THE SHORT VERDICT:
Slick, dark, and appropriately fierce, Bad Guys is a short little series that packs a pretty big punch.
Everything is carefully and beautifully filmed, and for the most part, Bad Guys manages to hit that sweet spot where the writing is complex enough to be interesting, yet simple enough to be accessible to the average viewer. Add a pretty excellent cast to flesh out the interesting premise, and Show is a winner in almost every checkbox.
My beef with the show is that it gets too melodramatic at parts, which detracts from its unique brand of cool, and instead places it closer to standard kdrama fare than it needs to be. The cinematography also feels less deliberate as we get into the later episodes. Despite its shortcomings, though, Show remains an interesting and engaging watch.
Gritty and disturbing at times, yet heartening and uplifting at others, Bad Guys manages to be badass with heart.
Bad Guys OST – Reason
THE LONG VERDICT:
From the very first time I laid eyes on this show’s teasers, I’d been intrigued about this show’s premise. I mean, forming a team of “top criminals” to catch other criminals? How cool is that?? I wanted in, like, immediately.
Happily for me, Show didn’t disappoint. Not much, anyway.
I came into the show hoping for a good amount of badassery, and I got badassery by the truckload. In fact, the first four episodes even exceeded my (already pretty high) expectations, they were so good.
To be sure, Show’s got some flaws, and I didn’t love it consistently or equally all the way through. But when all is said and done, I liked a lot of things about it.
A lot of what I liked – and didn’t like – about the show lies in its execution. And what I liked, I liked a lot. Which is why I thought it necessary to give the loving spotlight where it’s due.
This show is a curious combination of being starkly gritty, yet arrestingly beautiful at the same time. The quality of the cinematography is razor sharp, and you can literally see every pore and wrinkle on our team of bad boys. And yet, it all looks beautiful.
I love that combination, of grit and polish. There’s just something that feels so bold about it, like, yes, here’s every pore and every wrinkle and every physical flaw that you could spot, but you can’t deny its beauty.
Admittedly, things get violent and sometimes, they also get really bloody, but that’s no surprise, given the show’s subject matter and premise. What I can say is, the blood and gore doesn’t feel gratuitous (unlike Vampire Prosecutor 2, for example); instead, when Show serves up blood or violence, it always feels integral to our story.
Here’s a sampling of screenshots, to show off the dark beauty in the show. There’s often a play of lights, shadows, and angles, which just adds to the very deliberate aesthetic.
One of the things that I really, really liked were the fine touches provided by the camera angles, as well as the editing. This showed up more in the beginning of the show than at the end, so I didn’t feel its presence consistently. But when it was there, I really appreciated the finesse that it added to the show.
Perhaps my favorite instance of this is this scene in episode 2, when Tae Soo (Jo Dong Hyuk) stops in a deserted walkway and tries to imagine the scene as the crime had taken place.
The sequence starts with the camera focusing on Tae Soo’s face as he contemplates the walkway in the daylight.
And then the camera zooms in to his iris, where we see the walkway reflected as it is, in the day. As Tae Soo blinks, the reflection in his eye changes to a night scene; that’s our visual cue that he’s re-imagining the crime scene.
The camera zooms out, and this time, the color palette desaturates as the camera pans around him so that we are aligned with his line of sight; we see his imagined version of the crime, as he sees it.
As he imagines it, he sees himself playing the part of the killer, trailing the woman, stabbing the woman, and crouching over her body.
When his thought sequence ends, the color palette saturates again, and we see Tae Soo in the present, pondering over his thoughts.
So very polished, and clearly, so very thoughtfully conceptualized and executed as well.
Narrative & Pacing
From the get-go, Bad Guys serves up fast-paced intensity, and by the end of episode 1, I felt very nicely engaged.
Narratively, we get hints of backstory for the bad boys, and all almost immediately too; this made me curious to know more about each of them. Combined with the dramatic tension provided by the Case of the Day, this made for a very engaging balance for most of the show’s run.
I really liked how, in the midst of dealing with the Case of the Day, the moments of personal story shine through, sometimes when I least expected it.
[SPOILER ALERT] Like how in episode 3, Goo Tak (Kim Sang Joong) is unable to bring himself to check whether the victim is still alive, because of the memories of the moment when he’d checked the vitals of his dead daughter. It’s a poignant moment, built so organically into the narrative. I liked that touch a lot. [END SPOILER]
As I mentioned earlier, this show has no shortage of badassery (clearly, this is a word I will be using often in this review!). What I like about it is, all the fighting feels organic to the story and characters, and is well-executed and appropriately impressive.
There’s a distinct ease and, well, nonchalance with which our bad boys bring out the badass moves, like this truly is a walk in the park for them, and just another day in their regular lives.
We see it very quickly in episode 1, when Tae Soo and Woong Chul (Ma Dong Suk), who’ve quite literally just met, go together to get information that they need.
Facing a big warehouse full of gangster minion, Woong Chul eyes Tae Soo and casually asks, “Me?” and Tae Soo doesn’t even look back at Woong Chul, and simply answers, “Me.”
And just like that, it’s decided that Tae Soo will front this particular take-down. Tae Soo saunters casually into the warehouse, ahead of Woong Chul.
Our bad boys are clearly outnumbered, but that doesn’t stop them from completely kicking everyone’s ass, and in style too.
With all the minion taken down and groaning on their backs, as a final touch, Tae Soo flings a hammer in the direction of Head Minion, landing it squarely into the notice board behind Head Minion.
Tae Soo cracks his neck from side to side, then evenly looks Head Minion right in the eye. “I won’t ask again. Where is Yang Yu Jin?”
So. Bad. Ass.
Despite the predominant mood being of the tough, badass variety, Show injects little spots of humor to balance it out, which I welcomed very much. Even better, sometimes that humor appeared when I least expected it, which just made it all the funnier.
Right away in episode 1, we get a few shots of funny.
Woong Chul, having just very fiercely beaten the information he needed out of a gangster type, suddenly sticks out his tongue at the guy, and grins.
Ha! I nearly bust a gut, I so did not see that coming.
Again in episode 1, we also get a very cute exchange between Tae Soo and Woong Chul, when Tae Soo corrects Woong Chul’s repeated, mistaken use of the phrase “Jack and the Beansprout.” Pfft.
There are times in the show where beyond the fierce moves and tough talk, the conversation turns to “softer” things, like helping people, and justice, and hope.
I really like the fact that beyond the gritty badassery, the show has heart. I like even more, that this show of heart doesn’t at all detract from our characters’ combined edginess, since the little moments of thought-provoking statement are delivered with such smirk.
It’s a tough balance to achieve, and Show manages to keep that balance quite nicely most of the way through.
Focus, Tone, Melodrama
As we progress through the episodes, there is a distinct shift in the focus of the show. From the cases of the day, the focus turns to cases that actually involve our trio of bad boys.
While I appreciate the sentiment, and am also interested to know more about the boys, I felt that the way it was handled was rather uneven.
Given that the show’s premise was that Team Crazy Dogs was formed in order to solve crimes that were too difficult for regular police to solve, I would’ve liked to see that element sustained through to the end.
