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Witteman, H. et al.:Not every site needs a wiki: A conceptual framework for health Websites
• This slideshow, presented at Medicine 2.0’08, Sept 4/5th, 2008, in Toronto, was uploaded on behalf of the presenter by the Medicine 2.0 team
• Do not miss the next Medicine 2.0 congress on 17/18th Sept 2009(www.medicine20congress.com)
• Order Audio Recordings (mp3) of Medicine 2.0’08 presentations at http://www.medicine20congress.com/mp3.php
Holly Witteman & Laura O’Grady
Medicine 2.0 | September 4, 2008
Not Every Website Needs a Wiki:
A Conceptual Framework for Health Websites
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman3
Purpose
Increasing complexity of Web
Different applications, different
focus
key functions
strengths
weaknesses
Toward an ontology
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman4
Origins
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman5
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman6
CMC HCI
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman7
Whirlwind Tour!
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman8
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman9
Community
Preece (2000, p.10) defined online communities as consisting of:
"People, who interact socially as they strive to satisfy their own needs or perform special roles, such as leading or moderating.
A shared purpose, such as an interest, need, information exchange, or service that provides a reason for the community.
Policies, in the form of tacit assumptions, rituals, protocols, rules, and laws that guide people's interactions.
Computer systems, to support and mediate social interaction and facilitate a sense of togetherness."
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman10
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman11
Individuals and Identity
Membership rules
Criteria to join? (e.g. ganfyd.org, sermo.com, private groups/forums)
Profiles, signatures
Community norms, expectations
Implications for further participation (Bonniface & Green 2007)
Social identity
Key to engagement (Sandaunet 2008)
Different identities for different life roles
SNS implications on future employment (Cain 2008)
Managing converging and diverging identities
Identities blur across domains, e.g. access to medical librarian in Second Life (Seeman 2008)
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman12
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman13
Connections
Formal (SNS ‘friends’, blogroll) or less formal (recognition)
Key aspect of SNS
Social support site: multidirectional support is necessary for the
effective functioning of the community (Bonniface & Green 2007)
Sense of belonging may be associated with status within the group,
and status may be indicated indirectly by connections (Stets & Burke
2000)
Integral to collaboration
Collaboration = f (vested interest in problem, perception of interdependence with other stakeholders) (Langsdon 1991)
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman14
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman15
Authorship
Individual authorship vs. collective/abstract
Static vs. fluid
Anonymity Can be helpful
• E.g. stigma (van Uden-Kraan et al. 2008, Seeman 2008) … but also has potential for negative effects
• People more likely to lie, tell harsh truths (Whitty 2008)• Difficulty in negotiating gaps between anonymous online experiences and
'real-life' identified actions Social identification with author(s)
Key to trust (Sillence 2007) Implications for collaboration
When individual contributions are recognized as such, groups are more cooperative (Cress & Kimmerle 2007)
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman16
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman17
Authority
Literature on communities, online or otherwise, makes reference to rules,
norms, structures (Wood & Gray 1991), policies, tacit assumptions, rituals,
protocols, rules, and laws (Preece 2000, p.10)
Formal authority, "the right to decide," vs. real authority, "the effective control
over decisions." (Aghion and Tirole 1997)
Formal authority: editing privileges, moderator status
Real authority: being an opinion leader within the community.
Spreading formal authority = increased participation, communication by lower ranking members of an organization
Different models may affect participation rates and user satisfaction in a
tradeoff relationship, and may also have varying results for different
subgroups of users (Krowne & Bazaz 2004)
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman18
Authority (cont.)
Participation in online communities can both reproduce and challenge existing power structures
E.g. mothers of children with rare genetic conditions (Schaffer et al. 2008)
• Reconfigured authoritative knowledge about their children's conditions• Became critical of the standard processes of scientific research and medical
care• Perceived benefit of online sources of health information is to be able to
'speak the language' of health care providers and therefore be treated as more of an equal by physicians
• Maintaining authority or expertise in an eHealth community can be time-consuming and exhausting work
E.g. bipolar adults (Canal et al. 2008)
• Largely reproducing biomedical discourse E.g. women discussing birth experiences and options (Witteman et al., in
progress)
• Explicitly questioning knowledge/professionalism of health care providers
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman19
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman20
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman21
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman22
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman23
Dialogue and Dissent
Proxy for representation of (the complexity of) different points of
view
Skeptics may be better convinced by complex information
Acknowledgement of uncertainty may result in a, "fading trust in
expert knowledge," (Klingemann & Bergmark 2006)
Also depends on individual and cultural factors
Different countries have been classified as having different levels of comfort with uncertainty and tolerance for ambiguity (Zahedi et al. 2001)
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman24
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman25
Collaboration
Key theme of Web 2.0
eHealth literature: "allows individuals to publish, collaborate and share experiences with other like-minded individuals or groups," (Deshpande & Jadad 2006), "the latest generation of Web-based collaborationware," (Kamel Boulos et al. 2006), "it's the spirit of open sharing and collaboration that is paramount," (Giustini 2006), "online collaboration and sharing among users … a social phenomenon which harnesses the collective contributions of all participants," (Editors, J Vis Commun Med, 2007) "new collaborative Internet applications," (McLean et al. 2007), "better supports group interaction and fosters a greater sense of community in a potentially ‘cold’ social environment" (Kamel Boulos & Wheeler 2007), and, "improved communication and collaboration between people via social-networking technologies," (Eysenbach 2008).
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman26
Collaboration
"Collaboration occurs when a group of autonomous stakeholders of
a problem domain engage in an interactive process, using shared
rules, norms and structures, to act or decide on issues related to
that domain." (Wood & Gray 1991)
May look different for different types of applications
Requires participation
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman27
Dialogue vs. Collaboration
wikis
discussion forums and listservs
blogs
blog networks
social networking
rating systems
photo/audio/video sharing
primarily(consensus-oriented)
collaboration
primarily(discourse-oriented)
dialogue
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman28
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman29
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman30
Information (Input)
Narrative vs. points/numbers/tables
Individual experiential vs. generalized
Generic vs. tailored
Detailed vs. vague
Images and other media
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman31
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman32
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman33
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman34
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman35
Organization (Presentation)
Chronology
Synchronous vs. asynchronous
Location/layout on page
Linear vs. nonlinear
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman36
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman37
Reorganization (Output)
Aggregate (e.g. ratemds.com, thebirthsurvey.com,
PatientsLikeMe.com)
Mashups
Interactivity
Intended audience
Site-level characteristics
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman38
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman39
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman40
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman41
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman42
43
44
45
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman46
Putting it all together …
Nine elements grouped within two pillars
Tradeoffs
Differences between individual users
Differences between individual sites
47
48
49
50
51
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman52
Discussion/Conclusions
Fluid boundaries
Pitfalls in grouping by type of
application
No ‘one size fits all’ Website or
application
Different designs, communities
function differently
Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman53
Acknowledgments: Funding, Image Credits
Funding Photos from flickr.com licensed under Creative Commons courtesy of users:
artologCrash SoloDarren HesterDBarefootDeathByBokehfensterbmejaaronjahdakinemisterbissonmonoglotniallkennedyoutlier's eyepenmachineSeether AlphaTrois Têtes (TT)