Interactive Health Communication Workbook February 25 & 26, 2002

100 College Street Room 213 The Banting Institute University of Toronto Toronto, Ontario M5G 1L5 Tel: 416.978.0522 Fax: 416.971.2443 Email: [email protected] www.thcu.ca ADDITIONAL COPIES & COPYING PERMISSION Permission to copy this resource is granted for educational purposes only. If you are reproduc- ing in part only, please credit The Health Communication Unit, at the Centre for Health Pro- motion, University of Toronto. Additional copies of this resource are available free of charge. Please fax requests to (416) 971-2443.

The Health Communication Unit at the Centre for Health Promotion University of Toronto 100 College Street, Room 213 The Banting Institute Toronto, Ontario M5G 1L5 Tel (416) 978-0522 Fax (416) 971-2443 E-mail: [email protected] http://www.thcu.ca

DISCLAIMER The Health Communication Unit and its resources and services are funded by the Health Pro- motion Branch, Ontario Ministry of Health and Long-term Care. The opinions and conclusions expressed in this paper are those of the author(s) and no official endorsement by the Ministry of Health and Long-term Care, Health Promotion Branch is intended or should be inferred.

ACKNOWLEDGEMENTS For their input and assistance in the development of this resource, THCU would like to acknowledge the 2002 Interactive Health Communication Workshop Project Team: Larry Hershfield, The Health Communication Unit, Centre for Health Promotion at the University of Toronto Alison Stirling, Ontario Prevention Clearinghouse Shawn Chirrey, Canadian Health Network Youth Affiliate Penney Kirby, Ontario Health Promotion Resource System Dave Haans, Department of Sociology, University of Toronto Cameron Norman, Dept. of Public Health Sciences, University of Toronto Oonagh Maley, TeenNet The THCU would also like to recognize the 2000 and 2001 Health Promotion Summer School Project Team for their contributions to this workbook which have been retained (afilliations in 2000 and/or 2001): Michelle Black, Canadian Health Network Erica Di Ruggiero, Canadian Health Network Liz Rykert, Meta-Strategies, Inc. Paulina Salamo, Canadian Health Network Contents

Introduction ...... 1

Health Promotion Strategies: Functions & Capabilities of Online Applications...... 3 (Alison Stirling, 2002)

Educational Applications ...... 7 (Larry Hershfield and Shawn Chirrey, 2002)

Review Online Examples Canadian Health Network (Erica Di Ruggiero and Paulina Salamo, 2000) ...... 17 Ontario Health Promotion E-Bulletin Database (Larry Hershfield, 2001).23 CyberIsle (Oonagh Maley, 2001) ...... 25

Online Communities: Connecting with Others...... 35 (Alison Stirling, 2002)

Connecting with Others: Concepts & Strategies...... 49 (Liz Rykert, 2000)

Finding the Information You Need: A Tutorial for People Working in Health Promotion...... 55 (Penney Kirby, 2002)

Internet & E-Health Landscape: Why Use The Web For E-Health Promotion ...... 85 (Shawn Chirrey, 2002)

Assessing the Quality of Web Sites and Applications ...... 109 (Larry Hershfield and Shawn Chirrey, 2002)

Phases & Stages of Web Site Design ...... 115 (Oonagh Maley, 2002)

Evaluating the Impact of Your Web Site...... 129 (Cameron Norman, 2002)

Web Site Traffice – Part 1: Evaluating the Use of Your Web Site...... 133 (Dave Haans, 2002)

Web Site Traffice – Part II: Increasing Traffic to Your Web Site...... 143 (Dave Haans, 2002)

Clear Writing for the WWW...... 153 (Michelle Black, 2000)

Introduction 1

This workshop deals with general issues, as well as specific skills. General issues include functions, capabilities, and applications relative to the strategies of Health Promotion outlined in the Ottawa Charter and social science behavioral change theory. We also look at how quality of websites is defined and how they are actually assessed relative to quality criteria. We also review trends. In terms of skills, we look at finding information, building online communities, developing websites, and evaluation. Therefore, at the end of the workshop, we hope participants (depending on the sessions they attend) will be able to: 1. Identify major criteria for evaluating IHC applications, including health promotion values. 2. Identify ways in which IHC supports the major health promotion strategies. 3. Identify technical ways (e.g. listserv) to connect with others, as well as concepts and strategies for building online communities. 4. Search for information and related organizations and conduct a bibliographic search. 5. Identify key stages for website development, and guidelines for each stage. 6. Select appropriate approaches for formative, process and summative evaluations of own IHC applications.

Interactive health communication (IHC) can be defined as the interaction of an individual—consumer, patient, caregiver, or professional - with an electronic device or communication technology to access or transmit health information or to receive guidance on a health-related issue. For the purposes of this site, this definition does not include electronic applications that exclusively focus on administrative, financial, or clinical data, such as electronic medical records, dedicated telemedicine applications, or expert clinical decision-support systems. Some applications, however, integrate some of the above functions with health communication. (Source: The Science Panel on Interactive Communication and Health, October 1997)

More information about this workshop can be found at: http://www.thcu.ca/workshops/ihcWkshp.htm

A master list of all the URL’s used during this workshop is available at: http://www.thcu.ca/infoandresources/publications/URL_list.htm Interactive Health Communication Workbook 2 Health Promotion Strategies: 3 Functions & Capabilities of Online Applications

by Alison Stirling, 2002 OPC (Ontario Prevention Clearinghouse) [email protected] http://www.opc.on.ca

