Use of the Internet for health promotion

Electronic Media

Image credit
“Deep Investigation" by Stefan,
http://www.ﬂickr.com/photos/st3f4n/4272645780/in/pool-862681@N20/

Friday, March 22, 13

Our children will
never know the link
between the two :)

Image credit
“Cassette tape" by eocs,
http://www.sxc.hu/photo/965831
“pencil" by drniels,


Use of
Electronic Media
the Internet
for Health
Promotion

Iris Thiele Isip Tan MD, MSc
Chief, Medical Informatics Unit
Assoc. Professor, UP College of Medicine

Image credit
“The Death Star plans are not in the main computer" by JD Hancock,
http://www.ﬂickr.com/photos/jdhancock/5845280258/in/set-72157616246711843/


Image credit
“Super Troopers!” by JD Hancock,
http://www.ﬂickr.com/photos/jdhancock/3597447738/in/set-72157626809398652

Health Promotion:
Empowerment

Image credits
“#thewretched” by drothamel
http://www.ﬂickr.com/photos/realestatezebra/8505117857/
“Twitter Poster" by N Delaney,
http://neildelaney.blogspot.com/2011/11/twitter-poster.html


www.coursera.org

The Internet & Health Promotion
Korp P. Health on the Internet: Implications for Health Promotion
Health Educ. Res. (February 2006) 21 (1): 78-86. doi: 10.1093/her/cyh043

Empowerment

Disempowerment
Image credit
“Only what you take with you" by JD Hancock,


www.facebook.com/EndocrineWitch

Halikan mo
na lang ako.
I don’t need the
extra calories :)

Image credit
“Untitled” by e.mcclay,
http://www.ﬂickr.com/photos/emcclay/4532232202/

http://endocrine-witch.net

The Internet & Empowerment

Enabling of advanced information
and knowledge retrieval
Anonymity
Creation of social contacts and
support independent of time and
space
Challenging the expert-lay actor
relationship

Image credit
“Taking the World by Storm” by JD Hancock,


http://www.ﬂickr.com/photos/
azrainman/1003163361/

“For the ﬁrst time in history, we know now how to store
virtually all humanity’s most important information and
make it available, almost instantly, in almost any form, to
almost anyone on earth. We also know how to do that in great
ways so that people can interact with it, and learn from it.”
Dryden, Gordon; Vos, Jeannette (2005). The New Learning Revolution: How Britain Can Lead
the World in Learning, Education, and Schooling. UK: Network Educational Press Ltd. p. 127


GMG ...
Google Mo G*g*!


Search
the Internet for
health information,
I can. Yes, hmmm.

~80% ﬁnd the health
information they need
Pew Internet & American Life Project

Image credit
“The true mystery of the world is the visible, not the invisible.” by JD Hancock,


8 out of 10 American
internet users have
searched online for at
least 1 major health topic!
from Tom Ferguson, MD
& the e-Patients Scholars Working Group (2007)
“e-patients: how they can help us heal healthcare”


Diet, nutrition, Exercise
Speciﬁc vitamins, or ﬁtness
disease or supplements 42%
medical problem 51%
66% Prescription or
Medical
treatment or OTC drugs
procedure 40%
51%

Health Topics Searched Online
from Pew Internet & American Life Project Nov 2004 Survey


3 Categories of e-Patients*
from Cain, Sarasohn-Kahn & Wayne (2000)
“Health e-People: The Online Consumer Experience”

The Well Image by WebWizzard
http://www.ﬂickr.com/photos/webwizzard/3931165028/

The Acutes
Facing a new
medical challenge

The Chronics
Chronic but
stable illnesses

* Includes caregivers

Image by iwd

60- 5- 30-
65% 1 6% 35%

The
Well
every
few
months

Internet Access
from Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)


Image by iwd

60- 5- 30-
65% 1 6% 2 35%

The The
Well Acutes
every
few everyday
months

Internet Access


Image by iwd

60- 5- 30-
65% 1 6% 2 35% 3

The The The
Well Acutes Chronics
every several
few everyday times a
months month

Internet Access


e-patient & Empowerment
From Von Knoop at al of Boston Consulting Group (2003)
“Vital Signs: e-Health in the United States

