Health In Computer Mediated

Communication

Luke Harrison, Marley Gordon, Anthony Glynn, Samuel Hamer

and Simon Hill

What is computer mediated communication?

• John December (1997) states

• “Computer Mediated Communication is a process of human communication via computers, involving people, situated in particular contexts, emgaging in processes to shape media for a variety of purposes.”

• And Gerry santoro (1995) explains

• “At its broadest, CMC can encompass virtually all computer uses including such diverse applications as statistical analysis programs, remote-sensing systems, and financial modelling programs, all fit within the concept of human communication”

• Simply it can be seen as human to human comunication via computer mediated formats (e.g. email, instant messenger etc) for a variety of purposes.

What are the computer mediated communication core concepts

• Core concept 1 Communication– More related to human communication with socal

interaction as supposed to communications technology– The term ‘communication' covers just about any interaction

with another person. It includes sharing information, ideas and feelings between people. Radcliffe, M [2000]

• Core concept 2 Mediated – Mediation is simply the process or means by which

something is transmitted, so in the context of CMC mediation is carried out by computers

• Core concept 3 Computer– Very Vague takes mor of a look at “Informatics” (The

storage, manipulation and retreival of data.

What is health

• Many definitions• World Health Organisation (WHO) defines health as “a state of

complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

• A healthy state of wellbeing free from disease; "physicians should be held responsible for the health of their patients" (Wordnet)

• The general condition of body and mind; "his delicate health"; "in poor health" (Wordnet)

Background

• Health in CMC dates back to 1984• Tom Grundner and collegues in the school of medicine at western

reserve university (USA) needed a way to communicate with physicians at 5 different medical units

• He set up a bulletin board and developed a program called St Silicon's Hospital and Information Dispensary

• People could post messages/problems and a legitimate physician could respond to these messages with proffessional solutions

• Eventually it grew from an “Electronic hospital” to a fully developed online community complete with post office, libary, school system and administration centre

• 6 million user sessions in 1996

CMC in action, saved by instant messenger

• In a regular scheduled geneology chatroom Ken Walker posted this:

• Ken Walker (Scot) | Helo . . .have broblemd , , ,thhimk I am | wayin g stroke

• Dot Rhyne Arthur | Ken are you serious?, I'm worried. • Ken Walker (Scot) | Help: I think I a stroke . . .is not wind

| you. Please somebody help

• Ken Walker (Scot) | Dot HEP • Dick Eastman/SYSOP | Ken: Where are you? Your telephone number??? • Ken Walker (Scot) | (0241) 430045 • Dick Eastman/SYSOP | I am on phone with emergency operator in | Scotland • Dick Eastman/SYSOP | AMBULANCE IS DISPATCHED• Dick Eastman/SYSOP | TO 16B HIGH STREET, ARBROATH, SCOTLAND • Ken Walker (Scot) | thank you all • Dot Rhyne Arthur | Ken, help is on the way! • Ken Walker (Scot) | i am alone • MARY L. WITTLOCK | No you are not we are all here for you • Dick Eastman/SYSOP | Police are at Ken Walker's house right now.... • | ambulance is on the way. • ROBERT B. CROSS | God bless you all, thank God you were all here for him

Old health

• Doctors and specialists were the only source of health related information only during office hours and on their terms. (except in the case of an emergency)

• Anyone who wanted information about healthy eating or other worries relied on either magazines and literature or on their local GP. There was no real alternative.

• This lead to some GPs issuing completely contradictory treatments to different patients.

• Many people still routinely used home remedies if they did not agree with doctor’s treatments.

• Medicine was something only really understood by the academic elite.

Current health

• Medical and health related advice can be accessed at all times by anyone with a working internet connection.

• A wide variety of different opinions of treatment and advice ranging from no carb diets to meditation is available.

• Generally accepted medical facts and the advancement of medicine between professional doctors has occurred due to the sharing of research via the internet.

• Weeding out the health related advice that works from those that do not can take some time but does eventually happen as warnings travel as fast as success stories.

• Not only doctors but anyone with any knowledge (and some with none) publishing their own findings in regard to health

Comparison

The only opinion on health was that of a doctor or trained health assistant. This was only during their working hours and could cost a lot of money.

There are thousands of different opinions and theories on different aspects of health and healthcare. All of which are available free (apart from internet costs) and when the user needs it.

Family remedies often used and contradictory divides between the medical world causing different treatment for different people.

Sharing of facts widely creates standards and shared knowledge throughout the professional world but also gives room for more unconventional and sometimes useless cures among the uneducated masses.

All official records kept on paper causing difficulties in the case of fire or (more often) drink spillage or simply losing them. They could only be kept in one place at a time and in most cases would need to be handwritten to be placed elsewhere.

Databases can be searched instantly and backups in most systems are automatic meaning that there will almost certainly always be a copy of patients records as long as the internet survives and it can be accessed by anyone with permission.