Health Promotion Strategies

Functions and Capabilities of Online Applications

Health Promoters Use the Internet to

PUSH - provide information

PULL - find information

CONNECT - work together

Ottawa Charter for Health Promotion 1986

5 Action Areas: • Strengthening Community Action

• Healthy Public Policy

• Create Supportive Environments Strategies: Health Education • Develop Personal Community Development Skills Advocacy Policy Development Self-Help • Reorient Health Communications Services Interactive Health Communication Workbook 4

Health Promotion Subject Matrix

To use the search: choose one subject in each area. By choosing subjects in The OHPE Subject several areas Matrix is consistent you can build a with the key elements profile for the of health promotion - information action areas of you are seeking. Start Charter, determinants the search with of health, settings, the "GO!" strategies, populations button at the and issues. bottom, and It offers a framework to the search will search for health scan the database promotion information, ideas, resources, people

Health Promotion Action Areas

Strengthen Online Application Examples Community Action Web Communities http://www.web.ca/web/commun/index.h Set priorities, make Community Building tml decisions, plan, and Planning via online Kids HelpLine Virtual strategize, implement communities, e-lists Communities for community http://kidshelp.sympatico.ca/talk/home.htm

empowerment. Community action Community Building Tools Examples: modules and tools, - Community planning http://ctb.lsi.ukans.edu/tools/tools.htm checklists smoke-free social Halton Community Action programs with teens for Drug Free Youth - Youth engaged in online http://substanceabuse.region.halton.on.ca/ discussions in virtual communities Charity Village Communities

Health Promotion Action Areas

Healthy Public Policy Online Application Examples:

Combines diverse Research databases Alcohol Policy Network approaches including http://www.apolnet.org legislation, fiscal E-Forums for input Campaign 2000 for kids http://www.campaign2000.ca measures and Online Polling Smokescreen Forums organizational change Linking to related http://www.smokescreen.org campaigns Examples: Toronto Star Speak Out! http://www.thestar.com Tobacco packaging legislation changes Join Together Online Selling cigarettes to http://www.jointogether.org minors controls

Health Promotion Strategies: Functions & Capabilities of Online Applications 5

Health Promotion Action Areas

Create Supportive Online Application Examples: Environments Quit 4 Life – Stories E-Communities, Stories http://www.quit4life.com/html/s Living and working Research facts & plash.html conditions that are forums safe, stimulating Canadian Policy Research Listservs and forums Network http://www.cprn.org/cprn.html Examples: Peer supports Ontario Self-Help Network Forums http://www.selfhelp.on.ca/discus sion.html

Health Promotion Action Areas

Personal Skills Online Applications Examples Development Quizzes, skill testing CyberIsle http://www.cyberisle.org Providing information, Quit4Life Interactive Quiz education for health and Online forums, chats http://www.quit4life.com/html/steps/step1.html enhancing life skills Simulations Sympatico HealthTalk

http://forums.sympatico.ca/ - see also the section on FAQs, Facts & Interactive Virtual Party educational strategies information, visuals http://www.virtual-party.org O2Zone BC Tobacco Facts http://www.tobaccofacts.org/o2zone.html

HP Generic Strategies

Health Education Online Applications Examples Includes behavioral change, information Tailored Message/ Profile My Heart Watch

provision (see sec 6) http://www.myheartwatch.org Video-streaming PERIL Risk Management http://www.uoguelph.ca/cntc/educat/peril/ BC Tobacco Facts http://www.tobaccofacts.org

Community Online Applications Examples Development Success Stories Youth Activism http://www.youthactivism.com Creative Spaces for contributions Alzheimer Society http://www.alzheimer.ca/english Online Community Building /index.htm Online Community ToolKit http://www.fullcirc.com/community/com munitymanual.htm

Interactive Health Communication Workbook 6

HP Generic Strategies

Advocacy Online Applications Examples

Online Action Campaigns Americans for Nonsmokers Includes campaigns, Rights http://www.no-smoke.org actions, research to try Fax, Email, Letters online

and achieve changes in Effective Action Alerts public and private sectors SmokeFree Action Alerts http://www.smokefreeair.org/

Design Effective Alerts http://dlis.gseis.ucla.edu/people/ pagre/alerts.html

Policy Development Online Applications Examples Multimedia used to reach multiple sources. Email to fax, e-forums, phone, postal mail

HP Generic Strategies

Self-Help & Online Applications Examples Capacity Building CD – ROMS, kiosks Canadian Red Cross On Board CD-ROM http://www.redcross.ca/english/ onboard/online.html Interactive sites Healthy Student Software http://www.ualberta.ca/HEALTHINFO Teen E-Zine REACT Ezine http://www.react.com Other E-Zines Digital Eve Toronto Ezine http://www.ideaidee.com/

Communications Online Applications Examples Email & Web Newsletters How To Do Email Bulletins http://www.wilsonweb.com/articles/new sletter.htm

Educational Applications 7

by Larry Hershfield, 2002 The Health Communication Unit [email protected] www.thcu.ca Educational and Applications Shawn Chirrey, Manager, Youth Affiliate Canadian Health Network

100 College Street Room 213 The Banting Institute University of Toronto Toronto, Ontario M5G 1L5 Tel (416) 978-0522 Fax (416) 971-2443 E-mail: [email protected] www.utoronto.ca/chp/hcu/

Developing Science-based Educational Applications

Decide what key elements of change apply to your audience and desired change. (Text) Review the online applications. (Information Table) Prioritize and develop the most effective and efficient of the potential applications.

