by OHC

members to build the credibility of the advice (ie, how do

OHC members construct their comments to convince others

to take their advice)?

How do women with IPV experiences receive the help they

sought from OHCs (ie, are there specific ways they prefer

to receive help)?

What types of needs were mainly received and did it match

with their expressed needs?

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Methods

Study Design

This was a descriptive, exploratory study to explore the types

of help received by women with IPV experiences in OHCs.

Data Source

Data were collected from a social networking site, Reddit, to

understand the types of help received by women with IPV

experiences in OHCs. Reddit is a platform for knowledge and

information exchange based on a wide range of topics

categorized into subreddit communities, denoted as r/. This

study selected r/domesticviolence as the data source to

understand how women received help after sharing their IPV

experience. This subreddit community was created in 2010 and

had >22,000 members at the time of data collection. There are

2 rationales for choosing Reddit as our data source. First, the

Reddit policy allows free-text entry without word limits in user

postings. Second, the temporary “throwaway” account feature

is important for women to protect their privacy after disclosure

on Reddit. More comprehensive and detailed information about

users’ perspectives can be extracted from postings and

comments on Reddit compared with other OHCs.

Inclusion and Exclusion Criteria

Regarding inclusion criteria, we included postings that were

self-disclosed as written by adult women (ie, aged ≥18 years)

with IPV experiences and sought help to solve IPV-related

issues. However, postings that were written in a non-English

language, posts written by underage women or women with no

abuse experience, posts without help-seeking attempts, and

advertisements were excluded from our data set.

Data Structure

Data were collected between November 14, 2020, and

November 14, 2021, during the COVID-19 pandemic, and the

username, user number, URL, post title, post content, score (ie,

the number of upvotes minus the number of downvotes in the

postings), ups (ie, the number of upvotes), downs (ie, the number

of downvotes), and comments were extracted using the Python

program package (version 3.8; Python Software Foundation).

All usernames were deidentified and replaced with random user

IDs for protection of privacy.

Postings were ranked based on the number of comments and

number of times the original poster (OP) returned to the thread.

To achieve the objective of this study, we further excluded

postings without any comments to focus on the comments’

quality and types of advice given to women with IPV

experiences.

Data Analysis

Data Annotation

With reference to the latest help-seeking literature published

by Sivagurunathan et al [19], a codebook was created by the

first author (VH) to guide the annotation process. Overall, 2

nursing researchers annotated the data set and crosschecked

with 2 other undergraduate students for quality assurance.

Postings with ambiguous content or unclear information were

further screened by the first author (VH) and verified by IPV

domain experts (RC and JCC). Once the codes for help-seeking

behavior have been saturated from the data set, the first author

and domain experts finalized the codebook. The annotation

codebook included all the variables of interest, such as types of

help received (ie, information and emotional), networking offer

(ie, OHC members provide networking opportunity in their

responses), and experience sharing (ie, OHC members provide

their own experience in their responses).

Reliability of the Coded Data Set

The codebook provided clear guidelines about how each item

should be annotated. The entire annotation process was

performed using Excel (Microsoft Corp). All annotators were

required to highlight the sentence in each posting, based on

initial posts and comments, respectively. For information and

emotional support, annotators were required to highlight the

clues for each type of help received for quality assurance.

Overall, 2 nursing annotators (ie, principal investigator and

nursing undergraduate student) coded the complete data set and

discussed discrepancies on a weekly or biweekly basis. Then,

2 other undergraduate annotators in psychology and nursing

major with understanding of the IPV rechecked the results and

screened the major discrepancies for further discussion. The

final results were discussed and verified by 2 domain experts

in IPV research RC and JCC. To ensure the reliability of our

coded data set, Cohen κ agreement was calculated using the

SPSS statistics software package [20]. The Cohen κ agreement

obtained was 0.66, which indicates a substantial agreement

between annotators.