In episode 5, all we see are our bad boys wrapping up a drug bust operation, before we get into more personal stuff. I would’ve preferred to see how our boys took down the drug ring, instead of being given just a glimpse of them finishing up.
Instead of keeping the focus on difficult-to-solve cases, the cases thereafter take on a very personal nature, and somewhere in the middle-ish stretch, things get melodramatic. And that, honestly, is my one big disappointment with the show, that it got overly melodramatic.
I felt that this made the tone of the show feel rather uneven, and more importantly, took us into more standard and clichéd kdrama territory, which definitely took away from this show’s cool factor, I felt.
Just for the record, here are some of the things that I found overly melodramatic:
- Jung Moon’s (Park Hae Jin) persuasion of the shooter in episode 5;
- Woong Chul’s conversation with his Hyung-nim about not being able to sleep at night because of all the crimes that he’d committed;
- The whole arc involving Woong Chul and his Hyung-nim, from Hyung-nim threatening him, to Woong Chul surviving, to Woong Chul saving him, to Hyung-nim getting killed anyway;
- Goo Tak’s entire backstory about his dead daughter. The unveiling of the backstory in episode 9 was played ultra melodramatic, and despite a committed delivery by Kim Sang Joong, I didn’t feel emotionally hooked by it.
Maybe it’s just me, y’know.
It’s very possible that other viewers found these arcs perfectly engaging. For me, though, the heavy-handed melodrama was too stark a shift, after episodes of cool badassery. Essentially, it didn’t feel organic enough to capture my heart.
Despite my beef with the show’s shift in tone, I really liked the characters; in particular, the mad dogs. And it was the characters and their relationships that kept me invested through to the end.
I really liked that every member of Team Crazy Dogs looked and felt appropriately intense and badass, and just a little bit mad, each in their own ways. I thought that fit the Crazy Dog label nicely.
Here, I’d just like to give the quick spotlight to each of the main characters in this show.
Kim Sang Joong as Oh Goo Tak
Wearing a steely calm, a deadened gaze, and speaking with a consistently sardonic drawl, Kim Sang Joong is pretty great as Goo Tak, the rogue cop whose idea it was in the first place, to gather Team Crazy Dogs together.
Goo Tak is as tough and scary as each of his team members, if not scarier. His methods can be ruthless, and more than once, his actions and decisions left me gaping at his apparent heartlessness and cruelty. Despite his hardened outer shell, though, Goo Tak betrays a soft core that shows itself at times, albeit gruffly.
Kim Sang Joong plays that duality well, moving effortlessly between being a cruel hardass rogue, and revealing his softer side when teaching his mad dogs to actually enjoy saving people. Kim Sang Joong delivers each facet of Goo Tak’s persona with a sardonic ease, and makes that odd duality feel organic in spite of its, well, oddness.
All in all, I thought Kim Sang Joong gave a great performance, and the instance where that first really landed for me, is in episode 3, where we see a flashback of Goo Tak with his daughter in happier days.
In the flashback, he looks so bright and cheerful that he looks and feels like a completely different person.
And then we see Goo Tak, still in flashback, soon after his daughter’s death, and it literally feels like the light is gone from his eyes.
That’s when I thought, “What a great contrast, and what a great performance.”
Ma Dong Suk as Park Woong Chul
Ma Dong Suk is fantastic as Woong Chul, the bulldozer who’d rather let his fists do the talking, but who’s slightly slow on the uptake at times, and who (mostly inadvertently) brings some nice laughs.
Woong Chul is basically a big grizzly bear with a heart, and Ma Dong Suk, with his imposing build, naturally furrowed brow and gravelly voice, is perfectly cast.
The thing I loved most about Woong Chul’s character, is how we become acquainted with his feelings and his conscience as we delve deeper into the episodes.
From being the gangster who single-handedly took over the Seoul underworld with his fists, we see how, by episode 5, it’s actually become important to Woong Chul, for the perpetrators to be brought to justice, even if he’s not the one bringing them to justice. I love that spot of growth, that to him, it’s become more than merely a way to reduce his own jail term, but a real fight for justice. That he believed, in that moment in episode 5, that this was the last thing he could do before he died, just made it all the more meaningful and poignant.
And even though I found Woong Chul’s arc with his Hyung-nim to be on the melodramatic end of the scale, I liked how we saw his loyalty, and beyond that loyalty, his love for his Hyung-nim run so deep.
I just loved Woong Chul being a sentimental softie underneath it all.
Park Hae Jin as Lee Jung Moon
When I’d read that Park Hae Jin had originally been cast in Shin Sung Rok’s Creepy Brother role in You From Another Star, I’d really wondered whether he’d be able to pull off Creepy. After all, I’ve always had him in my mind as Adorable Puppy, ever since his very endearing turn in Famous Princesses (2006).
Well. Here in Bad Guys, Park Hae Jin proves that he does have the capacity to play creepy.
On the upside, Park Hae Jin is suitably cold and unreadable as Jung Moon. On the downside, by mid-series, I got bored with his delivery. We basically don’t see much more than the same cold and unreadable expression on Jung Moon, all series long, and I felt that that was a pity.
Still, in the context of our story, I felt Jung Moon was an interesting character.
His memory lapses form a fundamental piece of the overarching mystery from the very beginning of the show, and even Jung Moon himself isn’t sure whether he’d actually killed the victims.
I liked the reason that Jung Moon gave for accepting the mad dog assignment. “[I want to know] If it’s true that I killed people, then if it’s possible for me to save people. If it will stir my heart if I save people. Because I wanted to know that. That’s why I’m doing this.”
I found it believable – and at the same time, interesting – for his character, that he would accept a place in Team Crazy Dogs, to know himself.
In spite of my finding that the story hinged too heavily on this mystery, Jung Moon’s search for the truth felt poignant to me. It must have been so frustrating to be unable to remember the truth, and yet be punished so heavily for the elusive missing memory.
For this reason, I found Jung Moon a sympathetic character, in spite of wanting more from Park Hae Jin’s delivery, as well as from his character’s treatment by the narrative.
Jo Dong Hyuk as Jung Tae Soo
Out of the entire team of Crazy Dogs, I found myself liking Tae Soo the most, as a character.
On the shallow end of the scale, I love that Tae Soo is the coolest – and arguably the most formidable – of our mad dogs. He’s the most balanced in terms of smarts, skills and strength, and often manages to keep a cool handle on things even when the others don’t. And I love that on quite a few occasions, it’s his steely confidence and nonchalance that gets through to whomever the mad dogs happen to be dealing with, when others’ efforts fail.
Still on the shallow end of the scale, Jo Dong Hyuk looks fantastic.
Not only does he boast excellent muscle definition, he’s even wearing a non-blurred-out tattoo. I don’t know how he does that. I guess Tae Soo’s so slick that he even managed to circumvent Korean broadcasting guidelines? 😉
On top of the hot bod, his fight moves are the most stylish, and he takes down anyone in his path with an effortless panache which I found quite mesmerizing.
Oof. So! Badass!
To top it all off, Tae Soo’s got a sense of humor, and when he smiles, the fierceness melts away, and we get glimpses of melty cute.
