Wired for Health and Well-Being: The Emergence of Interactive Health Communication
Suggested Citation: Science Panel on Interactive Communication and Health. Wired for Health and Well-Being: the Emergence of Interactive Health Communication. Washington, DC: US Department of Health and Human Services, US Government Printing Office, April 1999.
The rapid proliferation of information and communication technologies that have emerged during the last several years has both hopeful and alarming implications for the future. These technologies have already produced profound changes in the US economy and continue to exert increasing influence on many aspects of daily life, including personal health decisions and behaviors, health care delivery and financing, and public health systems.
Evidence of this phenomenon is the growth of interactive health communication (IHC): the interaction of an individualconsumer, patient, caregiver, or professionalwith or through an electronic device or communication technology to access or transmit health information, or to receive or provide guidance and support on a health-related issue. IHC applications include health information and support Web sites and other technology-mediated applications that relay information, enable informed decisionmaking, promote healthy behaviors, promote information exchange and support, promote self-care, or manage demand for health services.
The rapid evolution of IHC raises many questions about its impact on public health and health care and our ability to evaluate it. To help clarify these issues, the Office of Disease Prevention and Health Promotion of the US Department of Health and Human Services convened the Science Panel on Interactive Communication and Health (the Panel), a 14-member, non-Federal panel of experts in many aspects of health and technology. This report summarizes the potential risks and benefits of IHC, the underlying science or evidence base for IHC, mechanisms for improving IHC quality and effectiveness, appropriate roles and responsibilities for IHC stakeholders, and relevant major policy and research issues. The report also presents the Panels consensus recommendations about national initiatives that are needed to achieve a preferred future for IHC.
IHC applications have great potential to improve health and well-being. Compared to more traditional media, interactive media may have several advantages for health communication efforts. These include: improved access to individualized health information; broader choices for users; potential improved anonymity of users; greater access to health information and support on demand; greater ability to promote interaction and social support among users, and between consumers and health professionals; and enhanced ability to provide widespread dissemination and immediate updating of content or functions.
IHC applications also may cause harm. A growing variety of entities and individualsmany of whom lack adequate expertise and training in the health and communication sciencesare developing, sponsoring, and disseminating IHC applications. The proliferation of applications available to the general public, who may not have the skills or background to evaluate the quality or relevance of applications, raises concerns about their potential to cause harm, their impact on health care quality and cost, the clinician-patient relationship, and the organization of medical systems. Without appropriate attention to these and other issues, IHC applications may result in inappropriate treatment, delays in care, damage to patient-provider relationships, violations of privacy and confidentiality, wasted resources, delayed innovation, unintended errors, and an increased technology and health gap.
To date, few IHC applications have been adequately evaluated for quality or effectiveness. Some health communication interventions have been shown to be efficacious, but research on the effectiveness of computer-based approaches is limited. Potential benefits of evaluation include improved quality, utility, and effectiveness of applications; reduction of likelihood of harm; better use of resources for effective applications; greater participation of stakeholders in the application development and implementation; and improved decisions about use of applications. The Panel has developed an "evaluation reporting template" and a "disclosure statement" to promote evaluation and assist developers in disclosing essential information about their applications to potential purchasers and users.
The Panel has identified several stakeholder groups that need to participate in IHC application development, evaluation, and quality assurance activities if meaningful evolution and quality improvement of IHC is to occur. These include consumers (e.g., patients, families, and caregivers), application developers, purchasers, health professionals, and policymakers, all of whom have related roles and responsibilities. Understanding the concerns, motivations, and perspectives of each stakeholder may be valuable in establishing collaborative efforts and in arriving at a consensus on appropriate directions and policy for IHC.
Currently, most health information policy discussions at the national level are centered largely around issues related to health care, provider-focused systems rather than consumer-focused applications. Major policy issues that are relevant to the development, implementation, and evaluation of IHC applications include standards, privacy and confidentiality, oversight and regulation, liability, accreditation and certification, public investment in development and research, payment and reimbursement, integration of IHC with health care and public health, and access to IHC.
The Panel developed the following vision for IHC:
The Panel proposes four overarching strategies to achieve this vision: 1) strengthen evaluation and quality of IHC, 2) improve basic knowledge and understanding of IHC, 3) enhance capacity of stakeholders to develop and use IHC, and 4) improve access to IHC for all populations. The Panel considers widespread evaluation of applications and dissemination of evaluation results to be the primary mechanisms to improve quality of IHC and to ensure positive outcomes. Because of the newness of the field, scientific knowledge about many aspects of IHC is very limited. Greater knowledge is needed to improve the effectiveness of IHC, inform application design and implementation, and, ultimately, further appropriate public policy. The Panel also identified major gaps in resources available to application developers and shortcomings in the skills of users. These deficiencies will need to be addressed to ensure the continued development of innovative applications and the ability of intended users to take full advantage of IHC. Finally, enhancing access to IHC for all populations is essential because, without equitable access, evaluation efforts will be incomplete and the potential for IHC to provide benefits to entire communities is not likely to be realized. Specific recommendations under each major strategy follow.
Strategy 1. Strengthen Evaluation and Quality of IHC
Strategy 2. Improve Basic Knowledge and Understanding of IHC
Strategy 3. Enhance Capacity of Stakeholders to Develop and Use IHC
Strategy 4. Improve Access to IHC for All Populations
There is little doubt that IHC applications will continue to grow in utility and popularity and consumers will increasingly turn to them for health information, communication, support, and health-related transactions. IHC has the potential to dramatically improve the ways in which people prevent disease, maintain their health, and recover from illness. However, for IHC to play a pivotal and positive role in creating a healthier society, a broad range of stakeholders must participate in application development and evaluation. An evidence-based approach to the development and diffusion of IHC applications is central to the process of ensuring that such applications are of high quality, effective, and accessible to all.
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Comments: SciPICH@nhic.org Updated: 05/01/08