The functions of modern mass media to give information, to provide orientation, and to promote health-related behaviors are widely recognized within the field of health communication. The media of television, radio, newspapers, and magazines influence intentionally or unintentionally, and mass media health campaigns are used purposively and effectively to change health practices. Nevertheless, the existing empirical research evidence is mixed. Content analyses (Will et al. 2005) and cultivation effects research (Brown & Walsh-Childers 2002), e.g., on media images of thinness and eating disorders, seem to prove many dysfunctional health effects, especially by television. Even though there is some controversy on the effects of mass media in health promotion, there is a large body of work that documents the effectiveness of mass media public health campaigns. So the Internet as a new platform gave rise to many new hopes, especially because of its unique features like convergence, interactivity, information capacity, and global reach.
Unique Features Of The Internet
The Internet allows interactive communications, giving and receiving information and advice between users and/or providers of health information. The persuasive potential of the Internet is especially enhanced because interactivity allows targeting of health messages to the special problems and needs of the individual user.
The Internet has the potential to give immediate feedback to its users similar to interpersonal communication. This feature can be used to target the information given according to the user’s needs, to foster motivation, and to strengthen the persuasive impact of health messages.
The Internet requires the potential user to actively search for information in contrast to traditional mass media, which are directed more toward passive audiences. On one hand, this is an advantage as users “tune in” to health messages based on their motivation and involvement. On the other hand, it may limit its reach as usually the more educated and more active people access the Internet.
Internet-based health services have the capacity to economically reach large and geographically diffuse audiences. Furthermore, the Internet can be used anywhere (at home, in schools, clinics, or community centers) and at any time during day or night (unlimited reach and flexibility).
In contrast to traditional mass media, the quantitative capacity of the Internet as well as the depth and specialization of the health information provided by the Internet is almost unlimited (information abundance).
Besides these opportunities and strengths, there are risks and threats as well. One problem is the reliability and trustworthiness of the health messages offered on the Internet because information providers or sources behind the information are not clear. As a consequence, it is not easy for users to estimate the credibility of the source. So there is an ongoing discussion on how to assess the quality of health information on the world wide web and how to improve it, e.g., by so-called “quality labels” (Eysenbach et al. 2002; Trepte et al. 2005). Then, there are ethical problems such as protective privacy of medical records and conditions.
Health Providers And Applications Of The Internet
There is an enormous and ever growing number of public and private providers of health information on the Internet at local, state, and international level, and the range of information provided by them includes news (e.g., disease outbreaks), statistics, advice and health tips on lifestyles, health promotion, and disease prevention. Besides, there are even more providers in the private area, such as insurance companies, health advisory services, and pharmaceutical firms. And last but not least, a large number of discussion groups and forums exist where many different health-related topics are discussed, and health information and personal health experiences are exchanged. The use of the Internet supports traditional health services and applications, but new services have also been created in recent years in the areas of e-content (e.g., health information and orientation, medical databases), e-commerce (e.g., online pharmaceutical providers, etc.), e-connectivity (intranets of hospitals), e-computer applications, and e-care (e.g., telehealth monitoring, teleisurgery).
As a result, health-related web pages and Internet addresses can no longer be overviewed and summarized. Nevertheless, the existing health-related content on the Internet can be broadly differentiated into three general types:
1 Health content: the Internet user can search and download health-related information that can be accessed easily in so-called general health portals in a unidirectional way and without the possibility of communicating with other Internet users.
2 Health communities: there is the opportunity of horizontal and two-way communication with feedback possibilities in countless general or specialized health-related news and support groups, such as chatrooms or community health information networks.
3 Health provision: direct contact between patients as clients and various providers of health services via the Internet, such as health consultants, physicians, pharmaceutical firms, insurance companies, etc., as a form of e-commerce. Here, cost, quality of care management, privacy, confidentiality, and security are important quality criteria.
