  Following Facebook's introduction of the "Like" in 2009, CaringBridge (a
nonprofit health journaling platform) implemented a "Heart" symbol as a
single-click reaction affordance in 2012. In 2016, Facebook expanded its Like
into a set of emotion-based reactions. In 2021, CaringBridge likewise added
three new reactions: "Prayer", "Happy", and "Sad." Through user surveys
($N=808$) and interviews ($N=13$), we evaluated this product launch. Unlike
Likes on mainstream social media, CaringBridge's single-click Heart was
consistently interpreted as a simple, meaningful expression of acknowledgement
and support. Although most users accepted the new reactions, the product launch
transformed user perceptions of the feature and ignited major disagreement
regarding the meanings and functions of reactions in the high stakes context of
health crises. Some users found the new reactions to be useful, convenient, and
reducing of caregiver burden; others felt they cause emotional harms by
stripping communication of meaningful expression and authentic care. Overall,
these results surface tensions for small social media platforms that need to
survive amidst giants, as well as highlighting crucial trade-offs between the
cognitive effort, meaningfulness, and efficiency of different forms of
Computer-Mediated Communication (CMC). Our work provides three contributions to
support researchers and designers in navigating these tensions: (1) empirical
knowledge of how users perceived the reactions launch on CaringBridge; (2)
design implications for improving health-focused CMC; and (3) concrete
questions to guide future research into reactions and health-focused CMC.
