The Effects of Dental Anxiety Online Support Groups: Evaluating the Difference between ‘Lurkers’ & ‘Posters’
Dental anxiety has been recognized as a prevalent problem in the world today. Despite advances made in the field of dentistry, more than 50% of the general population still feel some distress and uneasiness in attending dental treatment and a small but significant amount of individuals (7 - 12%) experience dental phobia (Coulson & Buchanan, 2008). Primarily, dental anxiety or phobia often causes one to avoid dental treatment, which often result in the development of poor oral health. Individuals who perceive fear as an important barrier to dental care tend to have more dental imperfections compared to those who perceive less potential barriers to attending dental treatment (Cohen, Fiske & Newton, 2000). In occasions where dentally anxious individuals are able to attend dental treatment, dental practitioners often report stressful experiences in providing treatment (Humphries & Peacock, 1993). Besides that, negative psychosocial effects such as regularly having negative feelings and thoughts, fear, insomnia and impaired social functioning are generally associated with individuals who experience dental anxiety (Cohen et al., 2000). Patients often report a great deal of shame and embarrassment as an impact of their anxiety or phobia, (Moore, Brodsgaard & Rosenberg, 2004) and what these individuals tend to highly seek for is social support (Davidson, Pennebaker & Dickerson, 2000).
One way of obtaining social support is through the use of social support groups, in which people gather voluntarily with an acknowledged purpose to solve a problem or help other individuals cope with their difficulties through provision of emotional support (Katz & Bender, 1976). They are proposed to work based on the idea that people who experience similar difficulties, illness, pain, condition or distress may have mutual understanding of each other's situation and thus are more sympathetic and more likely to offer emotional and pragmatic support as compared to people who do not share the same problems (Barak, Boniel-Nissim & Suler, 2008). Positive effects resulting from participation in support groups have been reported across a broad range of conditions (Taylor, Falke, Shoptaw & Lichtman, 1986). Applying this type of intervention to the dental context, Crawford, Hawker & Lennon (1997) evaluated qualitatively the support group for dentally anxious adults who were skipping dental care and found that support groups brought upon improvements in member's confidence, social support and ability in attending anxiety treatments. However, inconvenience in attendance and the dependence on a dentist as a group leader are one of the many weaknesses experienced through physical support groups.
More recently, online support groups (OSGs) has been growing in numbers since the improvement and advancement in computer technology and the Internet. Due to its removal of temporal, geographical and spatial limitations generally associated with physical support groups (Scott, 1999), individuals are able to participate whenever and wherever they are able to. This factor also brings together a more varied and diverse group of individuals with different perspectives, experiences, opinions and sources of information regarding a certain support group topic (Buchanan & Coulson, 2007). Besides that, OSGs often utilizes asynchronous communication which allows members to carefully consider the message that they intend to share before actually posting it to the members of the group (Buchanan & Coulson, 2007). Furthermore, OSGs provide a greater degree of anonymity compared to traditional face-to-face groups and may assist individuals in divulging sensitive issues without a risk of embarrassment or judgement from other members (Buchanan & Coulson, 2007). Thus, OSGs may prove to be a more effective and convenient setting in which dentally anxious individuals could both express their emotions and receive social support to further promote positive psychosocial outcomes.
Across various studies of OSG’s, access to information, sharing of emotions and experiences and receiving social support have been the most documented processes enacted in OSGs (Mo & Coulson, 2010) and has been argued to provide a sense of personal empowerment (Barak et al., 2008). Eysenbach, Powell, Englesakis, Rizo & Stern (2004) in their systematic review of health related virtual communities and electronic support groups failed to find any robust evidence of health benefits in participating in virtual communities. This could be attributed to their failure to evaluate ‘pure’ peer-to-peer interventions such as OSGs by itself. Barak et al. (2008) however argued that the concept of support was misinterpreted by Eysenbach and colleagues (2004) in their study. They stated that a sense that effectiveness of OSGs should be measured in terms of general emotional relief and increased sense of efficacy, which are the essential components of personal empowerment. Other studies have found improvements in empowering effects of OSG’s such as improved social and emotional well-being, quality of life and more effective coping (Mo & Coulson, 2010; van Uden-Kraan, Drossaert, Taal, Seydel & van de Laar (2008). Nonetheless, the answer of whether the empowering effects could be generalised to all members of OSGs remains elusive.