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The Internet and HealthCommunication: Experiencesand Expectations. By R. E. Riceand J. E. Katz (Eds.)Bradford W. HessePublished online: 10 Dec 2009.

To cite this article: Bradford W. Hesse (2003) The Internet and HealthCommunication: Experiences and Expectations. By R. E. Rice and J. E. Katz (Eds.),Health Communication, 15:3, 367-373, DOI: 10.1207/S15327027HC1503_7

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BOOK REVIEW

The Internet and Health Communication: Experiences and Ex-pectations. R. E. Rice and J. E. Katz (Eds.), Thousand Oaks, CA:Sage, 2001.

Bradford W. HesseHealth Studies

Westat

One measure I have of the value of a book is the degree to which it looks“dog-eared” or “well-worn” as I glance at it on my bookshelf. Many of the travelbooks I have in my personal library have this look, as well as the methods and sta-tistics books that line my office shelves. I purchased a copy of Ronald Rice andJames Katz’s edited volume, The Internet and Health Communication: Experi-ences and Expectations, just under a year ago. Already, its pages are tatteredthrough heavy use, its chapters are lined with yellow marker, and little blue andpurple Post-Its® stick out of the side of the book like so many “favorite place”markers on my own Internet browser.

Rice and Katz are veteran travelers in the environs of new communication me-dia. What they have done in The Internet and Health Communication: Experiencesand Expectations is to take their combined experience in mediated communicationand apply it to the problem of describing how professionals and consumers are us-ing the Internet to communicate about issues of personal and community health.The two editors were unabashedly expansive in their view of what would qualify asa chapter within their volume. Chapters range from theoretical discussions of pro-cesses and models to highly exploratory case studies, to original depictions ofquantitative data. Chapter authors were invited to share their experiences from thediverse perspectives of academia, research institutes and foundations, the privatesector, and government. The book reads much like a comprehensive travelogue,taking the reader down the byways and thoroughfares of the Information Super-

HEALTH COMMUNICATION, 15(3), 367–373Copyright © 2003, Lawrence Erlbaum Associates, Inc.

Requests for reprints should be sent to Bradford W. Hesse, Senior Study Director, Health Studies,Westat, 1650 Research Boulevard, Rockville, MD 20850. E-mail: hesseb@westat.com

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highway to catch a glimpse of how health communication is unfolding within awide variety of interdisciplinary applications. It offers a snapshot, as panoramic asthe Internet itself, of experiences and expectations at the beginning of the new mil-lennium.

The book is divided into five parts, with Part I (chapters 1–2) dedicated to set-ting the groundwork for the rest of the volume. Rice leads off by presenting a“framework of experiences” in chapter 1. He begins by making the sobering obser-vation that health care consumes 13% of the U.S. Gross National Product (p. 5) andthat, not surprisingly, over half of all Internet users surveyed in 1997 reported look-ing for some type of health information online.1 Once Rice has our attention, hetackles a point of complexity in understanding Internet communication: TheInternet is not one single communication technology; rather, it is a communicationprotocol (TCP–IP) that enables a whole host of new and traditional communica-tion modalities. To discuss Internet usage in health care is to discuss the use ofelectronic mail (one to one, as well as one to many), news groups, Web sites, onlinecommunities, and electronic data interchange (EDI). It enables communicationbetween public information sources and physicians; between physicians and phy-sicians; between physicians and patients; between patients and patients; and so on.

Chapter 2 suggests that there is a new type of health care consumer prowling therecesses of the Internet in search of personal health information. These “new con-sumers” are distinguishable from old consumers in terms of three defining charac-teristics: “cash, college, and computers” (p. 49). Chapter 2 offers a 5-year forecastsuggesting that the “new consumers” will be hitting the Web in ever-increasingnumbers. The challenge for health communicators will be in keeping up with de-mand for quality health care information.

