The Advent of E-health: How Interactive Media Are Transforming Health Communication

The following article was a very interesting one. At first I was hoping to see a study, which would relate to events happening in Estonia right now, as e-Health system activation deadlines are become surpassed every day now, thus doubling the pressure to activate web-based health-care systems.

It is important to state, that in this study (and appears, that even wider in the western world) e-Health as a concept means web-based health-aware websites mainly. In Estonia, we think of E-health as digital prescriptions, online registration for the GP etc - all in all, I would think that the concept of E-health is more innovative in Estonia than eg in this research.

But contrary, the article focused on a even more interesting study - how would and will interactive media affect people's health-related actions and what is the success rate over the traditional media. As expected, interactivity and personification of the message is more successful in instituting a healthy behavior from the person and I believe, that this is not the only field, where interactivity in a medium would benefit good intentions towards mankind.

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According to the authors of the study, half of industrialized countries population suffers from diseases because of actions they take upon themselves. New media and it´s communication channels have proven to be successful in acknowledgements of health risks and reducing these kinds of self-destructive actions by different studies.

The need to take action against this kind of behavior lies on the The World Health Organization stated fact, that 10 behavioral factors (damage that we choose upon us) make 50% of causes for diseases. WHO reports and the national health frameworks propose that health communication should be the primary strategy to influence people’s behavior.

Past research done it that field provides a large body of evidence that new communication technologies and an enhanced understanding of the communication needs of targeted audiences can significantly alter health behaviors associated with for example cancer risk reduction.

"It is our view that traditional health communication is frequently insufficient to engage people to change behavior within the complex contexts of their lives. “E-health communication,” health promotion efforts that are mediated by computers and other digital technologies may have great potential to promote desired behavior changes through unique features such as mass customization, interactivity, and convenience."

In the research, it was stated that both theory and empirical studies highlight the need to customize communication so that it more closely fits people’s personal characteristics and social settings. "Currently, much communication is delivered to the general public with “one size fits all” messages.," the researchers stated. Rice (2001) asserts that interactivity may be the attribute of communication with the greatest implication for health promotion, because it provides the user with control and a way to participate. This idea is supported by recent research that identifies “self-efficacy” and “perceptions of control” to be the most powerful mediators of behavioral change (Bull, Holt, Kreuter, Clark, & Scharff, 2001).

The e-health revolution has produced an ever-increasing number of new communication channels and strategies, such as: health information on the Internet, computer assisted learning, Internet radio and television, interactive voice recognition, online support groups, online collaborative communities, information tailored by computer technologies, computer-controlled in-home telephone counseling, CD-Rom's and DVD-Rom's, bio-metric assessment and transmission, and patient-provider e-mail contact.

All of these have become to life based on the statement, that interactivity and participation are hypothesized to increase self-efficacy and sense of control, the strongest known mediators of behavioral change.

"One outcome (of using new media) is that mass and interpersonal features can
now be combined – as a “hybrid medium” – in communication initiatives. For example, a health care organization can send highly personalized information to patients en masse. Likewise, patients can query their health providers at their convenience and in their own words. People with rare diseases can create online communities and even set up collaborative research programs. People can be developers as well as receivers of information. The Internet is the first “many to many” medium in history."

One of the examples the researchers used for descriptive purposes, was CHESS (web-based interactive health system in US) and it's user-base satisfaction level among users. Women subjects reported high usage of CHESS and that it improved their feelings of empowerment and motivation and reduced negative emotions such as fear, stress and anger. The CHESS group showed reduced health care visits and hospitalizations as compared with the control group outcomes.

It was also stated by the researchers, that (at least in US) health awareness is the main factor, which thrives people to use Internet. "Health information is a priority for Internet users. In the US in February 2003, 78% of 109 million online users (52% of all US adults) searched for health information online. (Harris Interactive, 2003). Users primarily searched for information about immediate health problems (91%); only 13% looked for ways to prevent health problems."

Even if nations understand the value of extensive, interactive health media, the applications still need to be developed. However, according to Eng (2001), there are few sustainable e-health revenue models outside of those for clinical care. Fisher (1995) concludes that because “free market forces” are not sufficient to develop e-health applications in the near term, government support is essential to promote highly effective communication.

In conclusion it was stated that E-health communication, mediated by computers and other digital technologies, has the potential to extend and amplify the impact of traditional health promotion media by "linking, personalizing, and expanding the coverage of health promotion messages".


