Academic journal article Journal of Broadcasting & Electronic Media

Unraveling Uses and Effects of an Interactive Health Communication System

Academic journal article Journal of Broadcasting & Electronic Media

Unraveling Uses and Effects of an Interactive Health Communication System

Article excerpt

The use of the Internet for health education has reached what many might consider a critical mass. According to the National Cancer Institute's Health Information National Trends Survey (Nelson et al., 2004), among women who have had breast cancer, the Internet is second only to their healthcare providers as a first choice for where they would go to obtain cancer information. As an increasing number of breast cancer patients turn to the Internet for health education and support, concern over its effect on their health behavior and quality of life has grown. Encouragingly, there is a growing body of evidence indicating that Interactive Health Communication Systems (IHCSs)--including the Comprehensive Health Enhancement Support System (CHESS)--which is the focus of this study, contribute to significant improvements in quality of life, participation in healthcare decisions, and effective use of healthcare services for those facing life-threatening illness or chronic disease (Gustafson et al., 2001, 2002, 2005; Hawkins et al., 1997). For example, in one intervention study, Gustafson et al. (2001) compared CHESS group to a control group and found that women in the CHESS group had significant benefits, including competence in dealing with health information, comfort in participating in their health care, and greater confidence in their doctor. Furthermore, a more recent study by Gustafson et al. (2005) focused exclusively on low-income breast cancer patients. When women from this study were compared to a low-income control group from another study, the CHESS group also expressed significant improvements in social support, reduction in negative emotions, participation in health care, and competence in dealing with health information.

However, effects of CHESS or any other IHCS are generally demonstrated through experimental designs in which a whole group given access to such a system is contrasted with a control group with or without access to traditional modes of information such as audiotapes, videos, or books (i.e., an "intention-to-treat" approach that treats all members of an experimental group as equally exposed to that intervention regardless of whether they actually used it or not). Although such designs do test efficacy, they typically do little to explain how the effects occur. That different designs or additional analyses are necessary to probe processes and provide explanations is commonly understood throughout research on interventions, but several particularly important issues with IHCSs, all centering around "use," deserve special attention. Clearly, a first concern with an intent-to-treat approach is that only some patients employ a system at all, and presumably only those who do so could be affected. But even within those who do access an IHCS, defining what constitutes "use" and especially what aspects of use are efficacious are much more subtle problems.

One common approach, borrowed from mass communication, tests for a simple monotonic relationship between amount of use of a system and likely effects (Pingree et al., 1996; Shaw et al., 2007). An implicit assumption of such an approach may be that more use will produce better health outcomes because it represents exposure to more IHCS content. Such an approach has long been recognized as problematic for many, though not all, effects of mass communication (Hawkins & Pingree, 1981; Salomon & Cohen, 1978; but note Gerbner, Gross, Morgan, Signorielli, & Shanahan, 2002). As with traditional mass media, one key reason this overall monotonic approach has not worked well to explain effects of IHCS is because such systems typically contain a variety of content, some of which may be more beneficial than others, and thus an overall amount of use has little practical meaning (Chory-Assad & Tamborini, 2003; Johnson, Braima, & Sothirajah, 2000).

For example, a qualitative study of HIV/AIDS patients' CHESS use (Smaglik et al., 1998) noted that many users who spent the most time with the system actually benefited very little or not at all, because their use was exclusively concentrated in the bulletin-board Discussion Group feature. …

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