Usage And Effects Of The Internet
It is difficult to estimate the number of users of the Internet but surveys conducted in the US estimate that between 50 percent and 70 percent of online users have sought health information on the Internet. The figures for Europe are significantly lower (Härtel 2003). For example, according to the 2004 Univox survey in Switzerland, although 70 percent had access to the Internet, only 23 percent of online users looked for health information, and 14 percent looked for information on a specific health problem. Then there are socioeconomic differences concerning the education and income of users; there is evidence that health is one of the few topics of Internet use where women outnumber men. On the other hand, there seem to exist significant knowledge gaps.
Even though it is widely acknowledged that the Internet is used to gather health information, its effectiveness in health communication requires more empirical work. Theoretically, given its hybrid nature of combining mass and interpersonal communication features, the Internet should be a powerful medium for health communication (Cassell et al. 1998). But this sender-oriented perspective has to be complemented by a view from the user as well. And here there are various challenges and risks, such as unequal access to the Internet – the digital divide – and the skills to use it. Although most of the users of health information on the Internet so far seem to be satisfied with the health content they are looking for, and rate the searched information as helpful, giving new insights, and even believe it (Houston & Allison 2002), there is only very limited evidence so far concerning the far-reaching consequences of the Internet as a new information source and service provider in the field of health communication.
- Brown, J., & Walsh-Childers, K. (2002). Effects of media on personal and public health. In J. Bryant & D. Zillmann (eds.), Perspectives on media effects. Hillsdale, NJ: Lawrence Erlbaum, pp. 453 – 488.
- Bryant, J., & Zillmann, D. (eds.). Perspectives on media effects. Hillsdale, NJ: Lawrence Erlbaum. Härtel, J. (2003). Nutzung und Nutzer von Gesundheitsinformationen im Internet [Use and users of health information on the Internet], keynote 1, Afgis Congress, June 23.
- Cassell, M. M., Jackson, C., & Cheuvront, B. (1998). Health communication on the Internet: An effective channel for health behavior change? Journal of Health Communication, 3(1), 71–79.
- Eysenbach, G., Powell, J., Kuss, O., & Sa, E.-R. (2002). Empirical studies assessing the quality of health information for consumers on the world wide web: A systematic review. Journal of the American Medical Association, 287(20), 2691–2700.
- Fox, S., & Rainie, L. (2000). The online health care revolution: How the web helps Americans take better care of themselves. At www.pewinternet.org/PPF/r/26/report_display.asp, accessed September 13, 2007.
- Hautzinger, N. (2004). Gesundheitskommunikation in der Informationsgesellschaft [Health communication in the information society]. In H. Bonfadelli, M. Leonarz, & W. A. Meier (eds.), Informationsgesellschaft Schweiz: Medien, Organisationen und Öffentlichkeit im Wandel. Zurich: Seismo, pp. 145 –158.
- Houston, T. K., & Allison, J. J. (2002). Users of Internet health information: Differences by health status. Journal of Medical Internet Research, 4(2). At www.jmir.org/2002/2/e7, accessed September 13, 2007.
- Kim, P., Eng, T. R., Deering, M. J., & Maxfield, A. (1999). Published criteria for evaluating health related web sites: Review. British Medical Journal, 318, 647– 649.
- Rice, R. E. (ed.) (2001). The Internet and health communication: Experiences and expectations. Thousand Oaks, CA: Sage.
- Trepte, S., Baumann, E., Hautzinger, N., & Siegert, G. (2005). Qualität gesundheitsbezogener Online-Angebote aus Sicht von Usern und Experten [Quality of health related online content in the view of users and experts]. Medien und Kommunikationswissenschaft, 53(4), 486 –506.
- Will, K. E., Porter, B. E., Geller, E. S., & DePasquale, J. P. (2005). Is television a health and safety hazard? A cross-sectional analysis of at-risk behavior on primetime television. Journal of Applied Social Psychology, 35(1), 198 –222.