Descriptive Statistics

The types of help (ie, information and emotional), networking

offer, and experience sharing were quantified using descriptive

statistics (ie, frequency and percentage).

Thematic Analysis

On the basis of the thematic analysis steps outlined by Brooks

et al [21], the comments on posts were qualitatively analyzed

to understand the themes of help-seeking behavior among

women with IPV experiences. Moreover, this study followed

the Reddit qualitative thematic analysis framework designed

by Caplan and Purser [22]. The project leader read through the

postings and responses independently to highlight the sentences

about help seeking. Then, researchers were instructed to group

similar help-seeking responses into different hierarchical

relationships. All discrepancies were discussed, and the

hierarchy was reorganized in an iterative manner. Multiple

annotations and themes were coded as mutually inclusively

when applicable, as multiple types of help were sometimes

extracted from the same comment. The final thematic codebook

and hierarchy were verified by IPV domain experts (RC and

JCC).

Matching Needs

To count the number of needs matched and unmatched in the

same posting, 4 variables were created initially (ie, matched,

unmatched, partly matched, and broad coverage). However, as

we only annotated 3.2% (8/250) of the postings with partially

matched needs, we further collapsed the variables by merging

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“partly matched” and “broad coverage” into “matched.”

Therefore, a dichotomized variable was created, and we further

explored the linguistic features of help seeking (ie, matched

needs or unmatched needs). In this study, “matched needs” refer

to the situations in which the OP receives the information they

requested from the comments. In contrast, “unmatched needs”

refer to situations in which the OP did not receive the

information they requested from the comments.

Analysis of Linguistic Features

Initial posting features include the scores, number of comments,

links shared, number of words on the initial post, and title

sentiment. New variables were computed, such as the number

of emojis used and the title sentiment score, to enrich the

linguistic features in the data set. Emojis were counted using

Python, and title sentiment score was calculated using Text2Data

plug-in on Excel. All initial post content was quantified and

analyzed using the Linguistic Inquiry and Word Count (LIWC)

tool, where 93 categories were included, ranging from emotional

affect, cognitive process, self-focus, perceptions, and so on. The

LIWC tool counts the frequency of words in each category and

transforms qualitative text data into quantitative data to

understand the psychological state and communication style of

individuals through their writing. LIWC has also been applied

to extract the linguistic cues for knowledge adoption,

information adoption, and perceived helpfulness of web-based

health reviews [23,24] and has been used for understanding the

psychological behavior of people in OHCs [25].

Postings were classified into 2 groups—matched needs and

unmatched needs. The linguistic features were compared

between these 2 groups using parametric and nonparametric

tests according to the parameter listed in LIWC. If the variables

obtained fit the requirement of a parametric test, a 2-tailed t test

was conducted. A Mann-Whitney U test was used for variables

that violated the normality and assumptions test. All statistical

analyses were conducted using IBM SPSS Statistics for

Windows (version 26; IBM Corp), with a statistical significance

assumed for P values <.05 [20]. Cohen d was used to quantify

the effect size between the 2 groups.

Ethical Considerations

As web-based data were publicly available for this study, an

approval for exemption was obtained from the institutional

review board at the University of Pittsburgh

(MOD20030179-002).

Results

Overview

A total of 1996 postings were collected from Reddit. In the

initial screening of the 1996 postings, 1568 (78.56%) postings

were selected and 1140 (57.11%) postings were identified for

relevance. After excluding the postings without comments or

OP return, 21.93% (250/1140) of the postings were annotated

quantitatively and analyzed qualitatively using thematic analysis

(Figure 1).

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Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of Reddit post screening among women with

intimate partner violence experience between 2020 and 2021. OP: original poster.