Moving on to the not-so-shallow end of the scale, I really liked Jo Dong Hyuk’s portrayal of Tae Soo. Despite Tae Soo’s badass veneer, I found Jo Dong Hyuk’s delivery to be subtle and sincere. I thought that subtlety really suited Tae Soo’s character, because as skillful and badass as Tae Soo is, he’s also the quiet, speak-only-when-necessary, thoughtful type. Jo Dong Hyuk made Tae Soo’s every reaction nuanced and thoughtful, and I liked that a lot.
While this held true throughout the show, I felt that this heartfelt sincerity shone the most during Tae Soo’s personal arc.
The Crazy Dog journey for Tae Soo is essentially a journey of realization, of coming-to-terms, and of healing and repentance.
From a top-notch contract killer who worked alone, we can see Tae Soo warming to the concept of working with the other bad boys. Out of the 3, I felt like Tae Soo was the first to show signs of actually liking the team.
In terms of repentance, we get glimpses of regret with Tae Soo’s lingering connection with Park Sun Jung (Min Ji Ah), the widow of his last victim through most of the show, but his inner agony is only voiced in episode 7 in his face-off with long-time comrade Jong Seok (Jang Sun Ho).
“The sadness of taking someone precious away from them, the agony… the sense of guilt of taking a life of someone dear to them. I… I found out what those emotions felt like, so I just can’t kill anymore.”
Much as Tae Soo regrets his past, it is only with Jong Seok’s death that he finally manages to empathize with Sun Jung’s deep pain of losing someone dear, and of feeling all alone in the world.
His eventual, final apology to Sun Jung is delivered with tears, make-no-excuses unflinching detail, and a deep sorrow that I found heartbreaking and very tragic.
So much pain and regret, and yet no way to fix it. So very sad.
And yet, I see this step by Tae Soo to be an important one, in his personal healing journey. In the absence of forgiveness, which he doesn’t seek, there is closure. Closure both for her, as well as for him. And closure is what I think will enable them both to move forward.
Kang Ye Won as Yoo Mi Young
In the course of this show’s run, I came across a fair bit of viewer sentiment, that Mi Young was an unnecessary character that could’ve been dropped from the show with no loss to our narrative.
While I didn’t like nor hate Mi Young’s character, nor Kang Ye Won’s delivery of her character, in my opinion, I actually thought Mi Young as a character had a distinct use in our story.
In the earlier stretch of the show, Mi Young serves as a barometer. Her incredulous reaction to the formation of the team and the rest of the developments is closer to a normal person’s – closer to our reactions, as viewers. I think that contrast, between her incredulity and Goo Tak’s nonchalance, helps to emphasize just how different and daring an experiment it is, to form Team Crazy Dogs.
Essentially, I think the show needed someone outside Team Crazy Dogs. Someone who was different, and who could not be part of them, to be near them, to bring out that emphasis.
Additionally, in the final leg of the show, Mi Young eventually became an instrument through which Team Crazy Dogs managed to nail Prosecutor Oh (Kim Tae Hoon) for his crimes.
Plus, when all was said and done, we also needed her to be on the outside, not in jail, in a position to help Team Crazy Dogs come out to work their badass magic again. I’d say that’s definitely pretty useful. 🙂
While I wasn’t too crazy about Mi Young’s stiff-upper-lip characterization through much of the show, I have to say that my favorite Mi Young moment, hands-down, was when she came out of nowhere in episode 4, to give smug organ trafficker overlord Madam Hwang (Lee Yong Nyeo) a mean right hook, when Goo Tak couldn’t bring himself to hit a women.
Augh. So satisfying.
Maybe that’s one more reason to have a woman on the team? 😉
TEAM CRAZY DOGS
I think perhaps the best part of the show was seeing Team Crazy Dogs come together, all suspicious and wary of one another, and over the course of the show, actually come to care for one another, no matter how grudgingly.
I found the treatment of the boys’ entry into Team Crazy Dogs quite realistic, at least, in the area of characterization.
For one, I thought it very apt, and quite entertaining, that Woong Chul and Tae Soo began their acquaintance by first eyeing each other suspiciously, and then very quickly, coming to blows.
It reminded me of how two strange alpha dogs might behave when faced with each other; immediately, the question of the alpha between the two needs to be established. I thought this worked so well with the mad dog metaphor.
I also found it amusing that Goo Tak had to keep reining in his mad dogs, from the very beginning, and I thought it made a lot of sense. Each of his mad dogs are extremely strong and efficient, and they have little interest in things like discipline and teamwork. It’s no wonder that things like teamwork and discipline were hard to establish from the get-go.
In the early episodes, as each mad dog kept going off on his own, I was quite amused at the idea that if they just kept tracking one another down and getting their sentences cut each time they did so, that they might soon be walking free. Heh.
Perhaps one of the things that impressed me the most about our mad dogs, aside from all the nifty fight moves, is how extremely useful they were, when it came to getting inside the killer’s head. Time and again, our bad boys demonstrate their skill and experience in psychoanalyzing killers, and I had to think how much more on point they were, compared to regular police investigators.
As a quick example, we have Jung Moon pointing out in episode 2, that if the killer had been captured, that he’d have looked angry because that meant that he would’ve lost to the other serial killer, whom he was trying to beat in terms of body count.
Another example is in episode 7, when Tae Soo quickly and effortlessly lists all the clues to the stabbing, that point to it being professional work. He knows, coz he’s been a professional himself.
I mean, it’s all pretty macabre and yet so spot on. This is why getting bad boys to beat crime had me so intrigued.
On the teamwork front, I loved seeing the mad dogs go from a fractured, independent working style, to eventually coming together to work as a team. Often, that teamwork is facilitated by catalysts like the boys being thrust into death-or-life situations where they are seriously outnumbered. Those were the moments when teamwork was forced to the forefront, and I really enjoyed seeing not only the resulting teamwork, but also, the resulting show of care, under duress.
During these scenes, another thing that struck me, is how lightly our boys seem to hold their very lives. Like in episode 4, when they are dangerously outnumbered by all of Madam Hwang’s minion.
The risk is really high, and they could literally die at any moment throughout the operation, but they jump into it with sardonic wild abandon anyway. It’s bemusing and cool and scary, all at once.
As much as our bad boys show that they hold their own lives lightly, we eventually see that they start to value the lives of their teammates.
We see it in Woong Chul’s continued reluctance to kill Jung Moon, even under threat of his own life, and how he chooses instead, to save Jung Moon.
We see it, too, in the reluctance of both Woong Chul and Tae Soo to kill Goo Tak and Jung Moon respectively in episode 10, after having been fed lies by Prosecutor Oh.
Despite their very experienced and seasoned backgrounds in killing people, and despite the lack of resistance from Goo Tak and Jung Moon, both Woong Chul and Tae Soo are unable to go through with it.
Tae Soo even begs Goo Tak to give him a reason not to kill him, while Woong Chul can’t shake off his gut feel that it’s not right.
We see a similar-but-different dynamic in episode 11, when, after Goo Tak realizes the truth, he apologizes deeply, then hands Jung Moon his own gun, giving Jung Moon the freedom to kill him if he so wishes.
Like the other boys, Jung Moon can’t bring himself to do it.
