Designing online forums to support health and wellbeing: guidance informed by self-determination theory and stakeholder perspectives (Preprint)

BACKGROUND The use of online forums to support health and wellbeing is widespread and growing, yet evidence of their safety and effectiveness is mixed. The absence of theory-informed guidance on how to design these forums, considering the expertise of forum users and moderators, is a barrier to improving outcomes. The development of evidence-based forum design guidance grounded in theory and lived experience could improve the efficacy and outcomes of these forums for the many people using them worldwide. OBJECTIVE To draw on the experience and expertise of online forum users and staff, together with insights from existing research on wellbeing-supportive design and self-determination theory, to generate a set of theoretically grounded and evidence-based design guidelines for safe, healthy and well-being supportive online forums. METHODS We conducted 52 semi-structured interviews with 36 forum users,18 with forum staff, and four design workshops with forum staff. We combined these with input from a multidisciplinary research team with expertise in forum delivery and evaluation. Principles of qualitative framework analysis were used to adapt a pre-existing framework for designing well-being supportive technology to the context of online health forums. RESULTS The resulting design guidelines for wellbeing supportive forum design are framed around four overarching principles relating to the psychological needs for autonomy, competence, and relatedness as defined by self-determination theory, and the additional need for safety in online forums. Each principle is provided with a series of pragmatic design heuristics and specific strategies that designers can use to promote the satisfaction of psychological needs in user experience and prevent harm. CONCLUSIONS User experience of online health forums shows that there is room for improvement with regard to how well these forums support basic psychological needs and safety. We have drawn on self-determination theory to respond to these findings by proposing a set of evidence-based guidelines for service development and refinement of online health forums. The guidance can be readily adapted to specific user groups across the diverse settings in which forums are hosted. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1136/bmjopen-2023-075142