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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions

G Eysenbach, J Powell, M Englesakis, C Rizo, and A Stern.

Review published: 2004.

CRD summary

This review assessed the effect of computer-based peer to peer communities and self-support groups on health-related outcomes. The authors concluded that there was no robust evidence available. These conclusions are appropriate and reliable.

Authors' objectives

To evaluate the effect of computer-based peer to peer communities and electronic self-support groups on health and social outcomes.


Eleven electronic databases, including MEDLINE, EMBASE, CINAHL and PsycINFO, were searched from inception to 2003; details of the search strategy were provided.

Study selection

Study designs of evaluations included in the review

Randomised controlled trials (RCTs), controlled trials, interrupted time series, cohort and before-and-after studies were eligible for inclusion.

Specific interventions included in the review

Virtual community interventions focusing on emotional and social support, health education, or health-related behaviour change, were eligible for inclusion. A virtual community was defined as a group of individuals with similar or common health-related interests, and predominantly non-professional backgrounds, who interact and communicate publicly through a computer communication network. In the majority of the included studies, the virtual community intervention was part of a multi-component intervention involving other psychoeducational or treatment components such as written material or one-to-one support from health professionals. The comparators in the controlled trials were diverse.

Participants included in the review

The inclusion criteria for the participants were not stated. The included studies were of diverse participants, including adults and children. There were patients with acquired immune deficiency syndrome, breast cancer, depression, heart and kidney disease, diabetes and eating disorders, and patients on weight loss programmes and smoking cessation programmes.

Outcomes assessed in the review

Studies assessing knowledge, health, psychological, or social outcomes were eligible for inclusion. The most commonly assessed outcomes in the included studies were depression, social support, health care use, eating disorder, weight loss, diabetes control and duration of smoking abstinence.

How were decisions on the relevance of primary studies made?

Two reviewers independently assessed the relevance of studies and any disagreements were resolved by consensus.

Assessment of study quality

The authors recorded whether the RCTs used an appropriate randomisation method, allocation concealment, blinding and intention-to-treat analysis. The other study designs were not quality assessed. The authors did not state how the papers were assessed for quality, or how many reviewers performed the quality assessment.

Data extraction

One reviewer extracted the data, while the team reviewed all extracted studies.

Methods of synthesis

How were the studies combined?

A narrative synthesis of the studies was undertaken. The studies were grouped by the content of the intervention, with studies investigating virtual communities as a single component identified separately from multi-component interventions.

How were differences between studies investigated?

Differences between the studies were investigated through the narrative synthesis.

Results of the review

Thirty-eight studies (from 45 publications) were included: 20 RCTs, 3 meta-analyses of n of 1 trials, 3 non-randomised controlled trials, one cohort study and 11 before-and-after studies.

Virtual communities as stand alone interventions (6 before-and-after studies and one factorial-designed RCT).

The reporting of the factorial-design RCT was incomplete. Five of the 6 remaining studies had some degree of facilitation by a health professional. No results were given for these studies as a group.

Results by outcome.

Depression (12 studies): 2 observational studies and an RCT found significant improvements in depression scores. The remaining RCTs found no improvement or did not report the significance level.

Social support (12 studies): 5 studies (3 RCTs) reported a significant improvement and 7 did not. Health care use (3 studies): one RCT reported no difference in the number of doctor visits, one controlled trial reported fewer phonecalls to doctors, and one RCT had mixed findings.

Weight loss or healthy body-weight interventions (9 studies): the findings were mixed but were mainly non significant.

Diabetes intervention (5 studies): there was a significant improvement in glycosylated haemoglobin in one before-and-after study.

Smoking cessation (6 studies): the levels of abstinence following the intervention were variable. One RCT found no significant improvement in the intervention group over the comparison group. One RCT found some small differences, although significance levels were not reported.

Authors' conclusions

No robust evidence exists on the effects of consumer-led peer to peer communities. This is partly because they have been evaluated only in conjunction with more complex interventions, or health professionals have been involved in the intervention.

CRD commentary

The review question was clearly stated. Relevant electronic databases, including unpublished literature, were searched and details of the search strategy were provided. There were no language restrictions. The study selection process was carried out in duplicate. The effectiveness of reducing error and bias in the procedure used for the data extraction was unclear. Appropriate details of the individual studies were provided and it was appropriate to carry out a narrative synthesis. The authors' conclusions reflect the available evidence.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that further research is required in this field, particularly on consumer-led self help. Research is needed to evaluate under which conditions and for whom electronic support groups might be effective. The outcome measures should include resource use.

Bibliographic details

Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions. BMJ 2004; 328: 1166-1170. [PMC free article: PMC411092] [PubMed: 15142921]

Indexing Status

Subject indexing assigned by NLM


Clinical Trials as Topic; Cohort Studies; Delivery of Health Care /standards; Health Behavior; Health Education /methods; Humans; Internet; Interpersonal Relations; Outcome Assessment (Health Care); Patient Participation; Peer Group; Program Evaluation; Randomized Controlled Trials as Topic; Self-Help Groups /organization & administration; Social Support



Database entry date


Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 15142921

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