Types of Help-Seeking Advice Received

The types of help received were divided into information support

and emotional support. Overall, 97.2% (243/250) of the postings

received information support, whereas 87.6% (219/250) received

emotional support (Table 1). Among the information support

received, the top 5 common types of information help received

were IPV knowledge (414/1568, 26.4%), IPV shelter (242/1568,

15.43%), legal information (190/1568, 12.12%), health care

information (187/1568, 11.93%), and safety planning (131/1568,

8.35%). In terms of emotional support, the top 3 were

encouragement (570/1173, 48.6%), empathy (174/1173,

14.83%), and mutual understanding (159/1173, 13.55%).

Approximately one-third (74/250, 29.6%) of the comments

received networking offer, and more than two-thirds (195/250,

78%) of the comments received experience sharing from OHC

members.

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Table 1. Types of help received by women with intimate partner violence (IPV) experiences in online health communities from 2020 to 2021.

Posts, n (%)

Information support received (n=250)

243 (97.2)Yes

7 (2.8)No

Types of information help received (multiple responses were allowed; n=1568)

242 (15.4)Shelter, IPV center, or agency

190 (12.1)Legal

59 (3.8)Childbearing

110 (7)Police

7 (0.5)Wound assessment, or record

77 (4.9)IPV report procedure, or documentation

131 (8.4)Safety planning

25 (1.6)Finance

37 (2.4)Housing

187 (11.9)Health care information

32 (2)IPV survivors’ network, or online support groups

414 (26.4)IPV knowledge

17 (1.1)Communication

40 (2.6)Miscellaneous

Emotional support received (n=250)

219 (87.6)Yes

31 (12.4)No

Types of emotional help received (multiple responses were allowed; n=1173)

77 (6.6)Love

174 (14.8)Empathy

159 (13.6)Mutual understanding

114 (9.7)Reassurance

79 (6.7)Acceptance

570 (48.6)Encouragement

Experience sharing (n=250)

195 (78)Yes

55 (22)No

Networking offer (n=250)

74 (29.6)Yes

176 (70.4)No

Themes of Help Received

Among the 250 postings, a total of 7 themes and 15 subthemes

were identified from the comments. All authors reviewed and

confirmed the hierarchy of each theme and subtheme. Overall,

seven main themes were generated, including (1) experience

sharing, (2) emotional empowerment, (3) IPV knowledge

display, (4) advice type, (5) clarification of scenario, (6)

networking offer, and (7) daily self-care tips. The 15 subthemes

that were found are shown in Multimedia Appendix 1.

Types of Help Matched

Overall, 80% (200/250) of the postings received matching help

from OHCs (Table 2). Among all types of help annotated as

matching help, only wound documentation was excluded from

the list because no women sought wound information in our

data sets, but some comments include wound information when

they provide advice regarding safety planning instead. Table 3

shows that the highest 2 information needs matched were legal

(90%) and IPV knowledge (86%). In terms of emotional support,

92.5% of the postings were successfully matched with emotional

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help. However, finance (57%), communication (53%), housing

(50%), health care information (48%), and IPV survivors’

network (33%) received the least information help among

postings with matched needs.

Table 2. Matching needs annotated among women with intimate partner violence in online health communities (n=250).

Posts, n (%)Categories

146 (58.4)Matched

50 (20)Unmatched

8 (3.2)Partly matched

46 (18.4)Broad coverage

After merging categories

200 (80)Matched

50 (20)Unmatched

Table 3. Information support matched rate among women with intimate partner violence (IPV) in online health communities (n=250).

Matched rate, %Types of support

83IPV shelters and agency

90Legal

66Childbearing

80Police

75IPV report procedure

78Safety planning

57Finance

50Housing

48Health care

33IPV survivors network

86IPV knowledge

52Communication

82Miscellaneous

Linguistic Features

We used the LIWC software to examine the use of 93

prespecified dictionaries (lists of words) between the 2 groups

(ie, matched help and unmatched help). Multimedia Appendix

2 displays the descriptive statistics of posting features from the

annotated data and linguistic features from the LIWC tools

among the 250 postings. All significant linguistic features

between the 2 groups are displayed in Table 4. The average

length of postings was 298 (SD 257) words, and no postings

were generated from the same user ID (ie, person). Among the

250 initial postings, a total of 18 features (n=3, 17% posting

features and n=15, 83% linguistic features) were found with

statistically significant differences between the 2 groups.

