Metaphor Diffusion in Online Health Communities: Infodemiology Study in a Stroke Online Health Community.

Background: Online health communities (OHCs) enable patients to create social ties with people with similar health conditions outside their existing social networks. Harnessing mechanisms of information diffusion in OHCs has attracted attention for its ability to improve illness self-management without the use of health care resources. Objective: We aimed to analyze the novelty of a metaphor used for the first time in an OHC, assess how it can facilitate self-management of post-stroke symptoms, describe its appearance over time, and classify its diffusion mechanisms. Methods: We conducted a passive analysis of posts written by UK stroke survivors and their family members in an online stroke community between 2004 and 2011. Posts including the term "legacy of stroke" were identified. Information diffusion was classified according to self-promotion or viral spread mechanisms and diffusion depth (the number of users the information spreads out to). Linguistic analysis was performed through the British National Corpus and the Google search engine. Results: Post-stroke symptoms were referred to as "legacy of stroke." This metaphor was novel and appeared for the first time in the OHC in the second out of a total of 3459 threads. The metaphor was written by user A, who attributed it to a stroke consultant explaining post-stroke fatigue. This user was a "superuser" (ie, a user with high posting activity) and self-promoted the metaphor throughout the years in response to posts written by other users, in 51 separate threads. In total, 7 users subsequently used the metaphor, contributing to its viral diffusion, of which 3 were superusers themselves. Superusers achieved the higher diffusion depths (maximum of 3). Of the 7 users, 3 had been part of threads where user A mentioned the metaphor, while 2 users had been part of discussion threads in unrelated conversations. In total, 2 users had not been part of threads with any of the other users, suggesting that the metaphor was acquired through prior lurking activity. Conclusions: Metaphors that are considered helpful by patients with stroke to come to terms with their symptoms can diffuse in OHCs through both self-promotion and social (or viral) spreading, with the main driver of diffusion being the superuser trait. Lurking activity (the most common behavior in OHCs) contributed to the diffusion of information. As an increasing number of patients with long-term conditions join OHCs to find others with similar health-related concerns, improving clinicians' and researchers' awareness of the diffusion of metaphors that facilitate self-management in health social media may be beneficial beyond the individual patient.