Journal of Health Psychology

There is substantial epidemiological evidence that widespread adoption of specific behavior changes can significantly improve population health. Yet, health communication efforts, while well intentioned, have often failed 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. There is growing initial evidence that e-health communication can improve behavioral outcomes. However, we have much to learn about whether the technical promise of e-health communication will be effective within the social reality of how diverse people communicate and change in the modern world. This article examines current evidence concerning e-health communication and evaluates opportunities for e-health applications.

The widespread use of the Internet by patients is transforming the delivery of health information. Little research has been done, however, to assess the relationship between patients' use of online health resources and self efficacy, behavior or health status. To understand these effects and create a national research agenda, professionals should establish theoretically based studies. This article provides an overview of studies using computer networks and Internet-based closed systems in which a specific population has access to online health tools similar to those available on the Internet. These studies provide a microcosm of the effects Internet use may have on a patient's health-related behaviors. Three areas of proposed research will be explored: content research; process research; and outcomes research.

This literature review of research on health-related computer-mediated support groups links features of these groups to existing theory from the areas of social support and computer-mediated communication research. The article exams computer-mediated support groups as weak tie networks, focuses on how these support groups facilitate participant similarity and empathic support and identifies changes in supportive communication due to characteristics of the medium.

A growing number of major health care organizations, such as the American Heart Association and the Mayo Clinic, are investing considerable resources in developing and marketing Internet-based programs for health promotion and disease management. These programs have the potential to provide some of the best-tailored interventions in behavior change science at relatively low costs. This report discusses review criteria developed in order to conduct a systematic evaluation of Internet programs for preventive behaviors (alcohol, diet, exercise and smoking) and disease management (pediatric asthma, depression and diabetes.) These criteria can be used to develop and evaluate the quality of health promotion programs on the Internet.

Full reviews were conducted on 37 public websites on health behavior change for disease prevention and management. All had at least four of five of the `5A's for effective health behavior change treatment on the Internet' (advise, assess, assist, anticipatory guidance and arrange follow-up) that are assumed to be minimum criteria for a program to have the potential for producing behavior change. The strength of these 37 programs included: rationales provided for assessments; privacy and confidentiality protections; some form of feedback provided; and some form of interactivity. The weaknesses included: few were theory driven; few had individualized tailoring; few had empirically based tailoring; and few were evidence based or reported subsequent plans for evaluation.

This study identified the criteria that are valued among Internet users when rating and accessing health information on the World Wide Web. Participants (N = 578) successfully completed a Web-based survey by ranking 12 criteria for evaluating health information. Then, by applying those same evaluation criteria, rated the quality of three preselected health-related websites and indicated their preference for one of the three sites. Six criteria including content, design and aesthetics, currency of information and contact addresses were significant predictors for selecting high-quality health information on the Internet. However, compared to their perceived importance, participants' perceptions about quality health information on the Internet were not consistent when selecting quality websites. This study identified the implications for evaluation criteria among Internet users, health professionals and website developers.

Within the last few years numerous support groups have emerged on the Internet, presenting new opportunities for patients to communicate with health care professionals and other patients. The present study examines discourse within online cancer support groups, increasing our understanding of sex differences in cybersupport. Two reproductive cancer groups were chosen for this investigation, the Ovarian Problems Mailing List (OPML) and the Prostate Problems Mailing List (PPML), making sex of the patient recognizable. Phenomenological thematic analysis was employed to describe and interpret messages sent and received. Analyses for the two groups were compared. Generally, it was found that the two online listservs provided opportunities for cancer patients to receive support, within western society's accepted forms of gendered communication.

