Health education and health promotion have a tradition of using information and communication technology (ICT). In recent years, the rapid growth of the Internet has created innovative opportunities for Web-based health education and behavior change applications—termed eHealth promotion. However, many eHealth promotion applications are developed without an explicit model to guide the design, evaluation, and ongoing improvement of the program. The spiral technology action research (STAR) model was developed to address this need. The model comprises five cycles (listen, plan, do, study, act) that weave together technological development, community involvement, and continuous improvement. The model is illustrated by a case study describing the development of the Smoking Zine (www.SmokingZine.org), a youth smoking prevention and cessation Web site.
Argyris, C., Putnam, R., & Smith, D. (1985). Action science: Concepts, methods, and skills for research and intervention (1st ed.). San Francisco: Jossey-Bass.
2.
Baecker, R., & Buxton, W. (1987). Readings in human-computer interaction: A multi-disciplinary approach. San Mateo, CA: M. Kaufmann.
3.
Baker, G. R. (2002). Improvement using rapid cycle change. In H. A. Skinner, Promoting health through organizational change (pp. 222-242). San Francisco: Benjamin Cummings.
4.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman.
5.
Bartholomew, L. K., Parcel, G. S., & Kok, G. (1998). Intervention mapping: A process for developing theory- and evidence-based health education programs. Health Education & Behavior, 25(5), 545-563.
6.
Biglan, A., Mrazek, P. J., Carnine, D., & Flay, B. R. (2003). The integration of research and practice in the prevention of youth problem behaviors. American Psychologist, 58(6-7), 433-440.
7.
Botvin, G., & Botvin, E. (1997). School-based programs. In J. Lowinson, P. Ruiz, R. Millman, & J. Langrod (Eds.), Substance abuse: A comprehensive textbook (pp. 910-927). Baltimore: Williams & Wilkins.
8.
Brodie, M., Flournoy, R. E., Altman, D. E., Blendon, R. J., Benson, J. M., & Rosenbaum, M. D. (2000). Health information, the Internet, and the digital divide. Health Affairs, 19(6), 255-265.
9.
Centers for Disease Control and Prevention. (1999). Best practices for comprehensive tobacco control programs. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
10.
Dryburgh, H. (2001). Changing our ways: Why and how Canadians use the Internet. Ottawa, Canada: Statistics Canada.
11.
Dusenbury, L., & Falco, M. (1997). School-based drug abuse prevention strategies: From research to policy and practice. In R. Weissberg, T. Gullotta, R. Hampton, B. Ryan, & G. R. Adams (Eds.), Enhancing children’s wellness (pp. 47-74). Thousand Oaks, CA: Sage.
12.
Ellickson, P. (1995). Schools. In R. Coombs & D. Ziedonis (Eds.), Handbook on drug abuse prevention (pp. 93-120). Toronto, Canada: Allyn & Bacon.
13.
Erickson, P. G., Riley, D. M., Cheung, Y. W., & O’Hare, P. A. (Eds.). (1997). Harm reduction: A new direction for drug policies and programs. Toronto, Canada: University of Toronto Press.
14.
Evers, K. E., Prochaska, J. M., Prochaska, J. O., Driskell, M., Cummins, C. O., & Velicer, W. F. (2003). Strengths and weaknesses of health behavior change programs on the Internet. Journal of Health Psychology, 8(1), 63-70.
15.
Eysenbach, G. (2003). SARS and population health technology. Journal of Medical Internet Research, 5(2), e14-e14.
16.
Friere, P. (1970). Pedagogy of the oppressed. New York: Continuum.
17.
Glanz, K., Lewis, F. M., & Rimer, B. K. (1997). Health behavior and health education; Theory, research and practice (3rd ed.). San Francisco: Jossey-Bass.
18.
Greenberg, M. T., Weissberg, R., O’Brien, M. U., Zins, J. E., Fredericks, L., Resnik, H., et al. (2003). Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. American Psychologist, 58(6-7), 466-474.
19.
International Telecommunications Union. (2004). Retrieved June 27, 2005, from http://www.itu.int/ITU-D/ict/dai/index.html
20.
Johnson, P. (1992). Human-computer interaction: Psychology, task analysis and software engineering. London: McGraw-Hill International.
21.
Johnson, S. B., & Millstein, S. G. (2003). Prevention opportunities in health care settings. American Psychologist, 58(6-7), 475-481.
22.
Kretzmann, J. P., & McKnight, J. L. (1993). Building communities from the inside out: A path towards finding and mobilizing a community’s assets. Chicago: ACTA Publications.
23.
Langley, G., Nolan, K., Nolan, T., Norman, G., & Provest, L. (1996). The improvement guide: A practical approach to enhance organizational performance. San Francisco: Jossey-Bass.
24.
Lynagh, M., Schofield, M., & Sanson-Fisher, R. (1997). School health promotion programs over the past decade: A review of the smoking, alcohol and solar protection literature. Health Promotion International, 12(1), 43-59.