Workshop Task

One of nineteen potential change elements has been assigned to you. Quickly agree on an audience and behavior. Visit the examples given in the Table. Visit others known to you. Be prepared to discuss: strengths, weaknesses, applications of this approach. Be prepared to nominate other exemplar sites (submit on file cards) Interactive Health Communication Workbook 8

1. The person has formed a Explanation strong positive intention (or Person/audience believes they are at risk for the problem, that the conse- made a commitment) to perform the behaviour. quences are severe, and that the proposed behaviour will lower the risk or prevent the problem.

Strategies • Provide clear information about the population at risk and the recommended behaviour. • Increase audience awareness about the need for change. • Provide details of outcome if existing behaviour continues. • Personalize information on risks and benefits. • Incorporate information about likely positive results of adopting recommended behaviour, into advice.

2. There are no environ- Explanation mental constraints Barriers can be tangible (e.g. not enough time or money, no access to facil- (barriers) that make it impossible for the ities or programs, etc.) or psychological (anxiety, discomfort, social pressure, behaviour to occur. etc.) and supportive environments can be created at many levels (e.g. society level policies, workplace or organizational policies, home environments, personal social support networks, etc.).

Strategies • Determine audience barriers to action and attempt to rectify. • Create supportive environments whenever possible.

3. The person has skills Explanation necessary to perform the Person/audience has knowledge and ability to take steps to make behaviour behaviour. change easier and success more likely. This also involves doing the behaviour properly so that the desired outcome is achieved (e.g. improper exercise can result in injury, or no effect rather than improvement in cardio- vascular health).

Strategies • Provide specific how-to information/training. • Assist with setting quantifiable, realistic, graduated and moderately difficult goals. • Identify/provide role models to emulate. • Provide suggestions/teach how to find own solutions for barriers. • Teach how to critically and realistically assess past failures/current relapse so that lessons can be learned and progress continues rather than stops. Educational Applications 9

Explanation 4. The person believes the advantages (benefits, antici- Benefits/costs can be tangible (e.g. increased endurance, financial savings, pated positive outcomes) of weight gain, medication side effects, etc.) or psychological (e.g. anxiety, performing the behaviour discomfort, sense of approval, etc.). outweigh the disadvan- tages (costs, anticipated Strategies negative outcomes). • Incorporate information about likely positive results of adopting recommended behaviour, into advice. • Increase benefits through incentives, assistance. • Emphasize positive and downplay negative consequences of recommended behaviour. • Personalize information on risks and benefits. • Assure visibility of positive results of people who have adopted recommended behaviour.

Explanation 5. The person perceives more social pressure to The person/audience perceives that people who matter to them (friends, perform the behaviour than family members, community/social network opinion leaders, celebrities, to not to perform the physicians, etc.) support/encourage the recommended behaviour (e.g. As behaviour. long as a young girl believes that the norm among her friend is striving for a dark tan, she is not likely to use sunscreen. As long as a person believes that they will be rejected if they suggest condom use, they are not likely to engage in the behaviour)

Strategy • Determine who is important to person/audience and either increase their support for behaviour or increase audience perception that the people important to them support the behaviour.

Explanation 6. The person perceives that the behaviour is The problem and the recommended solution/behaviour must be relevant consistent with their and appropriate to culture, lifestyle, beliefs, etc. self-image and does not violate their personal Strategies standards. • Personalize information on risks and benefits. • Tailor idea/program/behaviour for the intended audience’s values, norms, or situations. • Set goals within context of audience’s pre-existing goals. Interactive Health Communication Workbook 10

7. The person’s emotional Explanation reaction to performing A person’s emotional reaction will be affected by how they are rewarded for behaviour is more positive than negative. their behaviour. Rewards can be tangible or psychological and can be provided by others, or by self. It is important that rewards are meaningful, so person/audience should participate in choosing appropriate rewards when feasible.

Strategy • Set up systems of reinforcement tailored to intended audience.

