INTRODUCTION TO EVALUATION OF INTERACTIVE HEALTH COMMUNICATION APPLICATIONS

Virtually all aspects of society have been altered in some way by advances in computer and communication technologies. In 1997, the information technology industry was the single largest industry in the United States in terms of sales and accounted for 33% of the growth in GDP in 1996.1,2 An estimated 41.5 million U.S. adults were active users of the Internet in 1997,3 and more than 43% of Internet users have used it to research health information.4 At the same time that these new technologies have emerged, consumers seem to be demanding increasing access to a wide range of information, including health information, and social support as a vehicle for recovering from illness. Consumer demand for health information and the availability of new media technologies have spurred substantial interest in interactive health communication (IHC), the interaction of an individual—consumer, patient, caregiver, or professional—with or through an electronic device or communication technology to access or transmit health information or receive guidance and support on a health-related issue.5 Using this definition, IHC encompasses technology-mediated health communication and does not include direct communication such as face-to-face clinician-patient counseling. The panel chose the term IHC because it focuses on the content rather than on the technology that facilitates IHC. The panel uses the term IHC applications to refer to the operational software programs or modules that interface with the end user. This includes health information and support Web sites and clinical decision-support and risk assessment software (which may or may not be online), but does not include applications that focus exclusively on administrative, financial, or clinical data, such as electronic medical records, dedicated clinical telemedicine applications, or expert clinical decision-support systems for providers. Some of these latter applications, however, are integrated with health communication functions. The panel uses the term IHC technologies to refer to the hardware and infrastructure technologies that run or disseminate IHC applications, such as networks, computers, telecommunications equipment and the like. IHC applications are increasingly accessible to the public through the Internet and non-networked technologies, such as stand-alone computers and kiosks.6,7 Their major functions are to: (1) relay information, From the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services (Eng), Washington, DC; University of Wisconsin-Madison (Gustafson), Madison, WI; Dartmouth Medical School (Henderson), Dartmouth, NH; Oregon Health Sciences University (Jimison), Portland, OR; and San Diego State University and the University of California, San Diego (Patrick), San Diego, CA. Address correspondence to: Thomas R. Eng, VMD, MPH, Office of Disease Prevention and Health Promotion, HHS, 200 Independence Avenue, SW, Room 738G, Washington, DC 20201. Address reprint requests to: Mary Jo Deering, PhD, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Washington, DC 20201. Other panel members and staff: Linda Adler, MPH, MA, National Member Technology Group, Kaiser Permanente, Oakland, CA; Farrokh Alemi, PhD, Cleveland State University, Cleveland, OH; David Ansley, Consumer Reports, Yonkers, NY; Patricia Flatley Brennan, RN, PhD, FAAN, School of Nursing and College of Engineering, University of Wisconsin-Madison, Madison, WI; Molly Joel Coye, MD, MPH, The Lewin Group, San Francisco, CA; Mary Jo Deering, PhD, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Washington, DC; Albert Mulley Jr, MD, MPP, Massachusetts General Hospital, Boston, MA; John Noell, PhD, Oregon Center for Applied Science, Inc. and Oregon Research Institute, Eugene, OR; Thomas C. Reeves, PhD, University of Georgia, Athens, GA; Thomas N. Robinson, MD, MPH, Stanford University School of Medicine, Palo Alto, CA; and Victor Strecher, PhD, MPH, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI. For example, less than one year after free Medline searches became available on the Web, the number of searches increased 10-fold, and 30% of users were members of the general public (Testimony of Dr. Donald A.B. Lindberg, Director, National Library of Medicine to the House Appropriations Sub-Committee on Labor, HHS and Education, March 18, 1998. Accessed on April 6, 1998. Available from: URL: http://www.nlm.nih.gov/pubs/staffpubs/od/budget99.html For example, a search for the keyword “health” on the World Wide Web using common search engines yielded more than 16 thousand indexed Web sites (www.yahoo.com) and 20 million matching Web pages (altavista.digital.com) on October 28, 1998.