Very few people knew the importance of keeping fit and healthy. The connection between good health and lack of illness had been made but was hard to communicate.

Most of the population know how important it is to keep healthy. There are reminders on all major websites and news programs. Being able to communicate faster has made it a lot easier to get the message across.

How it effects usHeath in in the form of CMC is a massive medium, it’s a place where a persons problem can easily be solved. There is an increasing variety in information on practically every aspect of prevention, health promotion and treatment for patients, also information for families and care providers.

cancer on the internet has a well-established information and support communication infrastructure has been developed over the past years with in the CMC to help patients cope and deal with.

Also a study by Dr Aric Sigman says that social networking makes us ill, basically because we spend more time e- talking that face to face contact, but when we face to face contact we have cellular reactions that help natural killer cells, particular hormones to help heart problems

Full story http://news.bbc.co.uk/1/hi/uk/7898510.stm

Purpose of health on the internet

The purpose of health on the internet is to promote the deployment of useful and reliable online medical and health information. It’s a perfect source for users who are unable to talk to Heath workers such as doctors.

• Use of the Internet, and the opportunity to use computer-mediated

communication (CMC) provides new alternatives for nurse/doctors and health care professionals to collect data. The use of CMC for research purposes is advantageous for both researchers and participants.

• Beneficial to through reaching individuals who are geographically distant, and nurses have the opportunity to provide patience's with true anonymity, which may be beneficial when exploring sensitive issues.

An Example -Then and Now

About ten years ago there was no choice about which hospital you went to. But now you can choose selected hospitals, your not restricted to your GP’s view about treatment.

Another Example – Cancer buddies

Online support network, Help people who have cancer talk about

“Have you ever wished for somebody to talk to about what you're going through? Somebody who understands because they've experienced it too?”

Online health ethicsOn the internet there is no where that says that ethics have to be applied, unlike a GP or

doctor who take the “Hippocratic Oath” so any online user can comment and put there own option and it might not be ethical, there are three rules that Louis Scheidt says should apply online:

• Never put our subjects at risk.• Never lie to them.• Minimize social harm while enhancing social good

here is an example of bad ethics?

“Vaionessa 20/12/2009 16.16pm GMTGiving my 2 year old son paracetomol is ok, even tho it says on the packet for 5+”

A large number of mothers and other users would disagree with this but because if online there is no one to be ethical and say Stop!. Apart from common sense

Positive and negatives

• Positives• Enables patients that aren't able to leave the house for medical

reason to get advice on treatment… And during bad weather such as Snow.

• Enable patents that have life threatening diseases/illnesses such as caner to find support from other people who have gone through the same problems.

• Negatives • Quality of information available might not be up to scratch.• Increase in the amount Hypochondriacs.• No regulation to a majority of medial forums.• Fiction can be mistaken for fact.

Case studies

• What is a Health Event?A health event is any temporary or continuing interruption

to good health. A health event can involve minor physical symptoms or major physical symptoms.

• What is a Case Study?You may already be familiar with the term Case Study.

Case studies provide real-life examples of someone � �else s experience. They are learning tools.�

• A Health Event Case Study is a story of someone s �health event, recorded in sufficient detail to be useful to others as a learning tool.

Case studies continued • Starting from 1985, Bangladesh introduced the Extended Programme for Immunisation to protect

children from polio, measles, diphtheria, whooping cough and other infectious diseases.  The programme has a quite well-established and systematic structure and workflow, with health workers distributed all over the country, and able to visit any family in the country within one week.  A long and well-controlled 'cold chain' was also put into operation, enabling vaccines to be kept cold (and thus remain effective) throughout the country.

• The system was based largely on manual record keeping, which led to problems.  First, there was relatively limited ability to identify new-born children, since many births remained unregistered.  The manual system was also relatively poor at tracking the four different vaccine doses that are required at four different points of time for each child (for example, the first vaccination needs to be completed within four weeks of birth; the second after another four weeks, and so on).  Without the four vaccinations, children are not adequately protected.  Yet drop-out rates were around 40% under the old system.  There were particular problems for the fourth and final vaccination, which occurred nine months after the third, and which saw only 30-40% of children being vaccinated as parents and health workers simply lost track of what needed doing, and when.  This problem was, in part, associated with the seasonal flooding in Bangladesh, when even local journeys are made more difficult.

• The new computerised immunisation system addressed a number of these problems.  On a daily basis, the system uploads new entries from Rajshahi City Corporation's electronic birth registration system (follow this link for further details about this system).  For each new-born, a schedule of immunisation is created and printed, then given to the parents after registration of their baby's birth, attached to the child's birth registration ticket.  An example of the schedule is shown below:

http://www.egov4dev.org/health/case/banglaimmune.shtml

Case studies

Video clipon mobile e health

http://www.youtube.com/watch?v=czXkxal4KPY

Looking to the future• Scenario One – current conceptual thinking to 2010• There are two main strands: 

• Costs: governments have to find ways to contain the remorseless rise in the cost of providing care in the developed world; governments in the developed world have to find affordable ways to provide a reasonable level of care.