Postings with negative sentiment, more comments, and more

number of words in comments were easy to receive matched

help in OHCs. Postings containing words related to health (eg,

medic, patients, physician, and health) or wellness (eg, healthy,

gym, exercise, and diet) were found to be more difficult to

receive matched help in OHCs.

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Table 4. Statistically significant variables of Linguistic Inquiry and Word Count categories with help-seeking results (ie, matched needs vs unmatched

needs) among women with intimate partner violence experience in online health communities (n=250) from 2020 to 2021.

Mean differenceUnmatched needs, mean (SD)Matched needs, mean (SD)Features

Cohen dP valuet test (df)Mann-Whitney

U test (df)

Posting features

0.513<.0013.243

(248)

N/A

10.14 (2.98)

14.08

(8.45)

Number of comments

0.247.051.561

(248)

N/A1463.84 (803.16)1732.01 (1146.03)Number of words in com-

ments

−0.315.05N/A1.561 (248)0.07 (0.32)−0.05 (0.41)

Title sentiment

Linguistic features

0.328<.001N/A2.074

(248)

0.12 (0.23)0.31 (0.65)Culture (eg, car, united

states, govern, and phone)

0.239.003N/A1.510

(248)

0 (0)0.02 (0.08)Political (eg, legal, court,

law, and congress)

0.308.001N/A1.948

(248)

0.11 (0.23)0.29 (0.64)Technology (eg, Wi-Fi,

computer, and phone)

0.164.049N/A1.037

(248)

0.16 (0.39)0.40 (1.62)Politeness (eg, thank, please,

and thanks)

−0.338.02N/A−2.137

(248)

1.26 (1.70)0.87 (0.98)Health (eg, medic, patients,

physician, and health)

−0.534.047N/A−3.376

(248)

0.21 (0.67)0.04 (0.14)Wellness (eg, healthy, gym,

exercise, and diet)

0.245.04N/A1.551

(248)

0.26 (0.53)0.42 (0.68)Emotional anxiety (eg, wor-

ry, fear, afraid, and nervous)

0.351.03N/A2.223

(248)

1.29 (1.24)1.85 (1.69)Lifestyle (eg, work, home,

school, and working)

0.227.048N/A1.435

(248)

0.09 (0.22)0.17 (0.37)Leisure (eg, TV, cook, chat,

fun, and play)

0.337.006N/A2.132

(248)

0.25 (0.41)0.46 (0.66)Home (eg, home, lawn,

room, and furniture)

0.334.004N/A2.112

(248)

0.52 (0.63)0.87 (1.12)Work (eg, work, school,

working, and class)

0.386<.001N/A2.444

(248)

0.22 (0.43)0.55 (0.92)Conversation (eg, yeah, oh,

yes, and okay)

0.032.005N/A0.010

(248)

0.19 (0.39)0.42 (0.85)Netspeak (eg, I know, u, lol,

and haha)

0.249.004N/A1.577

(248)

0.03 (0.08)0.12 (0.41)Assent (eg, yeah, yes, okay,

and ok)

Italicized text represents higher tendency on associated features.

N/A: not applicable.

Title sentiment was assessed on a scale ranging from −1 to 1, with negative values indicating negative sentiment and vice versa.

Discussion

Principal Findings

This is the first study to investigate the types of help and advice

presented in OHCs among women with IPV experience through

qualitative analysis and quantitative linguistic analysis in a

western context. We found that most women received

information and support that matched the type of help they

requested in their original postings. In addition, the majority of

the postings (178/250, 71.2%) received response in which OHC

members shared their own experiences, mistakes, and lessons

learned.

