Women Insight, Inc. (Cousineau), Inflexxion, Inc. (Rancourt); Yale University (Green)

This 15-page report explores the health information sought by women experiencing the menopausal transition through a formal content analysis of online message boards. Carried out to shape the development of an internet-based computer-mediated psychoeducational resource for women in the United States, the research described here is based on the observation that information and communication technologies (ICTs) - internet-equipped computers, in particular - can play a key role in health promotion and prevention initiatives.

As background, the authors explain that women are reportedly significantly more likely than men to use the internet to search for health and medical information, and are twice as likely to report that their use of the internet played an important or crucial role as they coped with a health issue such as menopause. They authors note that the internet can be a useful research tool, as well, in that it enables social scientists to analyse the type of health information found or exchanged, allowing for "the observation of dialogue among various communities of interest and a window into the kind of information that on-line users are seeking." For example, researchers may observe archived message boards to help discern women's specific health concerns (from their own points of view and in their own words), providing a platform for developing and/or refining research questions that could be used in patient interviews or focus groups to shape health communication programming.

In this context, the authors carried out a content analysis of 2 archived online menopause message boards that were conducted before and after the announcement of a medical event that was highly publicised in the United States: the premature end of the Women's Health Initiative Study (WHI), which revealed that the benefits of hormone replacement therapy (HT) did not outweigh the risks. They note that, even prior to what they describe as the "landmark" WHI findings, "women have wanted more information about menopause than they actually get." For example, they cite research carried out in the United States which indicated that more than 1 in 4 women in this country (or 27.8 million women) feel that media coverage confuses their understanding of women's health issues, such as whether to take HT to reduce their menopausal systems. The question, then, is, "what kind of information do women actually want?"

To explore this question, the researchers began by using the search terms "menopause", "hot flashes", and "hormone therapy" to identify 135 unique menopause web pages, honing down this selection to 2 popular message boards exhibiting a high level of activity/exchange - one medically oriented and one community-support-oriented. A total of 785 messages were coded based on overall themes and specific content. Results showed that:

• "Seeking symptom advice" represented 49% of all codes. As hypothesised, the medical board had more codes of this type than the community board - at all time points. One particular code within this category, "menopause onset/diagnosis" (which involves questions such as "is this menopause?") increased in frequency after the WHI. According to the authors, this spike suggests a heightened awareness about menopause as a health issue as well as an aftershock of the uncertainty that the WHI caused about menopause symptom management, among both women and health practitioners.
• "Seeking pharmaceutical advice" accounted for approximately 25% of all codes. Chi-square tests showed an increase in pharmaceutical advice codings over time on the medical board and a trend on the community board after the WHI.
• The "seeking emotional support" context code accounted for approximately 11% of all codes; as expected, the community board exhibited more of these types of codes at all time points.
• Another 11% of all codings were composed of community check-ins and offering opinions or news items.

In the concluding sections of the piece, the authors highlight in more depth the potential that the internet holds in understanding and addressing health issues like menopause. First, they reflect on the fact that women clearly seem to be going beyond their physicians' offices to ask questions and to seek personalised advice from other women via the relatively anonymous medium of the internet. Taken as a whole, the authors say, there were as many messages seeking emotional coping advice and checking in with fellow online community members as there were messages seeking recommendations on whether to take HT. In short, "women want to know if what they are experiencing is menopause, if their symptoms are normal, and if someone out in the cyberworld can relate" - advice (and comaraderie/support) that health experts may not be able to provide.

Second, pointing to this qualitative data, the authors endorse analysis of online message boards as a methodology for discerning the needs of menopausal women, as well as for observing the impact of a widely publicised medical event. They argue that this research strategy can, in turn, help shape the development of tailored health promotion approaches and programming for women, who are described here as "avid information seekers" looking to one another as well as health experts when faced with health issues.

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