Countering silence through Online Cancer Support Groups: reframing trust cultivation in the South Asian diaspora

BACKGROUND: The stigma associated with cancer silences patients and caregivers, depriving them of effective communication in their daily lives. They seek alternative platforms like Online Cancer Support Groups (OCSGs) to express themselves without getting stigmatized. However, trust cultivation in OCSGs is under-investigated, specifically in the South Asian context. Drawing on Social Support Theory and Social Presence Theory, this study develops a culturally grounded model for trust cultivation among South Asians in OCSGs. METHODS: Semi-structured interviews were conducted with 15 cancer patients and 7 caregivers from South Asia, recruited through active Facebook-based OCSGs. Interviews were transcribed verbatim and analyzed using a two-stage inductive coding process - open and axial - supported by MAXQDA, until thematic saturation was achieved. RESULTS: Findings challenge prevailing West-centric trust models by introducing a five-phase trust cultivation framework: scanning, introductory, seeker, communicative, and meet-up phases. Unlike existing models that treat passive lurking as the first stage, this study positions trust as a prerequisite for meaningful support exchange. Trust-cultivation emerged as a function of structural elements (e.g. group netiquette, moderation), relational cues (e.g. emoji use, humour, experiential knowledge), and temporal patterns of interaction. CONCLUSION: This study shows how OCSGs operate not only as informational hubs but also as effective and relational support systems, broadly contributing to the field of health communication and bioinformatics. For South Asian patients and caregivers, these groups give a sense of agency and belonging, alongside fulfilling their need for communicative camaraderie and a robust support system that does not stigmatize their pain but helps them navigate through it.