The Dual-Edged Sword of Positivity: Disentangling the Effects of Online Positive Outcome Expectancy on Tuberculosis Medication Adherence

Medication nonadherence remains the primary cause of treatment failure for tuberculosis (TB). While content triggering online positive outcome expectancy (OPOE)— perceived recovery expectations from online narratives—is prevalent, its impact on adherence remains theoretically ambiguous. Drawing on social comparison theory, this study plans to disentangle how OPOE influences TB medication adherence by framing health information exposure as a comparative process. We theorize that TB’s clinical ambiguity drives patients to use online success stories as diagnostic anchors, triggering parallel mechanisms of upward identification and upward contrast. Furthermore, we plan to examine TB-related stigma as a critical dual-stage moderator acting as a cognitive filter and behavioral gate. We plan to test this model via a survey of TB patients. The expected findings will contribute to IS research by demonstrating how OPOE interacts with stigma to shape adherence, offering guidance for digital platforms to calibrate positive narratives for vulnerable populations.