And I think that’s essentially what distills the eventual relationship between our bad boys. They’ve gotten to the point of being able to put their lives in one another’s hands, literally, with guns and knives.
That’s like a trust-fall on steroids, man.
BACK TO TONE
Now that I’ve talked about the show at large, I thought it’d be apt to go back to tone for a bit. Coz while I’ve talked about the pluses and minuses of the tone, I haven’t mentioned some of these things, which I think fall into a more neutral sort of zone.
See, this show, while being engaging and even a little uplifting, is also dark and disturbing, and can get hard to watch. It basically puts the spotlight on the darker edges of society that most of us prefer not to think about, and being confronted with it can be quite uncomfortable.
Here’s a quick list of a couple of things that I found uncomfortable to watch:
- The unrelenting spotlight on the human trafficking trade in episode 4. It’s undeniable that such black markets exist, and such practices exist. These aren’t just random things that a scriptwriter dreamed up.
- Not just the spotlight on the organ trafficking per se, but the manner in which the characters talk about it. They talk about organ trafficking in a chillingly casual manner, as if they’re talking about picking up the morning paper, and I find that plenty disturbing.
- The Heartless City-like world in which this drama exists. Dirty cops are a given, and we even get a dirty SWAT team. I found the idea of a dirty SWAT team particularly disturbing, coz aren’t they the elite force to call when things go really wrong?
While part of me reveled in the seamless way this world felt matched to the world of Heartless City (review here), and wished for Baksa to make a crossover appearance (seriously, how fantastic would that have been?), I can’t deny that it’s sobering and disturbing to be faced with the fact that there really is such a dark and disturbing side to the world in which we live. That daily, there are people being trafficked ruthlessly for money. That maybe, there really is a dirty SWAT team somewhere, among the dirty cops that do exist in our world.
On top of this, all the internal attempts of coup d’état made this drama world feel extra unstable and dangerous. By extension, that sense of instability carried over a little bit, to my perception of the world in which I live. And I began to think that maybe, the world in which I live might not be as stable as I’d like to think.
In its own badass way, Show raises some thought-provoking questions and themes.
Like, what constitutes truth? What constitutes justice? And what constitutes culpability?
[SPOILERS THROUGH THE END OF THE REVIEW]
In episode 4, Goo Tak’s moral lesson to the IT staffer manning the CCTV console is thought-provoking. Even though the IT guy says he’s just a staff and doesn’t actually get involved in organ trafficking, Goo Tak’s point is that he’s equally culpable because he allows it to happen.
Which begs the thought-provoking question: if we’re not actively doing something against all the bad stuff in the world, does that make us culpable for standing by and letting it happen on our watch?
The reveal in episode 10, that Goo Tak is not certain of what he remembers, totally puts in question everything the show has revealed up to that point. At the same time, this poses the question of what constitutes truth. Is there such a thing as an objective truth, or is all truth tainted by our perception and memory of it?
And of course, there’s the reasoning of Big Bad Prosecutor Oh, who considers all of his dirty deeds a process of meting out true justice where the courts have failed to do so. Which raises the question: what is justice? Who gets to decide what constitutes justice?
All thought-provoking questions, which I found very interesting to chew on.
While Prosecutor Oh turning out to be the real psycho and the true Big Bad wasn’t completely unexpected, I thought the show did a good job of making his entrapment plausible, and wrapping up loose ends.
I particularly liked the way the team lured Dr. Kim (Nam Sung Jin) out to the car; I thought it was pretty genius, and I love it when the team looks smart.
At the same time, I found the truth chilling. It’s so twisted, that Prosecutor Oh was using Jung Moon as a scapegoat, and in such a calculated, deliberate, pre-meditated way. The man may think he’s meting out justice, but I think he’s evil.
Overall, I found the show and its ending a little – sometimes a lot – more melodramatic than I felt was absolutely necessary, but the story gets tied up quite tightly, and the ending is open enough.
And in the end, Goo Tak’s words to Mi Young summarize quite nicely, our bad boys’ collective road to redemption:
“We’ve decided to live like people, even if we only get to live for one more day and die. If there’s a crime we’ve committed, we’ll boldly accept punishment, reflect, and receive forgiveness. That’s how we live a new life. Isn’t that what it is to be nice? Heaven will acknowledge us if we’re not bad guys.”
In terms of a sequel, I don’t think the show needs one, in that this ending feels satisfying enough. But I honestly wouldn’t mind another season of watching these mad dogs solving crime together. Coz this time, they would’ve already worked through all their angsty backstories, and would be able to focus more on kicking underworld ass, while nurturing some long-overdue bromance.
Now, that’s a show I would like to see. 😉
THE FINAL VERDICT:
More melodramatic at times than necessary, but so polished, gritty and badass, that it’s still all worthwhile.
FINAL GRADE: B+
Here’s a quick trailer that gives a great feel for the badass vibe of the show:
And just coz I can, here’s an additional (gratuitous, for me anyway) trailer featuring just Jo Dong Hyuk, mostly coz he’s quite mesmerizing without his shirt 😉
Longer Glimpses of Badassery: MVs
Here are a couple of MVs which I consider only moderately spoilery, particularly if you don’t understand Korean. There are snippets of dialogue used as voiceovers in both MVs which could be potentially spoilery if you understood them, so fair warning.
On the upside, you get a glimpse of Team Crazy Dog’s brand of badassery as they declare war on crime, on their own terms. Be warned, though, that there’s a fair amount of blood in these MVs. It’s one thing to have these bloody scenes (& the fight scenes too, for that matter) show up more spaced out in the show, but quite another to have it all spliced together tightly into an MV. The effect can feel like it’s a little too much, but you just need to keep in mind that it’s not as overwhelming when you’re actually watching the show.
Categories: Review | Tags: 2014, B, Bad Guys, Famous Princesses, Heartless City, Jang Sun Ho, Jo Dong Hyuk, Kang Ye Won, Kim Sang Joong, Kim Tae Hoon, Lee Yong Nyeo, Ma Dong Suk, Min Ji Ah, My Love From Another Star, Nam Sung Jin, Park Hae Jin, Review, Shin Sung Rok, Vampire Prosecutor 2, You From Another Star | Permalink.
Proud to be a k-fangirl since 2007. Main diet of kdramas with movies and kpop on the side.
Social and Psychological Determinants of Levels of Engagement with an Online Breast Cancer Support Group: Posters, Lurkers, and Non-Users
Jeong Yeob Han, Ph.D., Assistant Professor, Jung-Hyun Kim, Ph.D., Assistant Professor, Hye Jin Yoon, Ph.D., Assistant Professor, Minsun Shim, Ph.D., Assistant Professor, Fiona M. McTavish, M.S., Researcher, and David H. Gustafson, Ph.D., Research Professor and Director
J Health Commun. Author manuscript; available in PMC 2013 Jan 28.
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Despite the benefits and growing availability of online cancer support groups, many breast cancer patients still do not actively participate in the support groups. To better understand cancer patients’ online information and support seeking behaviors, this study explores how various social and psychological characteristics predict different levels of engagement with an online breast cancer support group: posters, lurkers, and non-users. The study sample included 231 recently diagnosed breast cancer patients. Data included baseline survey scores of demographic, disease-related, and psychosocial factors and automatically collected discussion group use data over the 4-month intervention. Patterns of engagement with the cancer support group differed according to the patients’ characteristics, suggesting that (1) cancer patients have very different orientations to and engagement with an online support group, and (2) ‘deficits’ in social and psychological resources may not be barriers to participation in a cancer support group, but rather motivators to interact with other patients. Theoretical and practical implications of the findings are discussed.