• Viability: most governments face the huge challenge of existing healthcare processes and models which over the next decade will be unable to cope with increasing demographic change, current demand crises and growth in expectations.

• http://www.siliconbridge.co.uk/art_future_ehealth.html

Online health concerns

• There are a few concerns with Online health care as the user who is seeking medical advice uses the internet to gather information on what to do next or to treat themselves depending on there situation.

• For example there are way too many different resources that can be accessed to find out the relevant information, these include search engines, NHS sites etc. This means that there can be a number of different versions to the remedy of these problems.

Online health concerns cont..

• Also there are more and more people are turning to online health care because of the current state of the NHS with queuing times and service and if people don’t get the correct supervision that they require then this could have serve repercussions for there health.

• Another concern is that some of the information can be edited, take Wikipedia for example, a user can search this to find a remedy however this data can edit by anyone who has an account and this may cause problems the information posted by people might not be correct.

Professional opinions

• It is possible to get professional opinions via internet from sources such as the NHS direct which provides advice on health and medical problems.

• In America alone it is estimated that 52 million people have used the internet to find information about diseases and medical treatment.

• 55% of internet users surveyed had accessed health information.

• However only 9% of this figure had exchanged emails with their physician.

Information Sources

• Seeking advice over the web is popular this means that more qualified personal need to be available there is more and more demand for this. For example in America the site ‘America’s Doctor’ (www.Amerciasdoctor.com) states that it has over 142 physicians.

• WebMD (www.webmd.com) provides online group discussions with medical experts on various medial topics.

• Cyberdocs (www.cyberdocs.com) this is an online service that started in 1996 this offers consultations from board certified physicians that can cost from $50 - $100 a session. It is reported that by 1999 the service gets 3000 hits a day or about 10,000 a month.

Disadvantages of professional opinions

• Security concerns – Other than people’s financial data, a persons health is very sensitive information, and if consumers are giving this data over the internet then security becomes an issue. This may put people off using the internet to interact with doctors over their health which in turn means that they might not get treated.

• Quality of information – Due to the diversity of the information that can be found on the internet, there is most likely to be a great deal of poor quality information available. This quality of information can turn users off some customers and physicians from using the embracing the internet.

• Lack of Resources for Web Development – Information systems departments in most health care organization are not web-orientated as these departments they under funded.

The Future of Professional opinions on the internet

• Customers who seek health information may end up taking matters into their own hands by the following:

• Consumer Health information services – as consumers seek information from the thousands of web pages dedicated to health care, the number of these sites will increase. New web-orientated health start-ups will encourage individuals to put up their own content, rating services and trusted brands will help customers sort though all the information that can be found.

• Online support groups for patients and caregivers – Online support for patients with a given diseases and the people who care for them will continue to develop rapidly. Patients will feel more in control and for many diseases have better outcomes.

Video clipon mobile e health

http://www.youtube.com/watch?v=czXkxal4KPY

Looking to the future• Scenario One – current conceptual thinking to 2010• There are two main strands: 

• Costs: governments have to find ways to contain the remorseless rise in the cost of providing care in the developed world; governments in the developed world have to find affordable ways to provide a reasonable level of care.

• Viability: most governments face the huge challenge of existing healthcare processes and models which over the next decade will be unable to cope with increasing demographic change, current demand crises and growth in expectations.

• http://www.siliconbridge.co.uk/art_future_ehealth.html

References • December, J. (1997). Notes on defining computer mediated communication. CMC Magazine,

January. Accessed 12/03/09: http://decemeber.com/cmc/mag/1997/december.html

• Santoro, G.M. (1995). What is computer-mediated communication? In Z.L. Berge and M.P Collins (eds), Computer mediated communication and the online classroom. Cresskill, NJ, Hampton.

• Thurlow, C., Lengel, L., Tomic, A. (2004) Health Communication in CMC. Computer Mediated Communication: Social Interaction And The Internet. Page 209

• Mental Health: strengthening mental health promotion. (2007). Accessed:12/03/09 http://www.who.int/mediacentre/factsheets/fs220/en/en/

• Health. Accessed:12/03/09 http://wordnet-online.com/health.shtml

• Tucker, S.(2009) about the Cleveland Freenet Accessed: 12/03/09 http://www.atarimax.com/freenet/common/html/about_frenet.php

• Excerpts of on-line conversation from Compuserve’s Geneanlogy Forum on February 20, 1996. Accessed 12/03/09

• Walther, J. B., & Burgoon, J. K (1992). Relational communication in computer mediated interaction. Human Communication Research