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The willingness of OHC members to share their own IPV

experiences in response to posters’requests for help correlates

with one of the presumed reasons for the existence of this

subreddit community—to serve as a platform for experience

exchange and support for people with IPV experience or other

passion for the topic. By sharing their own experiences, OHC

members illustrate credibility to offer advice to the OP. Our

findings aligned with a previous study by Yan and Tan [26]

regarding OHC members’ perceptions and experiences about

the medical treatment for mental health were related to the

perceived effectiveness of treatment among other OHC

members. Similarly, Fan et al [27] pinpointed that the

experience-sharing behavior was an approach to building trust

with other OHC members. In the IPV context, Krisvianti and

Triastuti [28] concluded that the experience-sharing behavior

facilitates social support and empowerment among women,

whereas Afdal et al [29] reported that using OHC can improve

life satisfaction through experience sharing.

In addition, emotional empowerment was another important

theme identified in the OHC comments. Our study found that

OHC members provided different forms of emotional

empowerment, such as encouragement, empathy, and

reassurance when the OP was lost and helpless, as expressed in

the initial postings. A previous study pinpointed a strong

association between emotional support and IPV severity among

women [30]. Female survivors who either experienced physical

abuse or had unwanted sex with their partner have 2.28 higher

odds of receiving less emotional support, indicating a great

demand of emotional needs in this vulnerable population. Lyons

and Brewer [18] also reported the themes related to the IPV

survivors’ experience during the COVID-19 pandemic [17].

Specifically, one of their themes highlighted service disruption

such as IPV shelters, counseling service, and emergency room

in hospital, which could potentially undermine the help-seeking

initiatives from women. Therefore, it is possible that women

with IPV experience shifted their help-seeking attempts to OHC

web-based environment, where OHC members could provide

emotional empowerment with a timely response regardless of

geographical and time restrictions. Moreover, we found that

women with IPV experience used to seek help by asking OHC

members to prove whether they were acting normal or not

overreacting to what happened in an abusive relationship. Our

findings were consistent with other OHCs’findings in different

contexts ranging from ovarian cancer [31], breast cancer [32],

and pregnancy loss [33]. In the male IPV context,

Sivagurunathan et al [19] also reported the importance of

emotional validation in help seeking after sexual assault.

Therefore, our study consolidated that emotional empowerment

and validation are essential for OHC help seeking among women

with IPV experience.

Furthermore, it is noteworthy that demonstrating IPV knowledge

in the comments is a strategic way to present advice with

credibility in OHCs among women. Our findings demonstrated

that OHC members used to cite IPV statistics from well-known

organizations and highlight their IPV knowledge (eg, trauma

bonding, stages of abuse, reactive abuse, and warning signs of

IPV such as strangulation and choking) to build advice

credibility. When women were confused about their current

IPV risks and condition, OHC members presented their IPV

knowledge to guide them regarding how to recognize warning

signs and navigate them to related resources.

Interestingly, our analysis identified 2 advice styles—directive

and emphasizing empowerment and advice form. Directive

styles were commonly found to urge OP to make decisions and

seriously listen to OHC members in postings with multiple alerts

labeled by Reddit, such as multiple triggers, physical abuse,

and suicidal risk. Some OHC members reacted emotionally

without consideration for OP’s feelings as they were not well

trained with trauma-informed care strategies. Given the

disinhibition effect on OHCs [34], OHC members may not take

responsibility for what they suggested to OP owing to the

anonymity and invisibility environment in OHC.

Regarding comments identified as having more empowerment

and advice given by OHC members, this advice style is viewed

as more appropriate, considerate, safe, and helpful for this

vulnerable population. This result aligned with that of a previous

study that illustrated the importance of emotional support for

women with IPV experience [30]. Nevertheless, a previous

study reported that 37% of the comments contained harmful

messages with survivor-blaming intentions in OHCs [15]. As

we prioritized postings with the highest number of comments,

we filtered postings without comments or those without OP

returning to initial postings. Therefore, it is possible that some

negative responses were not well captured in our analysis.