8. The person believes (has Explanation confidence) they can Person/audience has confidence in their ability to take action and persist in execute the behaviour under a number of different action through difficulties and barriers including relapse. For example, a circumstances (i.e. the person must have strength of confidence in themselves to state their wishes person has the perceived to use a condom clearly before or during an intimate encounter. self-efficacy to execute the behaviour). Strategies • Provide specific how-to information/training. • Assist with setting quantifiable, realistic, graduated and moderately difficult goals. • Provide suggestions/teach how to find own solutions for barriers. • Teach how to critically and realistically assess past failures/current relapse so that lessons can be learned and progress continues rather than stops. • Set up systems of reinforcement tailored to intended audience. As you have probably noticed, in many cases, the strategies to bring a person to the point where they meet the condition, are the same for more than one condition. To make this framework even easier to apply, we have gone one step further, and made a concise list of the general strategies with examples of how to apply them (and how they have been applied online). Educational Applications 11 Examples: benefits and risks on Personalize information 4. Examples: Provide details of outcome if existing behaviour continues. 3. Examples: change. the for about need awareness Increase 2. Examples: the recommended Provide and population at risk information the clear about 1. • show smokers how other smokers who resemble them have been affected by affected been have them resemble who smokers other how smokers show • show young girls (who care about appearances) how sun exposure will cause • •premature death/injury of friend/family • disability • •death aging show a smoker the result of their blowing in a CO monitor • communication campaign • IV drug users? use clean needles • cover up use exposed is the sunscreen and Anyone who sun? to • Quit smoke? who women Pregnant • behaviour. smoking early aging General Strategies Online Application Specific Example Specific Application Online Strategies General www.hc-sg.gc.ca/real/smoking Nick’s Yellow Fingers Club (HC) – Anti-Smoking ADS http://www.lungusa.org/bin/wall/wallview.pl American Lung Association (Wall of Remembrance) www.cancer.ca Society: Cancer Canadian www.heartandstroke.caH&S Canadian Lung Association: www.lung.ca http://www.lungusa.org/bin/wall/wallview.pl American Lung Association (Wall of Remembrance) www.hc-sg.gc.ca/real/smoking Nick’s Yellow Fingers Club (HC) www.cancer.ca Society: Cancer Canadian Foundation: www.heartandstroke.ca & Stroke Heart www.lung.ca Lung Assoc.: Canadian www.hc-sc.gc.ca/real/smoking Nick’s Yellow Fingers Club (HC) www.hc-sc.gc.ca/hppb/tobaccoreduction/resources.htm Health (HC) Canada or roll models. at youthdirected by youth campaigns of AD Example dieing. relatives or their smokers Show examples of young impacts. and info, statistics, etc. on risk Associations provide clear loss from lung cancer. Personal experience’s of from around the world). time video of Ad campaigns Anti-Smoking ADS (quick Top 10 International behaviours. and risks on info Clear Interactive Health Communication Workbook 12 On-line examples of real real of examples On-line world programs pro- that financial where access vide and other barriers may free programs, fee (no exist condoms, clean needles, patch etc.) the Phone (multiple Kids Help confiden- for points access tiality – phone or web-based) supportOn-line/phone in access overcome general barriers of time, distance especially for isolated or (care- populations shut-in givers, etc.), rural, or busy con- time with people straints. Provides info on process process on info Provides supportsquitting, and side effects. Decision Balance tool cre- to weigh environment ates personal your positiveout and negatives about smoking. Planned Parenthood Toronto (reduce sexual health barri- Planned Toronto Parenthood ers) www.ppt.on.ca Clinic Shout CHC & West CHC (Queen Toronto Central Barriers): www.ctchc.com City Health – Inner Unit Health – Public of Toronto City www.city.toronto.on.ca/health/index.htm Phone: http://kidshelp.sympatico.ca Help Kids in general self-help On-line IVillages’s All Health – Smoking Resources – Smoking Health All IVillages’s http://www.allhealth.com/conditions/abuse/0,4264,377,00.html Balance) – Decision Zine (Smoking TeenNet www.cyberisle.org General Strategies Online Application Specific Example traditional (difficult to use) stethoscope model stethoscope use) to (difficult traditional available coming) continue to commitment into advice • etc.) life, longer energy, (more smoking of quitting benefits all discuss • and reduces risk sunscreen early how skin aging much the explain of cancer. • program exercise for fees eliminate or reduce • patch nicotine the benefits cover so that workplace policy adjust • short are lists waiting so clinic mammography at staff increase • use) (easy pressure blood make to available rather digital monitor than • to program/facility transportation provide • produce low literacy information materials • readily are tests HIV needles, clean condoms, where unit mobile a provide • no - seminar cessation free one-time provide (e.g. risk/trialability low ensure 5. behaviour, recommended adopting of results likely about information Incorporate Examples: 6. rectify. attempt to and action to barriers audience Determine Examples: Educational Applications 13 Examples: difficult goals moderately and setting realistic, graduated with quantifiable, Assist 9. Examples: information/training how-to specific Provide 8. Examples: Create supportive environments whenever possible 7. reduce smoking before quitting • walking slowly start up vigorous by walking day and ten to minutes per work • • promote physical activity physical guide promote • use how them to and best condoms that work type of pamphlets provide on • lesion cancer skin possible identify to how teach • sunscreen and apply skin check to reminding washrooms beach in stickers put • build low income housing • build walking/bicycle paths in community • get company to offer low-fat food choices • access that to easy groups are up set support • reassurance provide • change) behaviour successful when deposit refundable (prizes, incentives • policies non-smoking community/workplace • 30 minutes day per General Strategies Online Application Specific Example Specific Application Online Strategies General ene w.yeil.r Smoking ‘Zine TeenNet www.cyberisle.org TeenNet www.cyberisle.org www.city.toronto.on.ca/health/quit_smoking.htm Toronto Public Health: http://www.frontiercollege.ca/english/public/public.htm Frontier College TeenNet www.cyberisle.org www.cafeherpe.com Herpe: Café Canadian Lung Association: www.lung.ca Association of Cancer Online Resources www.acor.org ResourceSelf-Help www.selfhelp.on.ca Centre: IVillage: www.ivillage.com/diet/ Smoking ‘Zine supports. Quitting info, programs, Literacy tools Hottalk - support community Herpes F2F & Online support patients and caregivers. Online support for cancer groups. on-line and groups (F2F) List of face-to-face sional help with dieting). (profes- Buddy Support Quit plan to set • How to steps and • goals and steps and goals issues to consider Interactive Health Communication Workbook 14 alternatives alternatives by developed youth. • Quit and tips Christy Turlington (Mass. (Mass. Turlington Christy of Health) Dept SpokespersonsPETA balance process to weigh and pros cons the Examples of positive results campaigns. ad media/TV gram reali- building in and of change, (stages ties cycling). Contest. Writing www.hc-sc.gc.ca/real/smoking/cinema.html (mirror of original AD) www.peta.com PETA: for Positive Americans African of Association National Imagery: www.naaapi.org www.cyberisle.org TeenNet ‘Zine Smoking www.cyberisle.org TeenNet (HC) Club Fingers Yellow Nick's www.hc-sc.gc.ca/real/smoking/cinema.html Decision 'Zine- Smoking TeenNet www.cyberisle.org www.cyberisle.org TeenNet www.onyx-group.com/Rapcontest1.htm pro- Quit 'Zine- Smoking Song Rap Anti-Smoking General Strategies Online Application Specific Example changes ways) healthy (in outcomes • who made big lifestyle member community prominent on article newspaper • drugs avoided how they about stars talking movie young with campaign • chips eating others carrots when bowl to be up cut of will a big eat • to smoke wanting avoid to routine morning change behaviour. • campaign-support media group discussion/presentations lessons can be learned and progress continues rather than stops. • exercise or quit smoking challenge with prizes behaviour. • health positive the worth are of medication effects side that minor Convince 10. Identify/provide role to models emulate Examples: 11. barriers for solutions own find to how suggestions/teach Provide Examples: 15. positive results who of adopted Assure of have people recommended visibility Example: 12. how critically to and assess realistically past failures/current relapse so that Teach 13. assistance. incentives, through Increase benefits Example: 14. of recommended consequences positive and negative Emphasize downplay Example: Educational Applications 15 Example: Set goals within context of pre-existing goals. 18. Example: Tailor the intended idea/program/behaviour for audience's or values, norms, situ- 17. Examples: for support their increase and person/audience to important is who Determine 16. if person a does not want to quit smoking because they are frightened of • shiftwork as such lifestyles and schedules unique acknowledge • ensure that media campaigns show people who lookandact like theintended • ways relevant culturally in cooking low-fat teach • ations. Run a campaign promoting behaviour using spokespeople like the audience • already have who themselves) (like people of percentage on statistics Provide • Profile who already adopted recommended have leaders community • Ensure that doctors are making proper recommendations • behaviour or the perception that they support the behaviour. other ways (plus weight gain is unlikely to remain) gaining weight, emphasize quittinghow will improve ones appearance in many audience themselves or spokespeople who the audience admires/looks up to/emulates adopted recommended behaviour behaviour General Strategies Online Application Specific Example Specific Application Online Strategies General TeenNet www.cyberisle.org Set goals and goals doing quit Set Smoking Zine tools tailored TeenNet www.cyberisle.org TeenNetwww.cyberisle.org www.healthbehaviorchange.org Health Behavior Change: www.PratitionerNet.org coQuitSmokingNow/homepagePractitionerNet: http://beta.communites.msn.com/FreedomFromTobac- Freedom From Tobacco (MSN - Personal Site): www.naaapi.orgImagery: National Association of African Americans for Positive www.hc-sg.gc.ca/real/smoking Nick's Yellow Fingers Club (HC): program to youth needs their practices. motivational counselling in porate and stages of change for Practitioners to incor- Harvey Skinner 'sresources work. their incorporate online tools in cent health practitioners to adoles- for site Developing Personal Quit testimonial. image issues. media Afro-American audience. the like people and Spokespersons Anti-Smoking Ads with Interactive Health Communication Workbook 16 setting, feedback setting, nge. Final report prepared for NIMH theorists workshop, Washington, D.C. NIMH theoristsWashington, report prepared for workshop, Final nge. TeenNet www.cyberisle.orgTeenNet Support programs, goal General Strategies Online Application Specific Example Fishbein, M., Bandura, A., Triandis, H.C., Kaufer, F.H. & Becker, M.H. (1991). Factors influencing behaviour and behaviour cha and behaviour behaviour influencing Factors (1991). M.H. Becker, & F.H. Kaufer, H.C., Triandis, A., Bandura, M., Fishbein, 19. audience. to intended tailored reinforcement of systems up Set Example: decide a person how will reward achieve themselves they when a goal-establish support groups provide information for significant others on how to be supportive provide such and as token feedback rewards, praise-provide incentives refundable deposits (return reached) goal when (article, photo, award) success publicize Review Online Examples 17

