BMJ  2004;328:1166 (15 May), doi:10.1136/bmj.328.7449.1166

Primary care

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

¹ Department of Health Policy, Management and Evaluation, University of Toronto, Centre for Global eHealth Innovation, University Health Network, Toronto General Hospital, Fraser Elliott Bldg, 190 Elizabeth St, Toronto, ON, Canada M5G 2C4, ² Wessex Institute for Health Research and Development, University of Southampton, Southampton SO16 7PX, ³ Library, University Health Network, Toronto General Hospital, ⁴ Centre for Global eHealth Innovation, University Health Network, Toronto General Hospital

Objective To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely.

Design and data sources Analysis of studies identified from Medline, Embase, CINAHL, PsycINFO, Evidence Based Medicine Reviews, Electronics and Communications Abstracts, Computer and Information Systems Abstracts, ERIC, LISA, ProQuest Digital Dissertations, Web of Science.

Selection of studies We searched for before and after studies, interrupted time series, cohort studies, or studies with control groups; evaluating health or social outcomes of virtual peer to peer communities, either as stand alone interventions or in the context of more complex systems with peer to peer components.

Main outcome measures Peer to peer interventions and co-interventions studied, general characteristics of studies, outcome measures used, and study results.

Results 45 publications describing 38 distinct studies met our inclusion criteria: 20 randomised trials, three meta-analyses of n of 1 trials, three non-randomised controlled trials, one cohort study, and 11 before and after studies. Only six of these evaluated "pure" peer to peer communities, and one had a factorial design with a "peer to peer only" arm, whereas 31 studies evaluated complex interventions, which often included psychoeducational programmes or one to one communication with healthcare professionals, making it impossible to attribute intervention effects to the peer to peer community component. The outcomes measured most often were depression and social support measures; most studies did not show an effect. We found no evidence to support concerns over virtual communities harming people.

Conclusions No robust evidence exists of consumer led peer to peer communities, partly because most peer to peer communities have been evaluated only in conjunction with more complex interventions or involvement with health professionals. Given the abundance of unmoderated peer to peer groups on the internet, research is required to evaluate under which conditions and for whom electronic support groups are effective and how effectiveness in delivering social support electronically can be maximised.

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