Breast cancer is the most common form of cancer and the second leading cause of cancer-related death among women in the United States (American Cancer Society, 2009). Not surprisingly, past research has shown that, along with the direct physical effects of the disease, breast cancer patients face a variety of psychological challenges related to body image and sexuality (Gustafson et al., 2001; Gustafson et al., 2005), experiences of isolation and loneliness (Anderson, 1992), as well as feelings of anxiety, distress, and depression (Spiegel, 1997). Given the high prevalence of breast cancer and the extent of life trauma associated with the diagnosis and subsequent treatments, it is essential to understand how various coping mechanisms may help reduce anxiety and improve quality of life for cancer patients.
A review of the relevant literature suggests that an increasingly common way women with breast cancer cope with their illness is participation in computer-mediated social support (CMSS) groups (Han, Shaw, Hawkins, Pingree, McTavish, & Gustafson, 2008; Han et al., in press; Shaw, Hawkins, McTavish, Pingree, & Gustafson, 2006). Despite the benefits and growing availability of online cancer support groups, many breast cancer patients still do not actively participate in the support groups. A study on breast cancer support groups showed that, although they were provided with free computer hardware, Internet access, and training, about 54% of the patients either did not participate in the CMSS group or share their feelings and thoughts with others (Shaw et al., 2006). Another study also found that about 58% of breast cancer patients either did not access the online support group or posted messages for other patients to read (Han et al., 2008). The question that rises from these findings is why some women with breast cancer do not show interest in online support groups or do not write messages to others even after they have been provided with necessary tools and training. A closer observation into the factors that determine these different engagement types may lead to insights in patients’ social and psychological barriers for participation in online support groups.
To better understand the patterns of online information and support seeking/avoiding behaviors among breast cancer patients, this study explores how various demographic, disease-related, and psychosocial characteristics predict different levels of engagement in an online support group: posters, lurkers, and non-users. For this purpose, this study incorporates three theoretical frameworks: Johnson’s (1997) Comprehensive Model of Information Seeking (CMIS) and the competing models on online engagement (i.e., social compensation versus social enhancement). The CMIS model identifies several antecedent factors relevant to health information seeking behavior but the directions of these relationships are unclear. Justifications for the directions are to be offered by the social compensation and social enhancement models. To address our questions, we draw upon two types of data collected from a large-scale eHealth intervention study of breast cancer patients which includes: (a) action log data analysis of the message relevant behaviors (i.e., posting vs. reading messages) within the CMSS group, and (b) survey data collected before the intervention.
The CMSS group examined in this study was part of the XXXX system. The discussion group functioned as a text-based, asynchronous bulletin board, and not as an e-mail system. That is, all messages were available to and widely read by all participants, not just those addressed in a given sentence or in the ‘subject’ tag. Further, the discussion group was monitored by a trained facilitator to ensure that discussions were supportive and did not contain unchallenged inaccurate or harmful information, though the facilitator did not take an active role in guiding the topics of communication and rarely intervened. The CMSS group was limited to women who were diagnosed with breast cancer.
Who Engages More and Why? Two Competing Explanations
Two competing perspectives have been proposed as frameworks for explaining why breast cancer patients show different levels of participation in online cancer support groups. These two frameworks had been originally used for explaining uses and effects of the Internet (Kraut, Kiesler, Boneva, Cummings, Helgeson, & Crawford, 2002) and some specific online services, such as social network websites. The social enhancement model (the “Rich get richer” model) (Kraut et al., 2002) posits that individuals who have more social resources in their daily lives will use and benefit more from using the Internet compared to those who do not have many offline social resources. Having strong social support offline can make people feel comfortable exploring online world without much concern, since they know they already have their “safety net” offline. Knowing that they do not have to make up for what they lack offline provides them with confidence and easiness in using diverse online services. According to this perspective, such comfort and confidence would encourage those with more resources to actively engage in online social support groups.
Alternatively, the social compensation model (the “Poor get richer” model) (McKenna & Bargh, 1998) posits that individuals who are shy and do not have sufficient offline social resources will use and benefit more from participating in diverse online activities through connecting with people and obtaining supportive communications. According to this perspective, individuals who do not have much social support offline might be more active in participating in online activities or services, since they have more time to spare and be more eager to develop new relationships online. On the other hand, using online services might rather interfere with real-world relationships for those who already have satisfactory offline resources. This hypothesis has been applied to the cancer patient support group context, showing that cancer patients with emotionally supportive spouses were rather harmed by participating in peer support group (Helgeson, Cohen, Schulz, & Yasko, 2000).
Using the CMIS to Predict Online Support Group Participation
Since information seeking is considered as one of the vital reasons for participating in an online support group (e.g., factual information seeking, seeking for different viewpoints, and access to others’ personal experiences) (Han et al., 2010), the current study seeks to apply the CMIS framework in examining the antecedents to online support group participation. The two competing models of social enhancement and social compensation allow us to predict in either (or both) direction(s) with each antecedent variable.
Within the CMIS framework, demographic factors are considered essential in predicting the use of health information resources, including participation in online support groups. Recent studies have found that factors such as age, race, living situation, and education predicted differential use of various health information resources (Freimuth, Stein, & Kean, 1989; Leydon et al., 2000). Internet usage studies have reported that the older the person, the less likely he/she would be actively engaging in Internet activities; the propensity to use the Internet for health information was also found to decrease with increase in age (Ybarra & Suman, 2006); and a study specifically focusing on lurking in an online support group found that lurkers were relatively older than active participants (van Uden-Kraan et al., 2008).
Racial differences have been observed in using the Internet for health information. African Americans were less likely to turn to the Internet for information than Whites (Ybarra & Suman, 2006). More specifically with online cancer support group participation, past research has found that Caucasians produce greater volumes of writing than African Americans (Shaw et al., 2006). One reason for this discrepancy may be that African Americans were found to be less willing to share cancer information beyond their family boundary.
Online patient support group participation can also be linked with living conditions and education level (Assael, 2005; Ybarra & Suman, 2006). Patients who are living alone may be more likely to actively participate in an online support group since without the support of family or friends living together in the household, they might be motivated to turn to online, especially if the option is readily available, as a way of receiving alternative social support (McKenna & Bargh, 1998). Past research has also found that both Internet usage and health information seeking online increases with higher levels of education.
According to the CMIS, the level of individuals’ direct experience with the disease will predict their health information seeking behaviors (Johnson, 1997). For example, cancer stage is a key factor, as treatment choices, side effects, and prognosis are very different for patients with early-stage vs. advanced breast cancer (Czaja, Manfredi, & Price, 2003; Johnson, 1997). In addition, each phase of the cancer journey comes with its own set of concerns and thus may influence the type (Mills & Sullivan, 1999) and extent of using health information resources (Czaja et al., 2003; Leydon et al., 2000). From this information, we expect that the motivation to participate in an online social support group may be different depending on the patient’s disease progress, thus influencing participation levels in an online support group.