Moreover, we adopted the LIWC tool to quantify our annotation

results and compare the help-seeking results from a

computational point of view at the word level. As OHC members

may offer help primarily based on the textual description in a

web-based environment, traditional, in-person, help-seeking

factors such as facial expressions and differences in tone of

voice may not apply. Therefore, our results shed more light on

the linguistic and posting features that could affect help-seeking

results in OHCs. As such, displaying politeness in the initial

postings may indicate that OHC members will offer help more

comfortably. In contrast, our results found that postings with

wordings associated with health and wellness have low chance

of successful help seeking in OHCs. One of the possible

explanations is that OHC members are not well trained in

medical terminologies and do not have the related expertise to

address postings with complicated medical terminologies.

According to the scoping review conducted by Perry et al [35],

only 1 OHC featured a moderator with health care professional

qualifications in the related field, whereas most OHCs were

moderated by volunteers or survivors of IPV. Hence, postings

with health or wellness wordings may not be quickly addressed

by OHC members. Future studies can consolidate these results

by inviting OHC moderators for an interview to understand how

they offer help based on textual descriptions.

We also found that posting titles with negative sentiment were

more likely to receive help than using wordings with positive

sentiment. Given the anonymity provided, women may feel

more comfortable in seeking help urgently in OHCs to receive

real-time responses from OHC members [36]. Liu et al [37]

reported that patients with psychological diseases posted more

negative words and emotions than others. More importantly,

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49.5% of women were shown to develop psychological illnesses

after experiencing IPV [38]. It is possible that those who post

negative sentiments may have more complex information and

emotional needs than others, where OHC members may address

their needs and answer their questions easily. Therefore, title

sentiments should be considered as the primary indicator of IPV

severity and urgency in a web-based setting such as OHC.

Implications

This study has the potential to contribute to the management of

women with IPV experience from a clinical perspective. The

results obtained from this study demonstrated the usefulness of

OHCs in providing access to IPV knowledge and a platform

for experience exchange for women; therefore, clinicians are

encouraged to assess their perceived IPV knowledge (ie,

potential risks and consequences of IPV, potential danger, and

safety strategies to protect themselves) before referral to other

departments or planning for next appointment. Clinicians may

provide well-known resources that are available in the OHC

and appropriate to their personal situation. However, given that

professionals do not filter the comments and suggestions from

OHCs, clinicians should remind women to avoid taking all the

advice personally after seeking help in OHCs. Reading other

OHC members’abusive experiences could retraumatize women

with previous IPV experience. If some comments are typed in

a directive manner with harsh wordings, clinicians could advise

women to set a time-out period from reading these comments.

Moreover, OHCs, when moderated by IPV experts, have the

capability to identify comments with a reproachful tone and

provide tailored resource navigation based on the specific

geographical location of users.

In addition, IPV agencies and emergency departments in

hospitals should also establish a protocol to enable nurses,

medical social workers, and other health care professionals to

identify when they should refer women with IPV experience to

OHC. For example, health care professionals can streamline

the process by providing OHC information to at-risk women

after referring them to in-person support groups or IPV-related

agencies. Moreover, women should be advised about how to

seek help in OHCs effectively by emphasizing the value of

choosing a post title with negative connotations and seeking

help politely in the initial postings. Furthermore, a recent review

discussed how an automated system can assist IPV detection

[39]. Our study is a starting point for developing future IPV

automatic system interventions that allow users to search for

comparable experiences effectively. For example, IPV

experience can be further categorized based on positive and

negative feedback by domain experts and a computational

algorithm can be trained to classify relatable experiences based

on the needs of women, which could facilitate a better

help-seeking experience in OHCs.

