Liberty, Catherine and Lobban, Fiona and Swarbrick, Caroline and Marshall, Paul (2026) Superusers’ Engagement in Online Mental Health Forums : A Qualitative Exploration. PhD thesis, Lancaster University.
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Abstract
Background Online forums are increasingly utilised by people experiencing mental health problems as they offer accessible, anonymous, and immediate access to peer support. Forum users generally fall into three categories: observers (who read but do not engage), contributors (who engage intermittently), and superusers (who engage at a high frequency). Despite accounting for just 1% of forum users, superusers are crucial to forum stability. However, little is known about their impacts, experiences, motivations and support needs. This thesis aimed to respond to these knowledge gaps by asking (1) What is known about the bidirectional impacts of superusers and online health forums, and (2) What are the engagement experiences of superusers in online mental health forums? Methods Two research approaches were employed. First, an integrative literature review utilising Framework Synthesis synthesised thirty-one sources that focused on (1) the impacts superusers have on online health forums and/or (2) the impacts online health forums have on their superusers. Second, Reflexive Thematic Analysis was used to analyse seventeen semi-structured interviews with self-identified mental health forum superusers from the UK. These interviews explored superusers' engagement experiences, motivations and challenges. Both approaches were rooted in critical realism, which allowed exploration of observable facets together with the ability to infer underlying generative mechanisms. Results The integrative literature review resulted in the development of a novel conceptual framework and five bidirectional themes. Three themes centred on the impacts superusers have on online health forums, including their roles in enhancing forum engagement, cultivating emotionally supportive environments, and fostering cohesive, proactive communities. Two themes encapsulated the impacts forums have on superusers, encompassing effects on physical and psychological health, in addition to social connection and validation. The Reflexive Thematic Analysis generated five themes centred around superusers' mental health forum engagement experiences. These themes highlighted the evolving nature of superusers' engagement over time; superusers' deployment of strong interpersonal and intrapersonal boundaries; experiences of belonging and shared identity; the adoption of primarily help-giving roles that provide purpose; and the challenge of navigating perceived otherness. Conclusion As research into superusers remains in its infancy, this thesis makes a significant contribution to knowledge by providing a foundational understanding of the bidirectional impacts of superusers and online health forums, as well as insight into mental health forum superusers' motivations, challenges and overall engagement experiences. These insights highlight superusers' emotional investment, time commitment and vital roles in sustaining peer-led mental health communities. Insights from this thesis encourage critical reflection on digital peer support, ethical forum design, and future directions for research, practice and policy. Moving forward, the evolution of relational dynamics within forums warrants further exploration, and longitudinal studies would be particularly useful here. Regarding practice, digital forum providers should prioritise psychologically safe, inclusive spaces that support their superusers without restricting their autonomy. Regarding policy, new frameworks must formally recognise superusers' essential roles and introduce safeguarding structures that protect their wellbeing. Participatory approaches to forum design and governance are also essential if ethical and effective spaces for superusers are to be assured within online forums.