Write for life: Persisting in online health communities with expressive writing and social support

Expressive writing has been shown to improve physical, mental, and social health outcomes for patients struggling with difficult diagnoses. In many online health communities, writing comprises a substantial portion of the user experience, yet little work has explored how writing itself affects user engagement. This paper explores user engagement on CaringBridge, a prominent online community for writing about personal health journeys. We build a survival analysis model, defining a new set of variables that operationalize expressive writing, and comparing these effects to those of social support, which are well-known to benefit user engagement. Furthermore, we use machine learning methods to estimate that approximately one third of community members who self-identify with a cancer condition cease engagement due to literal death. Finally, we provide quantitative evidence that: (1) receiving support, expressive writing, and giving support, in decreasing magnitude of relative impact, are associated with user engagement on CaringBridge, and (2) that considering deceased sites separately in our analysis significantly shifts our interpretations of user behavior.