# Presentation: 928867

##  Future of Health CommunicationSusannah FoxAssociate DirectorPew Internet ProjectMay 4, 2007

**Notes:**
One of the most significant trends the Pew Internet Project is tracking is the rise of the participatory Web, or what some call Web 2.0. Today’s internet users, especially Digital Natives, turn to a diverse range of information sources online, many of which are created and maintained by their peers, not by credentialed experts.

I believe it is no longer useful to ask about “the internet” when many users would view WebMD as more akin to The Washington Post than akin to a friend’s blog or MySpace page, yet all four may be sources of health information. 

## Dooce.com:  Personal story of skin cancer

**Notes:**
39% of adult internet users read blogs and 8% of adult internet users keep a blog. In a special survey of bloggers we did in 2006, we found that most use their blog to chronicle their personal lives, which sometimes includes health concerns. 

For example, Dooce.com is one of the Top 50 blogs on the Web in terms of traffic. Last summer, Heather Armstrong, the woman behind Dooce, wrote about her basal cell carcinoma, which she had nicknamed “Ed.” This blogger doesn’t pretend to be a health educator, but she raised awareness of skin cancer among her thousands of fans. 

Most bloggers have much smaller audiences, but they can be influential in their micro-local communities in the same way that Dooce is influential. In qualitative research, we find that expert patients – those who have just gone through a treatment, for example --  are vital sources for basic home care tips and information. They are the “just in time someone like me” that many e-patients are looking for online.

## MySpace: “Fighting back cancer”

**Notes:**
20% of internet users age 18 and older have created their own profile on a social network site like MySpace or Facebook. 55% of online teens have done so.  Social network profiles are often messy, silly, heartfelt collages of photos, music, videos and links to other sites.  This is a page maintained by a 28-year-old cancer survivor from Fayetteville, NC, who provides tips on cancer detection, prevention, and links to ways to contribute money to the cause.  Teenagers and people in their 20s use MySpace and Facebook as their starting points online. For better or for worse, that is the current reality of the internet and possibly a trend that will grow in the future.

## Flickr: Chemo photos

**Notes:**
37% of internet users have uploaded photos to a public site.  28% of internet users have tagged or categorized content online such as photos, news stories or blog posts. The photo site Flickr is a great example of how people categorize their own photos and put them online for public display.  I found this one by searching for “chemo” – 1,700 photos came up. The caption on this photo explains that the lump on the girl’s chest is a port for her weekly chemo treatments for kidney cancer.  Where else could you see such an intimate moment?  Where else could someone get a clear picture of what weekly chemo actually looks like?

## YouTube: How to use an inhaler

**Notes:**
56% of adult internet users have watched a video clip or listened to an audio clip online. This how-to video was uploaded from a medical practice in rural Wales. I found another inhaler how-to video that was filmed in Guatemala by a med student from Penn. 

My last example of how Web 2.0 intersects with health & health care is Wikipedia. 36% of adult internet users have looked for information on Wikipedia. Wikipedia is the second site listed on a Google search for the word “asthma” – between NIH and MedlinePlus. 

Internet users, esp. young people, are not just surfing the Web. They are shaping it.  They download, upload, mash it up, and make it their own. And their peers rely on that new content to make choices about what movie to see, what products to buy, and I would argue, they will use it to answer health questions that pop up. Digital Natives, young people who grew up online, use multiple sources for information. The sources may not be vetted or credentialed, but the sources are seen as valid. I propose that the HINTS survey needs to diversify the health communication questions about the internet to begin tracking the participatory Web.

## Share of Americans online by education level(Based on Pew Internet Project telephone surveys)

**Notes:**
About one in five adults remains “truly disconnected” from the internet – they have never been online and don’t live with anyone who goes online.  That group is dominated by people over age 70, those with less than a high school education, those living with a disability or chronic disease, and those who do not have strong English skills.  They are as much a part of our future as are the Digital Natives.

This slide shows the disparity among college graduates and high school graduates, but the gap is even greater among those with less than a high school education, which describes about 40% of Latino adults in the U.S.  Just one-third of Latino adults with less than a high school education go online. Just one-quarter of African Americans with less than a high school education go online.

## Share of Americans online by disability status(Based on Pew Internet Project surveys, Nov-Dec 2002 and Aug 2006)

**Notes:**
To define this special group, we asked: “Does any disability, handicap, or chronic disease keep you from participating fully in work, school, housework, or other activities, or not?”

17% of adults said yes in Aug. 2006 (about the same as what we found in 2002).  Half go online. Two-thirds of American adults living with a disability or chronic illness are over age 50. This probably contributes to the relatively low internet penetration rate for this group.

## Please contact me

- Susannah Fox
- Associate Director
- Pew Internet & American Life Project
- _[sfox@pewinternet.org](mailto:sfox@pewinternet.org)_
- (202) 419-4511

**Notes:**
In conclusion, I recommend that HINTS consider diversifying the health communication questions about the internet as a source of information, but I also recommend that researchers continue to track the small but significant group of adults who are offline in an online world.