Link to text:
http://classweb.gmu.edu/gkreps/820/026.pdf

Who Pays for Content? Funding in Interactive Media

Thoughts:

The main reason for choosing this article was the interest to find out what an interactive media is and how it’s funding effects its content now and in the future.

The discussion of interactive media’s expenditures and incomes is more and more growing in Estonia where the internet user base has grown rapidly and more is consuming though internet (especially media – postimees.ee etc).

You get what you pay for. So according to the owners of for example newspapers people nowadays will soon not get anything relevant because they don’t pay for nothing. This is somewhat true.

But as stated by the research, non-profit (volunteer) based websites can and will exist. The reasons behind that for me are in the case of Estonia following – there is no point of paying for interactive media, because even the traditional media lacks quality. Also for the younger generation (majority of the consumers of interactive media) there are always free alternatives.

I would never ever pay a dime for a news site, because there is practically no difference linguistically what I am reading. Therefore I can consume free alternatives from the rest of the world (BBC, non-profit projects etc). Then it leaves the location factor. I think – at the moment at least – that the quantity of information I receive about Tallinn or Estonia today greatly exceeds reasonable amounts. That is because I am a victim of information-overdose, and that is mainly because of the so many free content providers that operate in .ee environment. In that kind of condition the question „Am I willing to pay for information“ is absurd. If anything, I’m willing to pay for some close-downs of certain content providers.

So in the end I think content (interactive media) will remain free where needed. The technical necessities to do that will only decrease (the fee for a server space has greatly declined in Estonia e.g. for as the technical spefications have improved). What about the quality of content? Now there’s the weak spot.


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The authors of the research clarified, that there are 4 types of interactive websites - Sales and Promotion, Sponsored Content, Public Information and Sponsored Content offering sites. Researchers feared that the latter 2 may die out because of the high maintenance costs. That itself comes from the situation, where consumers won't pay for content, if there are free alternatives available.

The aim of the research was to create a model of funding for a specific website, taking to account 3 categories: the site’s "interactivity, ideologies related to intellectual property, and audience size".

Authors referenced to a ongoing fight about copyright in web-based environments as a faceoff between the belief of "information wants to be free." vs. "information wants to be worth something."

The more common idea of "the primary business of content creators is not the creation of content but the creation of audiences" (seen in USA, where television creates ultra-entertaining but content-lacking (or quality lacking) broadcasts would be the main thrive for web-based sites as well. But the results of that kind of thinking would be “a system where content has little or no meaning except as a tool for attracting an audience which can be bought by advertisers".

The authors proposed three hypothesizes of which the first one took account the sites interactivity - sites are more interactive, when its user base is volunteer, non-profit or governmental. Also it was stated that sites value copyright beliefs more, when they receive funding from firms, government or they simply have mixed-funding. And finally – sites, that receive funding from advertising or government, will have larger audiences.

When measuring websites interactivity, the researchers used content-analysis. Autohers defined interactivity, using Heeter's definition: "She identifies six characteristics of interactivity: complexity of choice available, effort users must exert, responsiveness to the user, monitoring information use, ease of adding information, and facilitation of interpersonal communication". The justification for using Heeter’s definition was, that the “definition is one of the few analyses of interactivity that offers specific, measurable dimensions".

Specifically when grading sites interactivity, the things followed were: number of links on the first page, the presence of a search engine. Also there was a view on the tools what the website offered to its users: menu bar on the first page for example. NB! "While navigational tools might make the novice user more comfortable in using the site, they actually reduce the number of choices the user makes.” Thus it was believed that a elaborate navigational system would decline the sites interactivity.

Also there was a notion on the field that does the website have bulletin-boards or forums (which enable the user to quickly have interpersonal communication) which would increase the sites interactivity.

Conclusively researchers stated that despite the current situation (funding of non-profit websites, i.e. volunteer) being good, "for the future, public intervention may be needed to insure that costs of creating content remain low enough that multiple voices can be heard in arenas such as Community Content".

One of the interesting guides publicized in the article were the implications for communication educators, differenced for the 4 models: “Students need to have a broad range of skills if they plan to create computer-mediated communication content. Those creating Sponsored Content sites will need many of the same skills employed by traditional journalists. Those creating Sales and Promotions content will need the skills of advertising and public relations practitioners as well as selling skills. Those creating Public Information will need to learn to create databases and information environments. Those creating Community Content will need to blend interpersonal and mass communication skills.” It was also stated, that anybody, who wants to create content for the site types under research, the understanding of the interactive nature of the medium - regardless of how much interactivity is included in the site, is necessary.


