3. Research Model
The proposed research model seeks to examine the relationships between four distinct dimensions of social support and patient empowerment in the social media context. The study further investigates the relationship between patient empowerment and patient satisfaction in the social media context. Consequently, this study contributes to the body of knowledge in social media-based healthcare by offering a fresh take on the key dimensions of online social support. Previously, researchers demonstrated a positive link between online social support and empowerment, self-efficacy, knowledge, and health-promoting behaviours [
46]. However, the individual effects of esteem support, emotion support, information support and network support are relatively unknown. In order to address these inherent limitations in the extant literature, five hypotheses were devised for the proposed research model provided in
Figure 1.
It has been well established in contemporary literature that there is a positive association between social support and patient empowerment. This research proposes four separate dimensions of social support; namely, esteem support, emotional support, information support and network support, which exert a distinct impact on the notion of patient empowerment in the online healthcare context. In healthcare, esteem support is instrumental in encouraging patients to take actions to manage certain illness, and getting support patients’ encouragement [
25]. Thus, self-esteem can be considered a driver of patient empowerment. On the other hand, social media can also act as an avenue for emotional support. Social media enables communication and interaction between individuals who are experiencing similar health conditions [
2]. Consequently, emotional support can act as catalyst of patient empowerment.
The third dimension, Information support, can also be considered as an important driver of patient empowerment. Information support provided through social media channels are diverse and can range from symptom management, health tips, self-diagnosis routines, and wellbeing [
47,
48]. Finally, network support is another important dimension of social media-based social support in healthcare. These social media-based health communities enable patients to connect and develop healthy relationships and bonds without being near to other participants [
24]. As a consequence, social media can augment social connections among patients by overcoming the communication barriers in traditional healthcare [
49]. For example, a recent study concerning the role of online social support in the social and well-being of unwed single mothers in China reveals that online social support results in improving the wellbeing of single mothers [
50].
Consequently, many healthcare service providers have already created a dynamic, interactive online presence to encourage community engagement, and this has been applied in clinical practice, education, research, and administration. Many hospitals use social media as a tool for marketing to and involving their patient base. Physician practices are also using Facebook pages, Twitter accounts, and blogs in an effort to expand their practice and earn patient referrals [
51,
52]. According to Oh and Lee [
38], information support, esteem support, and emotional support provided by various social media-based patient groups act as an important antecedent of a patient’s sense of empowerment. Based on the four dimensions of social support and their effects on the notion of patient empowerment, the following hypotheses have been proposed.
Hypothesis 1a. Esteem support promotes patient empowerment.
Hypothesis 1b. Emotional support facilitates patient empowerment.
Hypothesis 1c. Information supports enable patient empowerment.
Hypothesis 1d. Network support positively influences patient empowerment.
The proposed research also looked at the relationships between patient empowerment and patient satisfaction. In healthcare, patient empowerment enriches the level of satisfaction [
53]. Similarly, Yeh and Wu [
54] demonstrated that empowerment improves patient health, and there is a positive relationship between patient empowerment and patient satisfaction. In an online health communication context, social media plays a pivotal role in ensuring patient engagement and satisfaction [
55]. Thus, the following proposition is considered:
Hypothesis 2. There is a significant and positive relationship between patient empowerment and satisfaction in the social media context.
6. Discussion
This study aims to investigate the antecedents of patient satisfaction. Firstly, this article tested the causal effect of four social support dimensions on patient empowerment. Second, this research tested the influence of patient empowerment on patient satisfaction. Consequently, this research endeavour provides valuable insights for developing health communication and online support strategies. Several findings are explained more fully below.
In H1a, the finding exhibited an insignificant relationship between esteem support and patient empowerment (β = 0.110,
p > 0.05). Prior studies have studied the effects of esteem support from different perspectives and reported positive results. Valkenburg and Peter [
70] reported that social self-esteem positively influences an individual’s wellbeing. In contrast, Deng and Liu [
58] found that self-esteem significantly influences health self-efficacy. Thus, the result contradicts the earlier findings and does not provide support for the notion that a significant relationship exists between esteem support and patient empowerment. This is an interesting finding and needs further investigation within a clinical setting. For example, recent research on 34 cancer patients demonstrates that learning from fellow cancer patients’ stories online has a significantly greater influence on cancer patients’ perceptions and expectations compared to medical professionals’ influence [
25].
