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Face-to-face health support groups have a long established pedigree, dating back to the 1920s and the inception of Alcoholics Anonymous. Since then, support groups have been started for a huge range off illnesses, from the trivial to the chronic, for both sufferers and supporters. However, face-to-face support groups rely on a number of somewhat limiting factors for their continued success, e.g. a dedicated and committed leader, a regular meeting place and time, a minimum number of “core” members attending most meetings etc. These limitations often lead to support groups being short-lived, even in large population areas, and may discourage the formation of support groups entirely.

On-line (virtual) support groups solve several of these problems. In particular the issue of everyone having to be in one place at one time is solved, and support groups can now be geographically dispersed. However, members can no longer “see” who they are communicating with, and serious cross-cultural problems can occur, for example the giving of inappropriate spiritual support from a Christian to a Moslem. It is much easier to sense the potential for cultural differences when the people concerned are physically co-located.

The issue of user mood is also critical. Mood can be sensed relatively easily, through non-verbal communication expressions, when the people concerned are in the same room (e.g. depression, agitation etc), but is almost impossible to sense mood online, except by the somewhat arbitrary use of, for instance, “smilies” or “emoticons”. Thus it would be inappropriate to have a CHI using personalized pop-up advertisements if a user suffered from paranoia or bright flashing graphics if someone were chronically depressed.

All users expect largely the same outcomes from a support group. At the core of this is “static” information such as the common drugs used for treatment and their side effects, the location (and quality) of local hospitals and clinics, etc. Similarly most members would be looking to discover the personal experiences of other sufferers and/or supporters, and to share their own. Members may want to communicate openly in the group, or one-on-one with other specific members as the mood and circumstances take them.

The challenge, then, is to design a CHI that can be tailored for the individual members’ cultural needs and that will be mood-neutral (or ideally mood sensitive), and yet will interface to the common “back-end” system associated  social networking such as blogs, wikis, chat rooms and discussion forums. This paper explores these multi-cultural dimensions in detail, and proposes a “universal metaphor” to address them.