Part II (chapters 3–6) takes the reader through a series of accounts related tosources of, and experiences with, online health information. Chapter 3, authoredby Phillip Napoli, reviews some of the broad communication literature, and resur-faces the notion of “information seeking” as an explanatory paradigm for under-standing online behavior. The implication is far reaching. Much of public healthcommunication is based on experience within traditional channels of broadcastmedia. Yet, a broadcast-based business model is unlikely to account for the infor-mation-seeking behaviors of the new consumers, as evidenced by the recent implo-sion of the so-called Dot-Coms (Levy, March 25, 2002). Internet users do not sim-ply “surf” the Web looking for interesting, “sticky” (i.e., attention-grabbing) sitesand paying close attention to the “pop-up” advertisements that bombard themalong the way. Rather, the new consumers select the medium of the Internet, andvery specifically the highly popular search engines within the medium, to search

368 BOOK REVIEW

1Actually, data released since publication of The Internet and Health Communication suggest thatsome “fifty-two million American adults, or 55% of those with Internet access, have used the Web toget health or medical information” (Fox & Rainie, 2001).

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for very specific types of health information. Web sites that do not support the newconsumers’ goal-oriented behavior will likely fail.

The following two chapters in Part II review original data analyses on Internetusage. Chapter 4 reviews the results of two national telephone surveys, one yield-ing a pool of 2,148 respondents of whome 30% reported being Internet users, andthe other yeilding an additional sample of 153 Internet users. Because there are nodescriptions of the sampling methods used (e.g., list-assisted vs. random-digit di-aling), nor of the resulting response rates, it is difficult to make strong inferencesback to an underlying population. The frequency of Internet users in the chapter(41%), for example, appears to be less than the number reported by Rice for thesame year in chapter 1 (≅50%). Nevertheless, the survey reveals that consumersare generally aware of the problem of differential quality of health information onthe Net and are actively looking for sites with information they can trust. Chapter 5reports the results of a mail survey to New Jersey physicians, with a low but “ac-ceptable” response rate of 27.5%. One of the chapter’s most useful observationswas in documenting the ways in which physicians use the Internet. Findings indi-cated that 83% of the physicians surveyed used the Internet primarily to access bib-liographic databases, 57% used it to access medical journals, 55% used e-mail,36% looked for government information online, 21% looked for information fromother providers, 15% used information from a local medical society, 12% joineddiscussion groups, and 11% used the Internet to access “other sources.” Part II con-cludes with a quaint anecdote describing one person’s experience looking forhealth information on the Web.

Part III (chapters 7–10) focuses the reader’s attention more specifically on thedevelopment and evaluation of health-related Web sites. Chapter 7 addresses a pe-rennial problem in public health planning: how to put evidence-based interventionstrategies quickly and efficiently into the hands of public health professionals. Al-though there were no impact data available at the time of printing, the chapter is in-teresting because of its illustration of how the Web can be exploited as a diffusionmechanism for distributing health intervention “technologies” to targeted healthcare intermediaries. The chapter describes a Web construction process that reliedheavily on formative evaluation and user data. Chapter 8 describes an even moreaggressive use of formative evaluation techniques to improve the ongoing serviceprovided by the United States’ largest public health insurer—Medicare. The au-thors of this chapter illustrate how standard social science techniques (audiencesurveys and focus groups) and nonstandard computer-based techniques(“bounceback” Web surveys and asynchronous forums) can work together to fill inthe complete picture of how users interact with a large, federally funded Web site.

The last two chapters in Part III (chapters 9–10) illustrate how content analytictechniques—another social science workhorse—can be used to evaluate the infor-mation and functionality of Web sites throughout a given sector. Chapter 9 com-pares Health Maintenance Organizations (HMOs) along dimensions of functional-

BOOK REVIEW 369

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ity, content, and ability to address member needs. Chapter 10 presents anexhaustive feature analysis of publicly and commercially funded health informa-tion Web sites. One of the more commendable aspects of these two chapters wastheir use of theory to guide their content-analytic methodologies. ElizabethWitherspoon, author of chapter 9, uses the transtheoretical or “stages of change”model (Prochaska, Redding, & Evers, 1997) to explain how certain informationalaspects of an HMO’s Web site might be tailored to meet the differential needs of itsmember base (p. 195). Likewise, Rice and his associates use the features analysispresented in chapter 10 to explore the hypothetical relationship between structuralcontext (public vs. commercial funding) and manifest content.