In H1b, this research demonstrates that emotional support significantly influences the notion of patient empowerment (β = 0.347,
p < 0.001). The finding is consistent with previous studies which also illustrate how online emotional support plays an important role in empowering patients to improve their health outcomes [
71,
72]. A recent multimethod study infers that social support and information utility derived from online health community participation helps to shape perceptions of patient empowerment among community participants [
13]. Thus, it is apparent that more investment is required to facilitate emotional support which empowers patients and produces more patient empowerment.
Referring to H1c, the positive relationship between information support and patient empowerment signifies that interacting with others in social media-based support groups enhances their ability to take more informed medical decisions (β = 0.161,
p < 0.005) [
73]. However, more caution needs to be observed in terms of facilitating information support. A recent study on colorectal cancer patient survivors demonstrated that the need for informational support changes over time, and individual patient characteristics play a vital role in terms of information requirements [
74]. Similarly, this study detected a positive relationship between network support and patient empowerment (β = 0.311,
p < 0.001) (H1d). Hence, network support can directly influence health consumers’ sense of confidence and efficacy while interacting with medical professionals and managing their health conditions. The benefits of network support have been documented in other research [
24,
75]. According to Naslund and Aschbrenner [
24], patients with serious mental illness report significant benefits from various forms of network supports, such as online peer interaction or story sharing.
Lastly, this study also demonstrates a positive relationship between patient empowerment and patient satisfaction (β = 0.640,
p < 0.001) (H2). However, it must be noted that empowerment is a multi-dimensional construct, and social support is an important but not the sole dimension of patient empowerment. Prior studies indicated that critical characteristics of patient empowerment include social support, patient education, disease awareness and self-efficacy [
54]. Although other research has shown that patient empowerment is connected to healthcare quality [
76], the relationship between patient satisfaction and patient empowerment is still not well understood. For example, Tartaglione and Cavacece [
77] found no association between patient empowerment and patient satisfaction. With this in mind, this study provides new insights that in developing countries like Bangladesh, patient empowerment will play a significant role in patient satisfaction.
Implications and Limitations
Our contribution to the literature lies in the development of a novel theoretical framework presented herein which considers different domains of social support, namely emotional, esteem, information, and network support, to enhance the current understandings of the determinants of patient empowerment, and satisfaction in social media-based health communities. This extends the current understanding of social support dimensions in online healthcare communities. This cross-sectional study reflects on the relationship of the four dimensions of social support [
6], patient empowerment and patient satisfaction. Firstly, we empirically tested the significant effects of the four dimensions of social support on patient empowerment, as well as the relationship between patient empowerment and patient satisfaction. These findings enrich the research on the dimensions of social support and patient satisfaction.
Secondly, this study examined the relationship between social support dimensions, patient empowerment and patient satisfaction in a developing country context. The results of this research confirm the need for providing online social support, which is likely to empower patients. The dimensions of online social support are often overlooked by healthcare providers in a developing country such as Bangladesh. The findings will also prompt healthcare providers to undertake initiatives that facilitate social media-based social support for healthcare consumers. An in-depth understanding of different dimensions of social support can help healthcare providers design and offer more targeted online services for patients and customers.
Finally, this research endeavour expands our knowledge of the social support dimensions of social media networks. The quantitative analysis performed for testing the research hypotheses also offers validation for the necessity of inspiring and supporting the use of social media to improve the health outcomes of healthcare consumers.
This study is not free from certain limitations. Firstly, this is a cross-sectional study due to time and resource constraints. Secondly, the sample chosen for this study comprises internet and social media users. Therefore, the results do not capture the perspectives or opinions of non-social media users. Thirdly, this study is based on a convenience sampling method and does not focus on any exclusive healthcare consumer group. Future research can be conducted on a specific clinical setting (for example, social support for people with an eating disorder) and social media platforms. Fourthly, this study only considers the active users of social media and their interactions with social support dimensions. It must be acknowledged that many patients who do not use social media for health-related matters may also feel empowered, supported or satisfied for other reasons, such as knowledge, access to infrastructure or having skills in self-efficacy. Thus, future studies should also consider the notion of bidirectionality. Further research should also examine whether the patients who feel more empowered, satisfied and need social support are more active in the healthcare domain of social media. Fifth, there are other micro and macro factors which play an important role in shaping how patient satisfaction is shaped and perceived. Finally, moderating factors such as trust and facilitating conditions should be incorporated to further validate the findings.