Severity of
Condition
High In control
Involved

Moderate

Informed
Low Accepting
Godlike Partner Supplier
Attitude Toward Physician

From Von Knoop at al of Boston Consulting Group (2003) Image by iwd

1

Accepting Informed In control
Doctor- Junior
dependent & medical
uninformed partners

Rarely go
online for
health
information


1 2

Accepting Informed Involved In control
Doctor- Doctor-
dependent & dependent
uninformed but informed

Rarely go Go online
online for before or
health after MD visit
information


1 2 3

Doctor- Doctor- Junior
dependent Autonomous
dependent & medical
but informed patients
uninformed partners

Rarely go Go online Prefer to
online for before or make joint
health after MD visit decisions but
information defer to MD


1 2 3 4

Doctor- Doctor- Junior
dependent Autonomous
dependent & medical
but informed patients
uninformed partners

Rarely go Go online Prefer to Make their
online for before or make joint own decision
health after MD visit decisions but even if MD
information defer to MD disagrees

Will the Internet
strengthen the position of
the patient and the public vs
experts and institutions?

Health Promotion:
Empowerment
Image credit
“Storm Loss” by JD Hancock,


“As opposed to the doctor-centric, curative
model of the past, the future is going to be
patient-centric and proactive.”
Elias A. Zerhouni MD, NIH Director
Dec 2007

Image by JD Hancock
http://www.ﬂickr.com/photos/jdhancock/4100030094/

www.endocrine-witch.net


Image credit
“smiley egg 4” by bizior, http://www.sxc.hu/photo/939148

DIABETES?
Ok lang yan!



Ask questions online without anyone
ever getting to see you or know who you are.

Image credit
“Storm Trooper vs Storm Shadow” by JD Hancock,


http://thesweetliferunner.blogspot.com/2012/06/
power-of-ampalaya-plus.html

Web 1.0
“the mostly read-only Web”

Image from liquene
http://www.ﬂickr.com/photos/liquene/3900145161/

Image from adactio
http://www.ﬂickr.com/photos/adactio/78600196/

Web 2.0
“the wildly read-write Web”

Crowd-sourcing
Harnessing collective intelligence

Image from antigone78
http://www.ﬂickr.com/photos/antigone/457089364/

“Movement in which networked patients
shift from being mere passengers to
responsible drivers of their health ...
providers encourage and
value them as full partners”
Society for Participatory Medicine

Image by Liz Grace
http://www.ﬂickr.com/photos/liz-grace/5078868809/

Participatory Medicine

Patients as members of
collaborative treatment teams
Community health
decision-making

Image fro
m
http://ww network
w.sxc.hu/
photo/98
5516

“Mindfully”
involved in
treatment
Online community/
“Participatory Medicine”
support group from Wikipedia

Ten Reasons Why You Should Join a Diabetes Social
Network by Manny Hernandez on www.dlife.com

Social but safe? Quality and safety
of diabetes-related online social networks
Weitzman et al. J Am Med Inform Assoc 2011;18:292-297

Image credit
“Storm crowd" by JD Hancock,


Quality and safety of diabetes-
related online social networks

Alignment of content with diabetes science
and clinical practice recommendations
Safety practices for auditing content,
supporting transparency and moderation
Accessibility of privacy policies and the
communication and control of privacy risks
Centralized sharing of member data and
member control over sharing

Image credit
“Heart of the Storm" by JD Hancock,


Quality and safety of diabetes-
related online social networks

50% aligned
with science
70% use moderation
(internal safety review)
Poor readability impedes
risk communication
Only 3 sites support
member controls over
personal information


Do we have an obligation for protective
action to improve quality and
support safety of social networks?
Image credit
“Career-limiting move” by JD Hancock,


“... interpersonal interactions are essential for
persuading individuals to adopt
health-promoting behaviors.”

Cassell et al. Health Communication on the Internet: An Effective Channel for
Health Behavior Change. Journal of Health Communication 1998, 3:71-79

Image credit
“Day 359” Pasukaru76,
http://www.ﬂickr.com/photos/pasukaru76/4857051395/


To persuade ...

Motivate receiver to attend to messages
Include solicitation of feedback
Elaboration of arguments and
counter-arguments

Image credit
“Maybe it’s another drill” by JD Hancock,


Limit
salt intake.