by Erica Di Ruggiero and Paulina Salamo, 2000. Canadian Health Network.

Canadian Health Network www.canadian-health-network.ca www.reseau-canadien-sante.ca Visit the Canadian Health Network web site: Erica Di Ruggiero http://www.canadian-health- network.ca Paulina Salamo

What to look for in a health promoting Web site

• Organizations that offer health information on their Web sites can support this in three ways:

– provide the right content (the "what") – support health-promoting processes (the "how") – be based on health promotion values

Health Promoting Content: the "what" of it • Web sites that are truly health promoting offer the most up-to- date and credible information. This information is also balanced, meaning that it presents more than one side of an issue

• Sites recognize that many things affect how healthy we are such as: – the social support we have available – the amount of control we have over our lives – the environment we live in

• Good health promotion sites reflect the fact that health is combination of factors that change all the time (determinants of health) Interactive Health Communication Workbook 18

Health Promoting Processes: the "how" of it

• Health promoting Web sites provide not only information, but also the tools that help you:

– develop personal skills – connect with other people and groups that have similar concerns – deal successfully with health professionals and others in your community

Health Promotion Values

• Behind all the content and processes are important values

• A health promoting Web site will: –relate to you –include you – show respect and caring toward you

• The organizations producing the sites will also involve you, by encouraging you to interact with them, give feedback, and take part in other meaningful ways

Checklist

•Key questions to ask:

– Does the Web site reflect a broad view of health?

– Does the Web site support a variety of activities? – Does the Web site make itself accessible to groups with all types of income, education, culture and other similar factors?

– Does the Web site give you opportunities to participate?

– Does the Web site treat you with respect? Review Online Examples

Interactive Health Communication Workbook 20 9 Values Respect Sharing Knowledge build- Knowledge & ing theories Ethical Conduct Ethical Capacity-building, Capacity-building, sustainability Equity Participation Empowerment 8 , Toronto: November 1993. November , Toronto: 1993. November , Toronto: Issues quences quences quences sequences quences of Health 7 Domains Physical con- Psychological Emotional Health conse- Health Emotional Partners in Action...A Background Document Background Action...A in Partners Document Background Action...A in Partners

November 24, 1992. 24, November 6 Settings Justice Family Family vices of Interest 5 Populations Multi-cultural com- Multi-cultural munities in remote, People rural northern communities diagnosed Dually groups People with disabili- with People ties Elderly peopleElderly Education Spiritual conse- Societal 4 Level Individual Students Workplace conse- Economic Family & Friends & Friends Family (informal networks) Community Women Leisure Mental Social conse- Sector / systemSector people Aboriginal Community/ Society youth Homeless ser- Health/Social 3 Generic Strategies Self helpSelf Francophones Caring Intersectoral collaboration Policy develop- Policy ment Community development Organizational development Health communication Health education 2 Action Areas Action Strengthen community action Reorient Health Services skills Create supportive supportive Create environments Build healthy pub- healthy Build lic policy 1 Hamilton, N., & Bhatti, T. (1996) Health“Population Promotion Model.” Health Promotion DevelopmentHamilton,& N., Bhatti, Division, T. Centre for Health Promotion.“Circle of Health, Edward Prince Island’s HealthFramework.” Promotion Practice.” Promotion Health of “Integration (1998) Promotion. Health for Centre (1996) T. & Bhatti, N., Hamilton, Ministry of Health (Ontario),behalf on of the Interministerial CommitteeSubstance on Abuse,Substance Abuse Bureau (Ontario), Ministry of Health (Ontario),behalf on of the Interministerial CommitteeSubstance on Abuse,Substance Abuse Bureau (Ontario), Makers. Policy to Recommendations Evaluation: Promotion Health Evaluation. Promotion Health on Group Working WHO European Centre for Health Promotion.“Circle of Health, Edward Prince Island’s HealthFramework.” Promotion AddictionResearchFoundation, A Population-based Strategy for the Prevention of Alcohol-related Problems in /Ontario, Toronto: 1 2 3 4 5 6 7 8 9 Determinants Sources Gender Culture Development of ChildrenHealthy ServicesHealth minority Visible Personal Health Health Personal Practices &Coping Skills Genetics Advocacy HIV/AIDS Enforcement/ Indoor & Outdoor Environments Employment & conditions Working Education personal Develop Social support net- Social works Income and social social and Income status Elements of Health Promotion Review Online Examples 21

Summary table of health promotion values

(column 9 of the previous table)

Value Commendable sites… Objectionable sites… Empowerment • offer choices, Actively or explicitly do the opposite. • facilitate learning, Note: Many sites fall in the middle, committing • avoid propaganda or persuasion, “sins by omission.” • treat stakeholders with respect These standards require some development. • promote dialogue • validate knowledge gained through personal experience. Participation • show evidence of power-sharing among many types • actively or explicitly do the opposite. of stakeholders, including the public. • go beyond consultation, to actual power to decide how resources are just allocated, how issues are framed, or how success is measured. Equity • ensure that access to the content itself is not blocked • cannot be useful to marginalized populations, due to: culture, socio-economic status, education, or cannot point the way to sites where the faith, sexual orientation, gender, language, age or information is presented in a user-friendly other personal characteristics. manner. Capacity-building, • build communities by hosting listservs, chatrooms, • actively or explicitly do the opposite. sustainability electronic conferences and other means of building connections. • freely offer resources that build knowledge and skills, and that are easily adopted and disseminated. Ethical conduct • provide a health promoting work environment for • are those of known offenders. their employees. • are ecologically responsible and take care to purchase goods and services from like-minded individuals and organizations. Knowledge build- • include evidence from a variety of sources. • actively or explicitly do the opposite. ing & theories • present evidence in diverse and engaging ways (e.g., use of narratives, visuals). Sharing • use resources from a variety of sources, and give full • actively or explicitly do the opposite. credit. • make their resources available, by making files available for downloading as simply and freely as possible. Caring • demonstrate a caring attitude through mission • actively or explicitly do the opposite. activities, language and tone used. Respect • content that reflects a respectful attitude, treating all • actively or explicitly do the opposite. with dignity and sensitivity Interactive Health Communication Workbook 22 ++ + - -- N/A The proposed solutions are multi-level, holistic, intersectoral. holistic, solutions areThe multi-level, proposed levels. multiple of health, broad definitions reflect determinants The problem groups. disadvantaged for marginalized, is concern There gaps. and problems as well as and strengths, on opportunities is emphasis There information. It provides communities. to build virtual opportunity It provides skills. supports generic or It teaches for feedback. opportunity It provides It incorporates community wisdom. material to populations of interest.It provides to populations of interest. It promotes etc. level, literacy by technology, caused barriers It lowers differen- to power sensitivity explicit of key stakeholders, participation is meaningful There tials. and hiring. purchasing in practices ethical are There partnerships. productive are There + - of the standard partial expression --N/Aomission by exception supported; is not standard health a contradicts content orvalue promotion format explicitly approach or or information not known not be applicable, will some of the standards Standards 1. Alignment of Content with HP approaches development 2. Process 3. Audience manages itselfsponsoring the organization How 4. KEY: ++ standard of the full expression Appendix 2 - Suggested Form Appendix 2 - Suggested Review Online Examples 23

