Doctor of Philosophy

dissertationDiabetes is a complex condition that can significantly affect quality of life and economic burden. New approaches to promoting diabetes knowledge and support to enhance diabetes management are necessary. Peer health is occurring within the diabetes online community (DOC), although very little is known about how it is being used to help manage diabetes. The purpose of this research was to better understand peer health within the nonmoderated, nontrained peer context of the DOC. In this multiple method approach, a cross-sectional survey was posted to DOC social media sites to describe adult DOC users, indicators of their health status, and perceived credibility of DOC information. A baby boomer subset of participants were interviewed to understand why they participated in the DOC, how they anticipated continued DOC use as they aged, and how they determined credibility of DOC information. Transcripts were analyzed using content analysis. Apomediation Theory guided this research. There were several significant findings. Individuals highly engaged with the DOC had better glycemic control. DOC users had high levels of diabetes self-care, health-related quality of life, and social capital. Baby boomers were using the DOC to increase their knowledge to improve self-care and for emotional support. The DOC was used in adjunct to, not in place of, regular healthcare visits to fill gaps in tacit knowledge and support. Baby boomer participants valued the wisdom of experienced individuals, "diabetes elders." Participants employed a process to find credible health information through the guidance of peers. Overall, DOC users found the DOC to be helpful with very little harm reported, suggesting DOC use is beneficial with low risk. Finally, DOC users found information from their healthcare providers to be more competent and trustworthy than information from the DOC, indicating DOC users still find their healthcare providers valuable. The findings from this research are promising. DOC users engage in a reciprocal process of sharing diabetes related experiences, encouraging knowledge attainment and support. Peer health in a naturally occurring online environment has the capacity to augment the traditional healthcare model by providing health information and peer support conveniently and at a low cost