1 tbsp soy sauce Image credit

= ~900 mg sodium
“soy sauce” by yuichirock,
http://www.ﬂickr.com/photos/yuichirock/5092927242/


“We do not persuade
others at all; we only
provide the stimuli
with which they can
persuade
themselves.”
Simons HW (1971).
Persuasion & Attitude Change

Image credit
“Not too bright” by JD Hancock,


Is it really worth it?
45 min
= recreational
swimming*

* This is just an approximation.
Will vary depending on calories per
Image credit pizza slice and person’s weight.
“slice of pizza” by nruboc,


Is it really worth it?

85 min
walking
(5 kph)*
=
* This is just an approximation.
Will vary depending on calories per Image credit
“doughnut” by pzado,
doughnut and person’s weight. http://www.sxc.hu/photo/880587


Make the right choice.

` OR
Banana
banana split?
Image credit
“Bananas” by harper07, Image credit
http://www.sxc.hu/photo/985337 “Banana split” by gabriel183,
http://endocrine-witch.net http://www.sxc.hu/photo/592509

Make the right choice.

OR
Apple apple pie?
Image credit
“An apple” by magurka, Image credit
http://www.sxc.hu/photo/1187239 “Dutch apple pie 3” by mikehome,
http://endocrine-witch.net http://www.sxc.hu/photo/918696

“Paradoxically, a patient’s interest in knowledge
may not always accompany an interest
in the medical decision making process.”
Gerber & Eiser, Journal of Medical Internet Research 2001

Image by nightRPstar
http://www.ﬂickr.com/photos/ninjanoodles/1586212326/

Image by Kurhan

Informed
decision-maker

Knowledge-acquirer

Physician-Patient Encounters


Image from carbonNYC
http://www.ﬂickr.com/photos/carbonnyc/3440688097/

Interested in learning
more about the
treatment decided
on by MD

The Knowledge-Acquirer
Provides some personal values to the physician

http://www.ﬂickr.com/photos/72341818@N00/4555752947/

Extra time to discuss
what patient knows
Avoid frustration of not
being the sole source
of information

The Informed Decision-Maker
Possesses both preference and knowledge


Image by Niklas Hellerstedt
http://www.ﬂickr.com/photos/niklashellerstedt/2414448568/

Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)

Internet-hostile
Clearly uncomfortable with, and sometimes seem to feel
offended by patient’s attempts to learn more online

“[Most doctors] really
do like to think they
have ALL the answers.
This will never
change, I am afraid.”

Pew Internet Project e-Patient Survey

Image by caricaturas
http://www.ﬂickr.com/photos/caricaturesbynelson/2031107541/

Image by southerntabitha
http://www.ﬂickr.com/photos/tabithahawk/567135091/


Internet-friendly
Encourages patient’s online efforts


Image by Charles Williams
http://www.ﬂickr.com/photos/charlesonﬂickr/3926259585/

Patients will likely seek
a “second opinion”
on the internet


The Internet Prescription
Recommend websites to the patient

Medline Plus
http://www.nlm.nih.gov/medlineplus


Mayo Clinic
http://www.mayoclinic.com


Look for the
HON Code seal

Health on the Net Foundation
Medical information you can trust!
http://www.hon.ch
also provides HONtools, HONsearch, HONtopics


Image by Yogendra174
http://www.ﬂickr.com/photos/yogendra174/4437447471/

Do not underestimate
patients’ ability to
provide useful
online resources


Image by steved_np3

Do not overestimate
the hazards of
imperfect online
information
Database of Adverse Events Related
to Internet Use (DAERI) reported only
a single case of possible fatality from
2000-2004


The Internet & Disempowerment

Shift towards expert control
Widens the gap between the
“information-rich” and the
“information-poor”
Increase in medicalization and
healthism
Image credit
“Creamed” by JD Hancock,


Is the power of judgment solely
in the hands of the expert?

Image credit
“See no Vader, Hear no Vader, Speak no Vader” by JD Hancock,


87% of HON-accredited sites
too difﬁcult to read
Kusec et al. Stud Health Technol Inform 2003;95:655-60.

Only 28% of diabetes
patient education sites are
HONcode-accredited
Thakurdesai et al. Patient Educ Couns 2004;53:309-13.

Health on the Net Foundation
Medical information you can trust!
http://www.hon.ch

Existing content in the WWW does
not meet the content needs of
underserved communities.
Lazaras & Mora (2000). Online content for low income
and underserved Americans: the digital divide’s new frontier.