The model created as a result of the research

Sales and Promotions Funding: Cost of doing business primarily of for-profit companies. Purpose: Direct sales and/or promotion of organization's products/services. Communication: One-to-one from sender to receiver.	Public Information Funding: Cost of doing business primarily of government and education organizations. Purpose: Provide detailed, complex information in a searchable format. Communication: One-to-one from receiver to sender.
Sponsored Content Funding: Advertising and/or sponsorship fees support creation of content. Purpose: Provide information and/or entertainment that attracts targeted and/or mass audiences. Communication: One-to-many from sender to receiver.	Community Content Funding: Volunteer efforts, non-profit groups, and other community-minded organizations. Purpose: Dialogue, networking, community building. Also provide information and increase awareness. Communication: Many-to-many with no clear distinction between sender and receiver.
Low	High
Level of Interactivity

Link to text:
http://jcmc.indiana.edu/vol4/issue1/mcmillan.html

New media interactive advertising vs. traditional advertising

Thoughts:

The overall conclusion that interactive advertising is not superior to traditional advertising is for me as clear as water. For example – when the television started to spread and became a mass-medium, many of the people stated that radio will soon be dead. As we can see today, the radio hasn’t gone anywhere and has maybe even monopolized some places in our everyday lives (cars, public places etc). The invention of new mediums, and with them the evolution of advertising is the outcome of needs of a certain interest group. It is not a step forward, but rather a step sideways.

There are no superior mediums as there are no superior ways to advertise, because people (in the spread of individualism) have taken so many steps sideways, that we can’t universally have a greatest way to advertise.

But still – why interactive media (and advertising) isn’t a superior (as it should be, with its audiovisual content and diversified info) way to get our attention and the decision to buy something. Well I think the internet is a info bank. The TV today isn’t an info bank, it’s a entertainment center. When visiting banks, I’m always conservative. When visiting entertainment centers, I’m not so conservative. And non-conservative people are regularly better spenders aka. better ad-targets.


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The text mainly focused on the study - is interactive advertising more efficient than traditional one-sided advertising. By the authors definition "interactivity is fundamentally the ability to control information". The researchers also divided potential consumers into two groups: consumer who thinks in pictures or in words. In the research, authors believed that interactive media would be bad for visual consumers, because of their lack of interest in textual material which dominates usually the interactive advertising.

Ads themselves can be visual or verbal. Authors stated, that visual advertising is better done through traditional methods, because of the reason stated earlier. In the comparison of the two, the focus was more on linear vs. interactive ways of advertising.

What was concluded was that verbal consumers ignore graphics and rather search for text, and because of that interactive ads seemed to be more suitable for them. Visual consumers liked linear ads more (thought of them as successful) than interactive. Verbal consumers also stated that they liked somewhat interactive ads better.

The reason behind the lack of interest for interactive ads in the case of visual consumers is the fact (according to the authors of the study) that interactive ads tend to be less persuasive for the visual consumers. “Highly visual people like highly visual products through linear advertising”.

In interactive ads, people spend less time and are unlikely to buy the product. In other case, when consuming linear advertisements, more time was spent viewing the ads and greater was the decision to buy the product.

Authors also wanted to state that visual processing is inhibited by interactive system. Therefore, under certain condition, interactivity interrupts the process of persuasion.

In overall, persons will to buy the product was bigger in linear ads than in interactive ads – that means, that the medium itself affected decision? Sic! "When customer uses interactive system, the link between retrieval and yielding to the persuasion may be broken."

The decreased time spent on viewing ads perhaps comes from increased control given to consumers over content, the authors believed. Nevertheless the authors wanted to state, that situation with longtime interactive media consumers may be different.

They also wished to focus more on the roll of sex when consuming interactive vs. linear ads: women are more verbal consumers, etc maybe more interactive ad consumers; men are more visual, maybe more linear ad consumers.

NB! In the study, interactive ads were Apple (computer)-based, where participants were able to control (clicked on ads, to see info). Linear was also computer-based, but more like a TV-show.


Link to the text:
http://marketing.wharton.upenn.edu/ideas/pdf/Iacobucci/Internet/jar1998-alexa.pdf