25.
Manske, S., Maule, C., O’Connor, S., Lovato, C., & Harvey, D. (2003). A call for action to support best practices in evaluation of comprehensive tobacco control evaluation strategies. Chronic Diseases in Canada, 24(1), 32-37.
26.
Marlatt, G. A. (1998). Harm reduction: Pragmatic strategies for managing high-risk behaviors. New York: Guilford.
27.
McBeth, A. J., & Schweer, K. D. (2000). Building healthy communities: The challenge of health care in the 21st century. Boston: Allyn & Bacon.
28.
Minkler, M., & Wallerstein, N. (2002). Improving health through community organization and community building. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health behavior and health education (3rd ed., pp. 279-311). San Francisco: Jossey-Bass.
29.
Nation, M., Crusto, C., Wandersman, A., Kumpfer, K. L., Seybolt, D., Morrissey-Kane, E., et al. (2003). What works in prevention: Principles of effective prevention programs. American Psychologist, 58(6-7), 449-456.
30.
Norman, C. D. (2004). The web of influence: Evaluating the impact of the Internet on adolescent smoking cessation and eHealth literacy. Unpublished doctoral dissertation, University of Toronto, Toronto, Canada.
31.
Norman, C. D., & Skinner, H. A. (2004). A systematic review of eHealth behaviour change research. Unpublished manuscript, Toronto, Canada.
32.
NUA. (n.d.). Retrieved June 27, 2005, from http://www.nua.com/surveys/how_many_online/index.html
33.
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47, 1102-1114.
34.
Rimal, R. N., & Flora, J. A. (1997). Interactive technology attributes in health promotion: Practical and theoretical issues. In R. L. Street, W. R. Gold, & T. Manning (Eds.), Health promotion and interactive technology: Theoretical applications and future directions (pp. 19-38). Mahwah, NJ: Lawrence Erlbaum.
35.
Robinson, T. N., Patrick, K., Eng, T. R., & Gustafson, D. (1998). An evidence-based approach to interactive health communication: A challenge to medicine in the information age. Journal of the American Medical Association, 280(14), 1264-1269.
36.
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78.
37.
Schneiderman, B. (1998). Designing the user interface: Strategies for effective human-computer interaction (3rd ed.). Reading, MA: Addison Wesley Longman.
38.
Sciadas, G. (2002). The digital divide in Canada. Ottawa, Canada: Statistics Canada.
39.
Skinner, H. A. (2002). Promoting health through organizational change. San Francisco: Benjamin Cummings.
40.
Skinner, H. A., Biscope, S., & Poland, B. (2003). Quality of Internet access: Barrier behind Internet use statistics. Social Science and Medicine, 57(5), 875-880.
41.
Skinner, H. A., Biscope, S., Poland, B., & Goldberg, E. (2003). How adolescents use technology for health information: Implications for practitioners. Journal of Medical Internet Research, 5(4), e32-e32.
42.
Skinner, H. A., Maley, O., Bercovitz, K., Haans, D., Jennings, M. J., Magdenko, L., et al. (1997). Using the Internet to engage youth in health promotion. International Journal of Health Promotion and Education, 4, 23-25.
43.
Skinner, H. A., Maley, O., & Smith, L. (2001). New frontiers: Using the Internet to engage teens in substance abuse prevention and treatment. In P. Monti & S. Colby (Eds.), Adolescence, alcohol, and substance abuse: Reaching teens through brief interventions (pp. 297-318). New York: Guilford.
44.
Sorensen, G., Emmons, K., Hunt, M. K., Barbeau, E., Goldman, R., Peterson, K., et al. (2003). Model for incorporating social context in health behavior interventions: Applications for cancer prevention for working-class, multiethnic populations. Preventive Medicine, 37(3), 188-197.
45.
Street, R. L., & Rimal, R. N. (1997). Health promotion and interactive technology: A conceptual foundation. In R. L. Street, W. R. Gold, & T. Manning (Eds.), Health promotion and interactive technology: Theoretical applications and future directions (pp. 1-18). Mahwah, NJ: Lawrence Erlbaum.
46.
Tobler, N., & Stratton, H. (1997). Effectiveness of school-based drug prevention programs: A meta-analysis of the research. Journal of Primary Prevention, 8(1), 71-128.
47.
U.S. Department of Health and Human Services Usability Guidelines. (n.d.). Retrieved June 27, 2004, from http://www.usability.gov/pdfs/guidelines.html
48.
Wandersman, A., & Florin, P. (2003). Community interventions and effective prevention. American Psychologist, 58(6-7), 441-448.
49.
World Health Organization. (1986). Ottawa charter for health promotion. Canadian Journal of Public Health, 77(6), 425-430.
50.
Whyte, W. F. (1991). Participatory action research. Newbury Park, CA: Sage.