Image credit
“I fought the lawn ... and the lawn won.” by JD Hancock,


More ...
Local-oriented content
Accessible to those with low literacy
Information in multiple languages
Information created by the
underserved communities
Lazaras & Mora (2000). Online content for low income
and underserved Americans: the digital divide’s new frontier.

Image credit
“I fought the lawn ... and the lawn won.” by JD Hancock,


Laging nauuhaw?

Baka diabetes na yan!
Magpatingin sa doktor.

Image credit:
“Drinking” by nkzs,


May diabetes ba si Itay o Inay?
Magpa-check up ka na! Namamana ang diabetes.

Image credit:
“paper chain in the dark” by hoeﬁ,
http://www.sxc.hu/photo/1215912 http://endocrine-witch.net

Alam mo ba kung ano
ang blood pressure mo?
Isa sa bawat apat na Pilipino
ang may alta presyon.
2008 National Nutrition & Health Survey

Image credit
“sphygmomanometer 1” by sundesigns,


Limit salt
intake

Image credit:
1 tbsp bagoong
“Kare-kare @ Golden Cowrie” by dbgg1979,
http://www.ﬂickr.com/photos/dbgg1979/3494113750/ = ~400 mg sodium

Diet ka ba kaya coﬀee na lang?
Skim milk, no whip cream and half the syrup :)

Image credit:
“coffee bean cup” by angood,
http://www.sxc.hu/photo/1005115 http://endocrine-witch.net

Are you a Downton Abbey fan?
Try the TV exercise game!
http://www.wikihow.com/Sample/
Downton-Abbey-Exercise-Game

Run in place for 30 seconds
every time O’Brien glares at
someone across the servant’s table

Image credit
“Highclere Castle (aka Downton Abbey Do 15 jumping jacks
in the TV series)” by garybembridge,
http://www.ﬂickr.com/photos/sis/156108576/ every time Mary’s hat/dress/gloves etc. are fabulous
http://endocrine-witch.net (add a set if Edith is less than fabulous in the same scene)


Awat na sa bacon!
Study* ﬁnds that high intake
of processed meat increases risk
of premature death by 44%.

*Meat consumption & mortality - results from the European Prospective Investigation
into Cancer & Nutrition BMC Medicine 2013, 11:63 doi:10.1186/1741-7015-11-63

“The quality of Internet health information is ... closely
linked to the trust that people place in it. However,
quality (according to scientiﬁc standards) and trust
are by no means identical issues.”


Image credit
“Trash talk" by JD Hancock,


Information Quality Criteria
Stvilia B et al. A model for online consumer health information quality. JASIST 2009;60(9):1781-91

Gallup Poll (2011):
Home internet access
still out of reach
for many worldwide
Lymari Morales
http://www.gallup.com/poll/159815/home-internet-access-
remains-reach-worldwide.aspx#1

Global median: 32%
Sweden &
Singapore: 93%
US: 80%
China: 34%
Philippines: 21%
Image credit
“The Death Star plans are not in the main computer" by JD Hancock,


Healthism
Excessive, usually anxious preoccupation with health
Image credit
“(Maybe he won’t notice" by JD Hancock,


Medicalization
When a normal bodily process/characteristic or a previously normal
behavior is considered worthy of medical diagnosis or treatment
Image credit
“(Maybe he won’t notice" by JD Hancock,


Kuya, are you
chubby
but cute?
Filipino male
112 lbs for 5 ft
Add or subtract
4 lbs for every inch
above or below 5 ft
Know your
ideal weight Image credit

for height.
“The scale” by crossﬁre,


Ate, are you Filipino female
106 lbs for 5 ft

pleasantly Add or subtract
4 lbs for every inch

plump? above or below 5 ft

Know
your ideal
Image credit
weight for
“Weighing” by nubuck,
height.

“We can’t value what we don’t understand.
And we’ll only understand what something can
offer by poking at it and trying it in different
ways. The world is increasingly networked. And
when you ﬁnd the right place to connect, share
and create, you’re likely to ﬁnd value.”

Thank You
http://www.endocrine-witch.net
@endocrine_witch

http://www.slideshare.net/isiptan

Image from http://wthr.frumph.net/


Use of the Internet for health promotion

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