The CMIS points out that individual’s health beliefs and perceived salience of the information influence information seeking. First, an individual’s “perception of the extent to which he or she can shape or control events” (Johnson, 1997, p. 73), has been found to enhance the ability to seek out and use cancer information in making a health care decision (Leydon et al., 2000). Thus, patients with higher information competence may be more likely to seek out relevant information and engage more within an online support group (Kraut et al., 2002; Valkenburg et al., 2005). Alternatively, it is possible that patients with low information competence may use this eHealth resource to augment their competence in dealing with their cancer and treatment decisions (Shaw et al., 2008).
Second, according to the CMIS, psychological salience, or “the personal significance of cancer-related information to the individual” (Johnson, 1997, p. 72), is an underlying motivation to seek out information. Applying this framework to our discussion, one possibility is that people who report lower levels of social support, quality of life, and confidence in physician-patient communication may turn to an online support group and engage more in order to compensate for the lack of those resources (Shaw et al., 2008). Similarly, higher levels of need for information can be a motivator to seek out needed information in support of lifestyle and cognitive/emotional adjustments. Another possibility is that those with higher levels of social support and quality of life at baseline may be best able to engage in and thus benefit from a new information resource such as online support groups (Kraut et al., 2002).
The data analyzed in this study were collected as a part of a larger Digital Divide Pilot Project (DDPP), in which underserved women with breast cancer in rural Wisconsin and Detroit, Michigan were given access to the XXXX “Living with Breast Cancer” program for 4 months (Gustafson et al., 2005). Although both the pretest and a 4-month posttest surveys were conducted with a sample of 231, the current study analyzed the baseline survey data only to explore the relationship between patient’s characteristics and different levels of engagement in an online support group. Detroit recruitment started in June 2001 and ended in April 2003 and Wisconsin recruitment began in May 2001 and ended in April 2003.
Eligibility criterion required that participants were at or below 250% of the federal poverty level, not homeless, within one year of diagnosis with early-stage breast cancer or within one year of a diagnosis of metastatic breast cancer, and able to read and understand an informed consent letter. After submitting their pre-test, all study participants were loaned a computer and given Internet access for 4 months. Over 80% of those who joined the study (more than 185 women) did not have a computer at home and they had very limited experience in both the computer and the Internet (Han, Hawkins, Shaw, Pingree, McTavish, & Gustafson, 2009). All study participants also received personal training to learn how to use the computer and the Internet, but the majority of time was spent on teaching participants how to use XXXX, including how to post messages in the CMSS group.
Action Log Data Action log tracking data on whether and how women used the discussion group for 4-months were also collected. Action log data files contain the unique identifier for each action, individual participants’ online handle and numerical ID, and the message relevant behavior (i.e., post, read). This enabled us to monitor whether participant joined the CMSS group or not and which participant wrote and/or read each message.
From this we could generate our measures of levels of engagement with the CMSS group. If women accessed the discussion group and wrote/read at least one message during the four-month intervention period, we categorized them as ‘users’. If they did not, they were assigned to the ‘non-users’ category. Among ‘users’, ‘posters’ were operationalized as women who wrote at least two messages during the study period. A woman was considered to be a ‘lurker’ if she read messages but never wrote at least two messages over the course of the study. We selected this criterion since as part of the training process women were encouraged to write a message introducing themselves to the rest of the group, which provided the participant the opportunity to show during the in-house training that she could use the communication function that allowed her to participate in the computer support group. Finally, these measures of engagement generated from action log analysis were combined with pre-test survey data to examine how demographics, disease status, and psychosocial needs related to different levels of participation in the online breast cancer support group.
Guided by the CMIS framework, we focus on antecedents of three categories: demographic, disease-related, and psychosocial factors.
Surveys administered at pre-test included demographic factors of age, race (a dummy variable with African American coded 0 and Caucasian coded 1), whether or not patients live alone (a dummy variable with ‘no’ coded 0 and ‘yes’ coded 1), and education.
Surveys also included disease-related measure of stage of cancer (a dummy variable with early stage (stage 0, 1, 2) coded 0 and late stage (3, 4, or inflammatory) coded 1) (Gustafson et al., 2005). This roughly defines a medical boundary at which treatment choices and prognosis differ considerably.
Measures of seven psychosocial factors at pre-test included: information competence, need for information, social support, functional well-being, emotional well-being, breast cancer-related concerns, and confidence in physician-patient communication. See Appendix for the exact wording of all the items belonging to these scales. For all measures, scale scores are calculated as averages across scale items.
Social Support and Information
A health information competence scale (M=2.96, SD=.87) assessed a woman’s perception that she could get and use health information (Gustafson et al., 2005). The five-point scale ranging from 0 to 4 asked whether participants agreed or disagreed with statements such as “I can figure out how and where to get the information I need” (Cronbach’s α=.74). A five-item need for information scale (M=2.90, SD=.76) assessed the extent to which a woman lacked information about her health or health care (Gustafson et al., 2001). Respondents were asked, on a five-point scale ranging from 0 = not at all to 4 = very much, if, for instance, they “needed more information about latest breast cancer news” (Cronbach’s α=.84). Lastly, a social support scale (M=2.93, SD=.86) used six items (Cronbach’s α=.87) on a five-point scale ranging from 0 to 4 to assess how true statements such as “There are people I could count on for emotional support” were (Gustafson et al., 2005). Social support assessed the informational and emotional support of friends, family, co-workers, and others.
Quality of Life
The five-item functional well-being subscale (M=2.35, SD=1.00) of the Functional Assessment of Cancer Therapy-Breast (FACT-B) was used to assess the impact of breast cancer on quality of life (Brady, Cella, Mo et al., 1997). Respondents were asked, on a five-point scale ranging from 0 = not at all to 4 = very much, if, for example, they are “able to work (including working in home)” (Cronbach’s α=.84). A six-item emotional well-being subscale of the FACT-B (M=2.44, SD=1.00) used a five-point scale ranging from 0 to 4 how often participants had felt, for example, “sad”. These items were reversed so that higher score means higher level of emotional well-being (Cronbach’s α=.86). Finally, we used the breast cancer-related concerns subscale of the FACT-B (M=1.49, SD=.72) to assess the degree of concern about potential emotional, physical, and body image consequences of cancer, its treatments and their side effects (Gustafson et al., 2005). Respondents were asked, on a five-point scale ranging from 0 = not at all to 4 = very much, how much they agreed or disagreed with the statements such as “I worry about the effect of stress on my health” (Cronbach’s α=.72).
Participation in health care
A six-item confidence in physician-patient communication scale (M=3.00, SD=.62) developed in our previous research (Shaw, Han, Hawkins, Stewart, McTavish, & Gustafson, 2007) measured women’s comfort and confidence dealing with physicians, other medical personnel, and health-care situations. We asked, on a five-point scale ranging from 0 = disagree very much to 4 = agree very much, whether they agreed or disagreed with statements such as “I am comfortable discussing my treatment choices with my doctor” (Cronbach’s α=.81).
