Table 1.

Sample messages from the American Diabetes Association (ADA) mapped to the communication themes.

Theme	Definition	Sample message snippets from ADA
Social support	Messages where the content reflects the elements of praise, advice, empathy, and guidance	Congratulations on a job well done – and Welcome to the 5% club. Your hard work and persistence paid off. Keep it up. :)
Traditions	Messages that focus on community-specific rituals such as pledges or any engagement practices conducted by moderators or users	How did you do this morning? How’ve you been doing over time? Nobody knew back then that there would be 28,196 replies to … question. Nobody expected that twice that topic would grow so large that we would have to start over again in a brand new topic to accommodate all those posts.
Teachable moments	Messages that describe incentives to make positive health changes	Stress can have a huge impact on your numbers. Even a single day can raise my numbers significantly and I have had longer periods of stress that I know upped my A1C. So when you are dealing with a stressful time you want to increase your exercise and decrease your carbs.
Obstacles	Messages focusing on hurdles to planned health practices	I did add 3 days of swimming that lasted for 3 months until my swim buddies got on different schedules. I do miss the sun and water so I’m on a search for other swimming holes and buddies. Transportation can be a hurdle, too.
Pharmacotherapy	Messages with explicit discussions on various pharmacotherapy options	Metformin may have a small effect reducing insulin resistance, but its main effect is to keep the liver from sending out too much insulin and over-compensating when blood glucose is a little low, like when it helps to prevent the dawn effect.
Relapse	Messages with descriptions of relapse reasons or confessions	On the issue of my numbers being too high in general… that’s a separate issue. I have gotten lax with exercise and eating too many carbs.
Readiness to change	Messages that inspire to initiate positive health changes	I discovered that I had to change “Can’t” to “Don’t” in my thinking. I “can’t” eat that cookie… means “Poor me, someone… is not allowing me to eat that cookie”… I “don’t” eat cookies… means that I have a choice it’s not something that’s part of my life. I am in control.
Cravings	Messages that capture real-time expressions of the urges to deviate from planned health behaviors	Do I miss stuffing my face with pizza or other carbilicious meals? I suppose so, but it’s not much of a loss… I miss sugary snacks, I guess that the biggest change.
Alternative medicine	Messages that describe therapies that are not regarded as orthodox by the medical profession	The article has a story of one woman who was getting ready to have a foot/leg amputated (after living with “a terrible wound for 5 years”), but she tried ‘the sugar treatment’ (my term) and … She ended up not having an amputation.
Progress	Messages in which members communicate their progress based on objective health measures	This summer will mark 8 years since I have been diagnosed with Type 2 diabetes. So far low carb eating, exercise and metformin are keeping me at my target blood glucose numbers.
Patient-reported Outcomes	A message that focuses on subjective progress (positive or negative)	Do I sometimes want to go back? Yes and no. I feel much better now and I know I’m healthier now, so no, I don’t want to go back.
Conflict	A message which is argumentative or clarifying a point/topic (not necessarily supportive)	Again I did not say it causes diabetes I said it can cause diabetes – which was the original question. I did not say that there is a direct link between alcoholism and diabetes – but the actions of an alcoholic can contribute to developing diabetes.
Miscellaneous	A message which contains questions or information not about an individual’s health status or diabetes management	I’m almost done with my First semester of college. Can you believe that? I did lot hard work.