Ontario Health Promotion E-Bulletin Database Visit the OHPE Database web site at: http://www.ohpe.ca/ Interactive Health Communication Workbook 24

by Larry Hershfield, 2000 Introduction to the OHPE Bulletin Subject Matrix THCU The OHPE editorial team created a framework of subjects that would make searching OHPE Bulletin’s easy and consistent with the key elements of health promotion and while remaining relevant to the client’s particular resource needs Three areas were first included: the determinants of health, action areas particularly as outlined in the Ottawa Charter, and settings. People are also interested in the wide range of skills, or generic strategies, necessary to execute the broader strategies Another way of looking at health promotion is through who it supports - the priority populations. We also want to cover resources relative to various issues. Sometimes these are risk factors, sometimes conditions and includes a wide range of states we call healthy or not, diseased or not, well or ill. The list includes those that are common to many program mandates in Ontario’s health promotion community. Health Promotion is a large and changing field; it is holistic and not easy to map. We hope that the subject framework will help you find your way around the amazing quantity of information accumulated since the creation of the OHPE Bulletin. For additional reference we offer the following: Planning model web site: The determinants of health, action areas (particularly as outlined in the http://www.hc-sc.gc.ca/main/ Ottawa Charter), and settings are captured in a planning model developed hppb/healthpromotiondevelop by Hamilton and Bhatti for Health Canada. ment/pube/php/php.htm Canadian Health Network The various dimensions of health promotion are discussed in the Health web site: Promotion FAQ’s on the Canadian Health Network website. http://www.chs-rcs.com/ We also recommend the WHO Glossary for those wanting definitions of key WHO Glossary web site: terms. You can download a copy from the WHO HP website. http://www.who.int/hpr/ backgroundhp/glossary/ Sources glossary.pdfl 1. Hamilton, N., & Bhatti, T. (1996) “Population Health Promotion Model.” Health Promotion Development Division, Health Canada, Ottawa. 2. Centre for Health Promotion. (1998) “Circle of Health, Prince Edward Island's Health Promotion Framework, Toronto.” 3. Centre for Health Promotion. (1998) “Integration of Health Promotion Practice.” 4. Ministry of Health (Ontario), on behalf of the Interministerial Committee on Substance Abuse, Substance Abuse Bureau (Ontario), Partners in Action...A Background Document, Toronto: November 1993. 5. Addiction Research Foundation, A Population-based Strategy for the Prevention of Alcohol-related Problems in Ontario, Toronto: November 24, 1992. Review Online Examples 25

TeenNet / CyberIsle by Oonagh Maley, 2001 TeenNet.

Cyber Isl e

Engaging Youth in Health Promotion using Technology

Oonagh Maley, MISt Visit the TeenNet web site at: Project Coordinator http://www.cyberisle.org TeenNet

Goal of TeenNet

To generate new knowledge and develop practical tools for engaging youth in health promotion using interactive technology.

Objectives of TeenNet

1. Produce practical tools (CyberIsle, Teen Clinic Online and Smoking Zine Websites) for addressing teen health issues, by linking information technology with community participation. 2. Enable youth of diverse backgrounds to identify and express their health needs, enhance control over their personal health, and make healthy choices (behavior change). 3. Generate new knowledge and strategies for the effective use of information technology in health promotion with youth. Interactive Health Communication Workbook 26

Objectives of TeenNet

4. Increase the knowledge and skills of practitioners (teachers, health professionals, youth workers, etc) in using the Internet for prevention and health care with adolescents (PractitionerNet) 5. To disseminate CyberIsle, Teen Clinic Online, Smoking Zine and PractitionerNet via the evolving Canadian Health Network.