To uncover dynamic relationships between antecedent factors and different engagement types, two analytic procedures were employed. To examine how demographic and disease-related factors are associated with different levels of engagement with the online cancer support group, differences in the demographic and disease-related characteristics between users and non-users, and among posters, lurkers, and non-users were first examined by using chi-square and analysis of variance test. Following this analysis, we examined how psychosocial factors are related with different engagement types. To do so, we employed analysis of covariance to determine if there were differences between users and non-users, and among posters, lurkers, and non-users regarding their baseline psychological needs. For this analysis, we adjusted for statistically significant covariates from the previous analysis. Analyses were followed by multiple comparisons using the Bonferroni method to identify the significant differences between engagement types.
The study sample of 231 women had a mean age of 51 years and more than half of them reported at least some college education. On average, more than two thirds of them were in the relatively early stages (I or II) of cancer. The racial characteristics of the sample were 62.3% Caucasian and 35.9% African American. In addition, about a quarter of them lived alone. Table 1 presents patient characteristics of the study sample by engagement types.
Characteristics of Patients by their Levels of Engagement with an Online Support Group (N = 231)
Of the 231 participants, about 23% (N=54) either did not write or read messages during the four-month study period and thus were classified as non-users. Among the 177 users (posting M=15.1, SD=43.1; reading M=269.6, SD=548.9), 103 women wrote at least two messages (i.e., ‘posters’, posting M=25.4, SD=54.3; reading M=435.2, SD=663.9), while 74 women read messages but never wrote more than one message over the course of the study (i.e., ‘lurkers’, posting M=0.7, SD=0.5; reading M=39.1, SD=134.5).
Factors predicting levels of engagement with a CMSS group
Statistical analyses were conducted to examine whether there were significant differences in patients’ social and psychological characteristics (1) between users (including posters and lurkers) and non-users, and then (2) among posters, lurkers, and non-users. As shown in Table 1, chi-square and analysis of variance (ANOVA) suggested that users were more likely to be Caucasian (χ2=63.3, p<.001) than non-users. When all of the three user types were considered, race clearly played a role in which user type the patients were more likely to be (χ2=74.5, p<.001). After adjusting the alpha level for multiple comparisons, post hoc chi-square analyses revealed that significantly more Caucasian women were posters, followed by lurkers, and then non-users. In contrast, African American women were more likely to be non-users, followed by lurkers, and then posters. Additionally, ANOVA showed that age (F (2,228)=3.78, p<.05) was a significant predictor and post hoc analysis indicated that posters were significantly younger than lurkers. Whether or not patients lived alone (χ2=7.05, p<.05) was another significant predictor, with post hoc chi-square suggesting that posters were more likely to live without friends/family than lurkers. However, we found no difference in the stage of cancer among different user types.
To determine which psychosocial factors predict different engagement types, analysis of covariance (ANCOVA) was employed and all analyses were adjusted for statistically significant covariates from Table 1. After controlling for age, education, race, and living situation, ANCOVA and following post hoc analyses suggested that patients who had a lack of competence in health information (F (1,220)=8.95, p<.01) and confidence in physician-patient communication (F (1,220)=3.90, p<.05) at pretest were more likely to be users than non-users. When all of three user types were considered, analyses revealed that information competence (F (2,219)=4.74, p<.01), social support (F (2,219)=4.74, p<.05), and need for information (F (2,219)=6.52, p<.01) were only significant predictors determining different engagement types. As shown in Table 2, post hoc analysis using the Bonferroni method indicated that non-users and lurkers’ social support level was significantly greater than that of posters, respectively. Similarly, non-users’ competence in health information was greater than that of posters. There was also a significant difference between lurkers and posters in terms of their need for information, suggesting that posters’ need for information was greater than that of lurkers’ at pretest. Overall, these results suggest a trend that those who were in worse conditions regarding their perceived state of affairs were likely to engage more in the discussion group for information and support.
Group Differences on Support, Participation, and Quality of life at Pre-test (N = 231)
This study incorporated the CMIS and the competing models on online engagement into an overarching theoretical framework to examine how cancer patients’ background characteristics, disease-related factors, and psychosocial factors predict different types of engagement with an online cancer support group. Previous studies have found that support groups play a significant role in improving cancer patient’s emotional and physical health by providing diverse informational, instrumental, and emotional support (Dumont & Provost, 1999; Shaw et al., 2006). For those who do not have strong support from their family members/friends, it is comforting and almost therapeutic (Walther, Pingree, Hawkins, & Buller, 2005) to be a part of the online group that consists of individuals who share similar concerns. For those who already have good offline support resources, they can share their physical or psychological concerns with more confidence.
Even with such benefits breast cancer patients can gain from online support groups, our findings suggest that many of them still do not actively participate in sharing their concerns or issues by posting messages, but rather choose to remain as lurkers. Only 44.6% actively posted messages while 32% lurked and the remaining 23.4% did not log in to the system. Some of the possible explanations behind lurking behavior might be that certain members think that posting takes up too much time, have concerns about privacy or safety issues, feel uncomfortable using the user-interface of discussion boards, or still can feel a strong sense of community just from reading others’ postings without writing anything (Nonnecke & Preece, 1999). However, there is little empirical research examining why some breast cancer patients lurk and do not actively engage in online support group activities. Our finding clearly shows that patients have different orientations to and engagements with an online cancer support group and research efforts to examine what factors potentially determine their levels of engagement with the online system are warranted.
Our results suggest that the CMIS is a useful framework for understanding cancer patient’s diverse patterns of engagement with an online support group. Demographic variables had some predictive value in this study. It is worth reiterating that participants were provided free computers, Internet service and individualized computer training. By removing the barrier of access to technology, we posit that demographic characteristics might reflect differences in experience, preferences, and comfort with a mouse-driven medium and on-screen text. Thus, the fact that posters were younger than lurkers suggests that older women may have been less comfortable in typing and sharing their personal experiences with anonymous others beyond their family boundaries (Squires et al., 2005). Posters were also more likely to live alone than lurkers, signifying that those who live alone might have greater motivations to express their problems online as an alternative way of receiving feedback and support from their offline peers (McKenna & Bargh, 1998). Equally interesting is the finding that the majority of African Americans were non-users whereas the majority of Caucasian women participated in the online group and posted messages for others to read. This is in line with the past findings that African American women may have been reluctant to share their cancer experiences in a predominantly white and anonymous discussion group (Freimuth, 1993; Shaw et al., 2006).
In addition to the CMIS, this study relied on two competing perspectives on online engagement – the social compensation model and the social enhancement model – as complementary frameworks that provide more insights into how cancer patient’s social and psychological resources can affect their engagement types in the support group. Of the two models, the social compensation model (McKenna & Bargh, 1998) gained greater support by the data. Specifically, those who did not use the online support system at all and those who were only lurking had had more offline social support from their close friends or family than those who were actively posting messages. The application of the social compensation model is not limited only to social support. Those who were highly competent in their ability to deal with information about breast cancer did not participate in online social support discussions as much as those who lacked in their competence. Also, posters had higher levels of need for information than lurkers. Taken together, these results suggest that these “deficits” in psychosocial resources may not be barriers to participation in an online support group, but rather motivators to use more demanding and engaging communication tool. This is particularly noteworthy because participation in an online support group requires substantial thoughts and input, often over time, in order to receive/provide needed support and feedback from/to other group members.