Part IV (chapters 11–15) is perhaps the most heterogeneous section of the bookas it brings together disparate treatments of a wide variety of Internet-based appli-cations. Chapter 11 looks to the trend of online patient support groups to ask anage-old question in interpersonal communication: Can participants in a purelytext-based communication medium express and experience true empathy? The an-swer appears to be “yes,” and the treatment helps to explain what role online sup-port groups play in the lives of their participants. Chapter 12 asks whether it is fea-sible to use the distance-learning capabilities of the Internet to support thedevelopment of successful Continuing Medical Education curriculum. The answerin this case is “it depends”—most probably on the organizational style of the spon-soring agency (but with only two case studies it is impossible to know with any cer-tainty). Chapter 13 asks whether the “telecomputing” capabilities of a wide areapublic network could be harnessed to support the health maintenance activities ofpatients with chronic diabetes. The answer to this question also appears to be“yes,” but from a theoretical perspective, the success of the implementation de-pends on the successful negotiation of multiple stages in process and outcome.

The final two chapters in part IV tackle broad infrastructure issues. Chapter 14presents data collected from an exploratory survey of 103 hospitals in the UnitedStates to investigate the mediating influence of certain organizational and technicalcharacteristics of hospitals on the adoption of a Web-based infrastructure. Throughlogistic regression, the authors found that CEO support and an internal Web “cham-pion” were positive determinants of Web adoption. The finding may not be too sur-prising given the organizational literature on information technology adoption.What may have been surprising was to learn that the most common use of the Web,endorsed by 76% of hospitals surveyed, was in “hospital marketing.” That findingreinforced theperception that the Internet isavehicle forpublic, inter-organizationalcommunication first and intra-organizational communication second. Chapter 15takes the inter-organizational perspective even further by describing the successesand pitfalls of establishing an Internet-based trading community within the pharma-ceutical sector in Australia. Motivation for the undertaking emerged when partici-pants up and down the supply chain within the pharmaceutical sector (from manu-facturers, to wholesalers, to retailers, and finally, to consumers) realized the

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inefficiencies that they were accruing by not adopting a common platform for Elec-tronic Data Interchange (EDI). Erstwhile competitors formed a tentative alliancethat, if successful, would not only create a more effective platform for e-commerce,but should also enable commonalities between the public and private sectors, twosectors that rarely communicate effectively.

Part V (chapters 16–19) turns the book’s focus to the issue of harnessing expec-tations by setting evidence-based policies. The section leads off in chapter 16 witha blueprint, of sorts, for how to manage national priorities on e-health through fed-eral initiatives in the United States. There are six areas of focus, the chapter argues,that need attention at a federal policy level: (a) ensuring quality, (b) improving ef-fectiveness through evaluation research, (c) preventing fraud, (d) safeguardingpersonal privacy, (e) filling missed opportunities and reducing redundancy, and (f)ensuring equal opportunity through equitable access. These areas are treated in athorough and persuasive fashion throughout the chapter, and their implications arecarefully tied to the emergence of a National Health Information Infrastructure inthe United States (United States Department of Health and Human Services[U.S.D.H.H.S.], 2001). Chapters 17 and 18 offer legal analyses of two especiallyvexing and long-standing issues in Internet-supported health care. Chapter 17deals with online sales of pharmaceuticals. It argues that, although e-commerce isa relatively new phenomenon, the existing case laws governing sales ofpharmaceuticals across state boundaries are probably sufficient to deal with anyspecific concerns that may arise in the area. Chapter 18 reviews the ongoing debateover electronic medical records, a debate that has been brewing within the field ofmedical informatics for the past two decades. Still, the chapter does an adequatejob of outlining the potential for abuse in the area, and it presents a useful review ofsecurity provisions as mandated by the Health Insurance Portability and Account-ability Act of 1996 (HIPAA).

