Rituals of introduction and revolving roles: Socialization in an online breast cancer community

• This article examines an online breast cancer community through the lens of a community of practice construct.
• The study was a two-year ethnographic analysis comprising online archive analysis, participant-observation, and interviews.
• Participants moved from being novices, to novice/mentors, to mentor/experts.
• The community helped participants to understand their illness, address treatment, and build lasting relationships.
• Using a community of practice lens can contribute to understanding and developing online health communities.

This research sought to understand the role of information exchange and social support in an online breast cancer community relative to healthcare decisions and participants' everyday lives.Through a two-year ethnographic analysis comprising archives analysis, participant-observation, and 31 interviews, the data revealed that the forum's structure illustrated characteristics of a community of practice (CoP), a construct that has rarely been used in examining online health communities. Newcomers began as legitimate peripheral participants who progressed through the community from being novices, to novice/mentors, to mentor/experts. This progression represented a cycle of identification with three phases: a) an introductory phase, where novices made themselves known to the community and began to wrestle with breast cancer; b) learning the community's social practices and building identity as they evolved into novice/mentors who became more knowledgeable; and c) becoming mentor/experts who were looked up to and could provide information and support to others. Attaining mentor/expert status indicated a completion of the cycle in that mentor/experts were identified as being central to the community, and were also participating in the introduction phase by welcoming novices. Analyzing online health communities using a CoP perspective offers a lens that provides insights into the mechanisms that assist patients as they navigate through illness and treatment.