Notably, the findings of this study have implications for research on computer-mediated communication. One interesting aspect of lurkers worth further investigation is whether they have a strong group identity and attachment to online support groups although they do not actively post. According to the social identity model of deindividuation effects (Lea & Spears, 1992), deindividuated members of online groups are expected to not only identify with other members, but also show their attachment to the group by explicitly agreeing with other members or conforming to group norms. If lurkers identify strongly with other breast cancer patients, but do not engage in posting activities, can we say that they are contributing to the group’s cohesion? In this sense, the existence of lurkers in online communities can be an interesting new domain for testing boundary conditions of the model.
This study has several limitations and suggestions for future research. Given the somewhat dated nature of the data presented here, it seems to be necessary to replicate our findings with a more recent collection. The CMSS group examined here was text-based, asynchronous bulletin boards, but given the rapid advances in technology, it is likely that CMSS groups accommodating photo sharing, real-time chat, audio, and video are not far off. Then it is suggested that future research should examine preference of and familiarity with advanced technology as important factors predicting different engagement types. Notably, while our study attends to antecedent factors that might explain different engagement types with the CMSS group, it is quite possible that simply reading others’ messages while not actively contributing to the group could have benefits for lurkers in terms of understanding their illness and situation. Thus, future study should extend our inquiry and examine the effects of engagement types on various outcomes.
The findings of this study provide several important practical implications for health informatics. First, we found that there was a significant gap in usage of online support systems between different race and age groups. Although various factors may attribute to these differences, one reason may be the perceived lack of commonality between cancer patients (Andrews, Preece, & Turoff, 2002). Especially for racial minority group members, interacting with those belonging to a majority group can be a barrier that can keep them from greater participation. One way to solve this issue may be to create subgroups in terms of race and age, so that people would be more comfortable in sharing their feelings and experiences (Pettigrew & Tropp, 2006). Another way is to increase understanding and familiarity among members by encouraging them to create online profiles containing their information and interests (Andrews et al., 2002) but also holding offline meetings with relevant experts and organizations to increase trust and intergroup interaction (Pettigrew & Tropp, 2006). These efforts would help reduce barriers among participants and increase active participation.
Second, we found greater lack of participation among patients with more resources and support in their daily life. This is an important matter since they could potentially contribute more with the knowledge and experience they gain from their strong offline support systems. One reason for their lack of participation may be that they find online participation takes time away from their time with doctors or caregivers (Helgeson et al., 2000). Then it is suggested that future online support groups provide means of communication that allows caregivers, doctors, and family members to participate together with the patient. This could decrease potential conflict between offline and online support systems and create a synergy effect between the two. Finally, given that the patients with the greatest deficits in their resources and psychosocial competence were likely to be more active in online support groups, screening for and giving access to patients who are more socially isolated and lacking in offline resources could result in meaningful outcomes.
In closing, the current study contributes to our understanding of why breast cancer patients do or do not actively participate in online support groups. There are some studies that compare online support group participants and non-participants (e.g., Hoybye, Dalton, Christensen, Ross, Kuhn, & Johansen, 2010). To our knowledge, however, this is the first research to conceive both non-users and lurkers as another form of engagement and examine different factors in their relationships, resulting in deeper knowledge about cancer patient’s preferences with a coping resource. To accomplish our goal, this study merged survey data collected from an eHealth intervention with action log data on whether and how participants used the discussion group. From a methodological standpoint, our approach offers an avenue to explore the nature of the exchanges occurring within the CMSS group and their antecedents previously inaccessible for testing due to the limits of extant research methodologies.
The Digital Divide Pilot Project study was funded by grants from the National Cancer Institute and the John and Mary Markle Foundation (RFP No. NO2-CO-01040-75). The authors would like to thank Haile Berhe, Helene McDowell, and Gina Landucci for their central role in conducting the operational aspects of this study. We would also like to thank the women who agreed to participate in our study.
Appendix: Question Wording
Confidence in physician-patient communication, a 6-item scale. All items were scored on a 5-point scale ranging from 0= disagree very much to 4= agree very much.
I am comfortable discussing my treatment choices with my doctor
I am able to be assertive with my doctor
I feel comfortable in asking the physician or nurse a lot of questions
I understood what doctor told me
I have confidence in my doctors
I know what questions to ask my doctor.
Health information competence, a 5-item scale. All items were scored on a 5-point scale ranging from 0 = never to 4 = always.
I know exactly what it is that I want to learn about my health care
I can figure out how and where to get the information I need
Health information is more difficult for me to obtain than other types of information (reverse coded)
I am satisfied with the way I currently learn about health issues
I feel that I am in control over how and what I learn about my health.
Social support, a 6-item scale. All items were scored on a 5-point scale ranging from 0= not at all to 4= very much.
There are people they could count on for emotional support
There are people who will help them understand things they are finding out about their illness
There are people they could rely on when they need help doing something
There are people who can help them find out the answers to their questions
There are people who will fill in for them if they are unable to do something
I am pretty much all alone (reversed).
Emotional well-being, a 6-item scale. All items were scored on a 5-point scale ranging from 0= not at all to 4= very much.
I feel sad (reversed)
I feel nervous (reversed)
I am worried about dying (reversed)
I am worried that my illness will get worse (reversed)
I feel like my life is a failure (reversed)
I feel like everything is an effort (reversed).
Functional well-being, a 5-item scale. All items were scored on a 5-point scale ranging from 0= not at all to 4= very much.
I am able to work (including working in home).
My work (including work in home) is fulfilling.
I am able to enjoy life “in the moment”.
I am sleeping well.
I am enjoying the things I usually do to relax.
Breast cancer-related concerns, a 10-item scale. All items were scored on a 5-point scale ranging from 0= not at all to 4= very much.
I was self conscious about the way I dress.
I was bothered by swollen or tender arms.
I worried about the risk of cancer in other family members.
I worry about the effect of stress on my health.
I was short of breath.
My change in weight bothered me.
I feel sexually attractive.
My hair loss bothered me.
My skin bothered me as a result of radiation.
I am fatigued.
Need for information, a 5-item scale. All items were scored on a 5-point scale ranging from 0= disagree very much to 4= agree very much.
I needed more information about breast cancer from the point of view of women who have had breast cancer.
I needed more understandable information about breast cancer.
I needed more information about the latest breast cancer news.
I needed more contact with people who understood what I was going through.
I needed help making decisions.
Jeong Yeob Han, Department of Telecommunications, Henry W. Grady College of Journalism and Mass Communication & Center for Health and Risk Communication, The University of Georgia, Athens, GA 30602-3018, Office: (706) 542-5019.
Jung-Hyun Kim, School of Communication Studies Kent State University.
Hye Jin Yoon, Temerlin Advertising Institute, Southern Methodist University.
Minsun Shim, Department of Speech Communication, University of Georgia.
Fiona M. McTavish, Center of Excellence in Cancer Communication Research, University of Wisconsin-Madison.
David H. Gustafson, Center of Excellence in Cancer Communication Research, University of Wisconsin-Madison.
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