Limitations

It is noteworthy that the results of this study should be

interpreted with caution. First, owing to Reddit’s privacy policy,

we could not collect the users’ demographic data, such as race,

age, and educational background. Second, Reddit is only widely

recognized in a few English-speaking nations, such as the United

States, Canada, the United Kingdom, and Australia. Therefore,

conclusions from this study are not fully generalizable to women

with IPV experiences from other regions. Third, this study

examined the type and pattern of advice provided by OHCs in

1 subreddit community. Future research endeavors should

include more OHCs for analysis and comparisons. In addition,

this study depended on the details provided in users’initial posts

during the screening procedure to determine whether the OP

was female and aged >18 years. However, some users may have

hidden their actual sex and age because of privacy concerns.

Moreover, our study reranked the postings based on their

number of comments and the number of times the OP returned

to the initial postings. As such, it is highly possible that some

negative comments have not been analyzed thoroughly in our

data set. Future studies should evaluate the risky suggestions

or harmful comments from postings and analyze the potential

danger score with an IPV domain expert to prevent

retraumatization in these vulnerable populations. An additional

constraint pertains to the data collection period—from

November 2020 to November 2021. During this period, the

COVID-19 pandemic posed significant challenges, such as

quarantine orders, business closures, and limited access to health

care services. As the World Health Organization has since

declared that COVID-19 is no longer a global emergency, it is

plausible that help-seeking behaviors and available resources

may have evolved after the time of data collection.

Conclusions

This study elicits empirical data about the types of help given

to women with IPV experience and what constructs the advice

credibility among OHC members. Our findings show that OHC

members often describe their own relevant experiences before

highlighting the IPV knowledge to the OPs. In this manner,

OHCs offer an accessible platform for knowledge acquisition

and experience sharing for women who feel baffled and

distressed following their IPV experience. Our study has

implications for developing digital textual initiatives to educate

women about IPV and exploring computation methods to

connect women with others who have similar experiences. In

addition, we assessed linguistic variations between successful

and unsuccessful help-seeking postings in the OHC. Our

findings demonstrate how linguistic variations in politeness and

title sentiment may affect to what extent OHC members meet

the help seekers’ needs. Future studies should examine the

language variations between postings with the most and the

fewest comments. Overall, the responses from OHCs are

constructive to provide various sources of help for women with

IPV experience, including emotional validation, IPV knowledge,

and relatable experiences, so that they can identify the warning

signs and potentially far-reaching consequences of their IPV

experiences.

Acknowledgments

The authors would like to express sincere gratitude to all the undergraduate annotators for this project.

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Data Availability

The data sets generated and analyzed during this study are available from the corresponding author upon reasonable request.

Conflicts of Interest

None declared.

Multimedia Appendix 1

Thematic analysis to explore the help received by women with intimate partner violence experiences in online health communities

from 2020 to 2021.

[DOCX File , 22 KB-Multimedia Appendix 1]

Multimedia Appendix 2

Descriptive statistics of posting features from annotated data and linguistic features from Linguistic Inquiry and Word Count.

[DOCX File , 27 KB-Multimedia Appendix 2]

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Abbreviations

IPV: intimate partner violence

LIWC: Linguistic Inquiry and Word Count

OHC: online health community

OP: original poster

Edited by A Mavragani; submitted 16.05.23; peer-reviewed by N Rao, C Pehora, Z Guo; comments to author 20.07.23; revised version

received 09.08.23; accepted 27.08.23; published 09.10.23

Please cite as:

Hui V, Eby M, Constantino RE, Lee H, Zelazny J, Chang JC, He D, Lee YJ

Examining the Supports and Advice That Women With Intimate Partner Violence Experience Received in Online Health Communities:

Text Mining Approach

J Med Internet Res 2023;25:e48607

URL: https://www.jmir.org/2023/1/e48607

doi: 10.2196/48607

PMID: 37812467

Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 09.10.2023. 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, 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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