“Thoughts & Prayers” or “💗 & 🙏”: How A New Reactions Bar Reshapes Supportive Communication During Health Crises
You’re scrolling through Facebook and you come across a funny cat video that makes you chuckle. You click the 💗 reaction and scroll on. Next you come across a devastating status update from a friend facing a dire health condition. Do you click that same 💗? Or perhaps choose a different reaction from the reaction bar? Do you comment about thoughts and prayers along with everyone else commenting on the post? What will your friend think of however you choose to respond? What does your friend really need in this moment?
Everyone using social media these days is familiar with using a single click to “Like” a post, or more recently to be able to “React“ using a set of symbols with similar quick-click interaction. But are these common, lightweight features for responding to posts appropriate when it comes to critical posts like your friend’s?
A research opportunity: the launch of a reaction bar in a health community. CaringBridge (caringbridge.org), an online blogging platform for people to share about life-threatening health journeys, followed these popular social media trends. In 2009, they first emulated Facebook’s Like to implement a single-option, single-click “Heart” reaction (branded using the platform’s logo). In 2021, they expanded the feature to a limited bar reaction style with a menu of pre-selected reactions including “Heart”, “Prayer”, “Happy”, and “Sad” symbols:
We used this product launch as an opportunity to examine how this update was received and how it affected communication of support on CaringBridge during life-threatening illness. We surveyed and interviewed users shortly after the launch, and we share our findings in our upcoming #CSCW2023 paper, “Thoughts & Prayers” or “ 💗 & 🙏”: How the Release of New Reactions on CaringBridge Reshapes Supportive Communication During Health Crises. This figure summarizes the main results:
Is “liking” on CaringBridge an appropriate form of communication to offer in health-critical contexts? For the majority, the answer was yes. When there was only one Heart reaction, users believed it carried far more meaning than “default liking” on other “general purpose” social media (like Facebook) due to the high-stakes medical context of CaringBridge and the platform’s branded design. CaringBridge’s single-click Heart was consistently interpreted as a simple, meaningful expression of acknowledgement and support.
However, adding new reactions to the mix incited a lot of disagreement among users. Some users found the new reactions to be useful, convenient, and reducing of caregiver burden: rather than reading dozens of repetitive variations on phrases like “we’re praying for you,” a concise and efficient list of Prayer reactions saves on time and cognitive strain. But others felt the additional reactions cause emotional harm by stripping communication of meaningful expression and authentic care, noting that these are not just more “silly cat videos.” We also observed that this feature increased complexity of the interface and introduced ambiguity for both visitors providing support and authors receiving support. With the Happy and Sad faces, it was unclear whether the symbols were intended to show a visitor’s own emotion, to show empathy with the author’s emotions, or to change or improve the author’s mood. With the Heart and Prayer hands, their distinct meanings became less clear, whereas previously the single Heart was an all-encompassing representation of support. Finally, the new set also raised issues of inclusion and exclusion, given associations of the new reaction symbols (Prayer hands, Happy and Sad faces) with both religion and skin tone.
To make things even more interesting, even though the additional reactions came with contentious opinions and considerable issues, over 90% of users were accepting of the new set of reactions, or wanted even more reactions to choose from. Thus, though the simplicity and intuitiveness of a single-option, single-click “Heart” may make it conceptually preferable, niche platforms like CaringBridge may still opt to use the additional reactions feature to “stay relevant” with social media trends and survive amidst giants.
We offer several design implications for better customizing health support platforms to meet the profound communication needs of patients and caregivers during health crises. For example, designers could refine the set of reactions offered to address some of the issues we found: perhaps a health-promoting, gesture-based set of reactions would better address the needs of users in health-critical contexts, such as Heart, Prayer, Hug, Flowers, Candle, and Clap — ideally with non-yellow skin tones and the ability to let users customize the options to best suit their preferences and needs. (See below for a prospective “reaction-picker” feature.) Or, platforms could allow patients and caregivers to configure info boxes above the comments section that specifies whether they prefer to receive comments, reactions, or both during a given timeframe in their health journey. Then, when it comes time to react to your friend’s dire health post, such features will make it harder for you to go wrong–instead you’ll be set up to support your friend the way they want you to.
This blog post is a condensed summary of users’ perceptions when new reactions were launched on CaringBridge. We highly encourage you to read the full paper to get the full story, enriched with illuminating quotes from users. We also hope you’ll consider attending our presentation of this work at CSCW in Minneapolis this fall! (It’s gorgeous in October; we’ve all lived there and can attest!)
Citation: C. Estelle Smith, Hannah Miller Hillberg, Zachary Levonian. ““Thoughts & Prayers” or “💗 & 🙏”: How the Release of New
Reactions on CaringBridge Reshapes Supportive
Communication During Health Crises.” Proceedings of the ACM on Human-Computer Interaction 7, no. CSCW2 (2023).
ArXiv Preprint: https://arxiv.org/abs/2304.07418