Part V culminates in a postscript (chapter 19) by the editors, intended to add acautionary note to the expectations envisaged by the preceding chapters in thebook. A pervasive and appropriate theme is that, in spite of the optimistic views ofsome technologists, the full systemic impact of a health care system intertwinedwith consumers through wide area connectivity will be very difficult to predict.The banking industry, for example, looked to the adoption of automatic teller ma-chines (ATMs) as a way of conserving labor costs while at the same time providingcustomers with better service. History shows that, in the end, banks did not con-serve labor costs, but merely shifted personnel charges from tellers to informationtechnology specialists. Moreover, because ATMs gained in popularity, banks hadno choice but to adopt the technology or fall behind competitively. So, too, thehealth care sector might find itself running faster “simply to stay in place” (p. 418)with the competition.

Taken as a whole, The Internet and Health Communication: Experiences andExpectations offers an encyclopedic view of health communication as it is unfold-

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ing in its own distinct ways throughout the thoroughfares and byways of theInternet. This expansive view is both the book’s strength and its weakness. What ismissing is an objective sense of what is important here—what is working and whatis not. With a traveler’s eye always fixed on a destination, on expectations, it is easyto become overwhelmed with a sense “of not being there yet,” of always waitingfor the next big technology (e.g., broader bandwidth) to make a “true difference.”As the editors themselves say, it is too easy to “surmount the foothills only to seethe mountains” (p. 420). No, the Internet is not a panacea in solving all health com-munication dilemmas; no, computer-mediated communication will never replacehuman communication in richness and nuance; and no, not all areas of currentInternet development will bear fruit.

Nevertheless, what is useful about the stories coming out of the Rice and Katzcompendium is how people are making use of the medium in spite of the technol-ogy’s limitations. The experiences from Chapter 11 tell us that, in spite of the inter-personally lean nature of text-based forums, people are turning to the Internet morethan ever for “emotional support and succor” (p. 423). As understated by the au-thors in their concluding comments, this is a “vital but underappreciated” contribu-tion to the public welfare. Similarly, the Harris Poll cited by Rice in chapter 1found that 70% of Internet users had researched a disease or medical condition on-line, with 19% of those listing depression as the topic most frequently sought. Af-ter September 11, 2001 (well after the publication of the Rice and Katz volume),monitoring sources revealed that the CDC Web site had averaged some 75,000+unique visits a day from people looking for information about anthrax.2 None ofthese results are “flashy”—visitors aren’t looking for the latest downloadable soft-ware to put on their Personal Digital Assistants (PDAs)—but the implications forhealth communication are staggering.

New research should begin where Rice and Katz left off, finally accepting theInternet as a viable—if not unavoidable—channel for communication among“new consumers” (chapter 2). It should then move toward greater specificity in as-sessing the information-seeking behaviors of Internet users (chapter 3). Re-searchers should be in a position to juxtapose new findings in health communica-tion against current theories in health education and behavior change as implied bychapters 9 and 13.

The Internet and Health Communication: Experiences and Expectations is anexcellent starting point for researchers, policymakers, and Web designers who arelooking to make a substantive public and personal impact. It highlights the re-search that, once connected, should enable the development of health communica-tion campaigns that take full advantage of the Internet’s distinct capabilities tocomplement communications in other modalities. Like a well-worn travel book, its

372 BOOK REVIEW

2“Anthrax cases fuel 118 % more traffic to CDC.GOV, according to Nielsen/Netratings.” The pressrelease is available from www.nielsen-netratings.com.

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chapters serve as an invaluable guide for those who wish to understand more aboutthe habitat of the “new health information consumer.” Readers should recognize,however, that in many respects the journey has just begun.

REFERENCES

Fox, S., & Rainie, L. (2001). The online health care revolution: How the web helps Americans takebetter care of themselves. Pew Internet & American Life Project Online Life Report. Retrieved April22, 2002, from http://www.pewinternet.org

Levy, S. (2002, March 25). Silicon valley reboots: The dot-com bust was bad for Wall Street, but it wasthe best thing to happen to this high-tech crucible. Newsweek, pp. 42–50.

Prochaska, J. O., Redding, C. A., & Evers, K. E. (1997). The transtheoretical model and stages ofchange. In K. Glanz, F. M. Lewis, & B. K. Rimer (Eds.), Health behavior and health education: The-ory, research, and practice. San Francisco: Josey-Bass.

U.S.D.H.H.S. (2001). Information for health: A strategy for building the national health informationinfrastructure. Washington, DC: Author.

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