This article describes how 121 women newly diagnosed with breast cancer used a computer mediated discussion group to cope with their diagnosis. These data are part of a larger data set from a randomized clinical trial assessing the impact of a computer-based system called CHESS (the Comprehensive Health Enhancement Support System) on health outcomes. The larger study found significant improvement in health outcomes for those in the experimental group (those receiving CHESS), especially for women of color. Since discussion group is by far the most heavily used service of CHESS, one might conclude that these benefits (both overall and greater for women of color) should be attributed to amount of discussion group use. This study looks at how women of color and Caucasian women used the CHESS discussion group over the period of the study. Content analysis of messages in the discussion group showed that women of color used the discussion group differently from Caucasian women—they used it less frequently but their messages were more focused on breast cancer, suggesting they used discussion group more instrumentally.

The following article documents an iterative, user-oriented process to develop a nutrition education website for a rural multicultural population. Study participants were purposefully recruited from a six-county region in Southern Colorado and Northern New Mexico representing the range of ethnic backgrounds, demographics and computer experience of the site's target audience. Three studies are presented. Study one, using a card-sorting process produced a basic shallow and broad structure for the website. Study two, using verbal protocol analysis of the prototype website identified six recurring problems and Study three, using verbal protocol analysis of the nearly completed website identified nine recurring problems. The website was redesigned to eliminate the problems and recommendations were provided for training users.

Can a health-care website stimulate its members to become a `community of care and caring', facilitating both medical `information' and personal `support'? This study of MSWatch.com provides conceptual distinctions about `ties' to a `community' and raises questions about communications designed to serve patients with Multiple Sclerosis. An online survey of members of the website shows that members tend to: (1) make use of both its health-care information (care) and support (caring) functions, especially the former; (2) evaluate the website more highly overall if they make use of both information and support; (3) use the website the most during early stages of the disease; and (4) enhance their ties to the virtual community through using communication information and support.

Many current smokers do not plan on quitting any time soon. For these smokers, the immediate treatment goal is not a quit attempt, but an increase in readiness to stop smoking. In the present study we developed an interactive multimedia simulation and tutoring environment that teaches healthcare professionals to provide brief motivational interviewing-based smoking cessation interventions tailored to the patient's current readiness to change. This tutorial utilizes a cognitive science-derived learning approach that provides tailored feedback and lessons based on learners' pre-existing knowledge, is highly interactive and allows learners to practice skills in simulated clinical situations. Results from two pilot studies indicate that healthcare professionals and students found the software easy and enjoyable to use and successfully learned MI-based strategies for smoking cessation.

Under-treated pain is a significant problem. Health care institutions are under increasing pressure from patients and accreditation bodies to improve staff training in pain management. Pain assessment, a necessary pre-cursor to good pain management, is a complex multi-step process requiring sophisticated understanding and superior communication skills. This article describes the development and usability testing of an interactive, Internet-deliverable, multimedia tutorial to teach best practice pain assessment. The software platform allowed non-programmers to create multimedia tutorials and included the capability to simulate role-plays. The tutorial was designed to actively engage and respond to the learner and to include skills practice. Twenty-five nurses took the tutorial and rated it positively on a usability questionnaire in terms of ease-of-use and learning method.

The Internet might transform the way in which health information is communicated to patient and general populations. Understanding differences in usage patterns will be critically important to ensuring the successful distribution of health information. The present study presents early data on the use patterns and predictors of use of a Web-based intervention in a population-based subsample of women aged 18—74 in King County, WA. By three months over half (51%) of users had logged into the website, using multiple components. Predictors of use by three months included employment, perceptions of health and mental health scores. These data have implications for how to conduct Web-based intervention research and for individuals that may not benefit from such interventions.

Given the potential of patients using computer programs in health care settings, we studied the effect of a fingerprint reader on responses to a computerized health screener. We randomized 76 primary care patients into two conditions: (1) fingerprint reader prior to screener; and (2) control condition. Overall, the reader was well accepted and those who used it had more positive attitudes toward using it than those who did not. The fingerprint reader had a positive effect on reporting low fruit and vegetable intake and poorer health status, but no effect on reporting physical inactivity, smoking, excessive alcohol intake or being overweight.