TeenNet’s Guiding Principles

z Participatory z Relevant to Youth z Autonomy Supporting z Active Learning and Fun z Accessible

‘Youth in Action’ Approach

Act

Dissemination

O wnership Study

U tilizatio n

Community Capacity Do Rapid Prototyping

Engagem ent

Plan F easibility

Relevance

L isten/D ialogue

Technology Development Com munity Options C ycles Involvem ent

TeenNet Action Research M odel Review Online Examples 27

‘Youth in Action’ Approach z Focus groups with youth z Youth Staff z Youth brain storming sessions z Reality checks with youth z Youth evaluation z Ongoing feedback from youth

CyberIsle

Evaluation

TeenNet works in a Participatory Research Model: constantly consulting with teens and implementing their ideas. z Phase 1: Process & implementation z Phase 2: Dissemination: Engagement z Phase 3: Impact on Health Behaviour Interactive Health Communication Workbook 28

What Did You Like?

z Graphics....Graphics.....Gr aphics z Access to information about things that I need to know z Colours and animation z It’s real - typical teen setting z Information fits - it’s real for teens

“Techno-phobe”

z 85% of respondents thought that someone who was afraid of computers would visit CyberIsle. z The traveling would be easy to understand. z Difficulties would be experienced with the error messages.

English as Second Language

z 83% of respondents thought that someone who has difficulty with English would visit CyberIsle. z They believe people would find the traveling, symbols and graphics easy to understand. z They believe that reading the information would be difficult. Review Online Examples 29

Qualitative Results

z "Yes...because instead of going to their family doctor, or something it's another thing ... not being humiliated or anything or being conscious of oneself so it's better just to go on to this (CyberIsle) and get information off the Net." z “It's just good, you could find it somewhere else but this is a huge package deal”.

Qualitative Results

“At school they just tell you everything that so bad about it. I mean like some people smoke because they enjoy it or it makes them feel good. Or some people makes them less depressed….But at school all they say is ‘it’s bad’, ‘never do it or you will get in trouble by the cops’… [CyberIsle] is more helpful this way. At school they are just mean about it.”

Qualitative Results z “...here (in CyberIsle) it's anonymous so it's better I think” z “you can look at something rather than being seen...(you can) conceal yourself...cause you probably feel embarrassed” z “when you want to find out something, you don't want to ask the teacher because everyone will (ask) why do you want to know that. So when you go into CyberIsle you can read...what you want to know about...you can be embarrassed at school.” Interactive Health Communication Workbook 30

Qualitative Results

Makin’ Cents - Smoking Cost Awareness Game z “It was showing that, like, if you spend money on cigarettes, like, you won’t have enough money to buy other stuff” z “It shows what you can buy with the money if you don’t smoke”. z “It’s interesting to find out what’s in [CyberIsle]… a lot of information and stuff that would be helpful”.

When asked if Makin’ Cents would encourage teens not to smoke respondents replied; z “Yes!”, “Cause then you save money”.

Qualitative Data (Non-Smokers)

¾ “I don’t smoke anymore so I couldn’t use it as much but I used to smoke and I would have found it helpful. The activity that makes you aware of the money you spend on smoking is a most excellent idea”

¾ “I liked the activities on the site. I always love filling out surveys and learning more about myself. I think the notepad for yourself is an excellent idea too. I liked how the program takes you step by step.”

Qualitative Data (Non-Smokers)

¾ “I like how it tells you and gives you advice about the pressures on smoking. It was also very easy and fast”

¾ “I think it’s a program worth using for smokers” Review Online Examples 31

Qualitative Data (Smokers)

¾ “It gave you a chance to realize how stupid smoking is but once you start it is really hard to stop”

¾ “It didn’t force morals and opinions on me. It just helped me to realize how much time and money I was spending on smoking”

¾ “It made me feel more confident on quitting”

Feedback on CyberIsle

I don't know a lot but I do know that you are the best website that I have ever been to!!!

You solved my questions to things I was to embarrassed to ask to my parents!!

Thanks a lot and keep up the good work!!!

Quantitative Results Interactive Health Communication Workbook 32

Where are our Visitors from?

z Australia Germany Sweden z Italy France Norway z Singapore Japan Switzerland z Brazil Austria Russia z Israel Iceland Denmark z India Kuwait Bulgaria z Argentina Czech Republic Greece z South Korea Latvia Portugal z Turkey United Kingdom South Africa

Hot Spots on CyberIsle

Places on CyberIsle % users who access HotTalk 44% Posted Message to Hot Talk 8% CyberIsle Quizzes menu 35% Women’s Bathroom 34% Graffiti Wall 31% Smokin’ Island 30% Men’s Bathroom 28% Cyberia 23% CyberIsle Resources Page 18% Smokin’ Island Talk to Me 17% Beach By Day 16% Makin’ Cents 14% Smokin’ Island Whats New 14% It’s My Life (CLA) Quiz 13% Quality of Life Quiz 12%

Impact Study Design

z Randomized controlled trial – Intervention Condition: complete Smoking Zine – Control Condition: Semi-structured web surfing task z Instrumentation: – Lifestyle & Technology Profile – Likelihood of Action Index (Pre) – Likelihood of Action Index (Post) z Qualitative data Review Online Examples 33

Likelihood of Action Index (LAI) z 10 key scales based on the five major behavior change theories used to guide the Smoking Zine (Skinner, 2001) z Pilot tested with youth (N=338) z Scale items obtained through tobacco survey databases, published scales and partnership with other researchers in the area of adolescent health

Pilot Study: Summative Evaluation z 15 Community-based settings throughout Ontario z N = 118 (83 Non Smokers/35 Smokers) z Age: 0 14.92, Range: 12 – 21 z Gender: 53.4% Female z Education: 0 Grade 10 z Diverse cultural backgrounds Interactive Health Communication Workbook 34 Online Communities: 35 Connecting with Others

by Alison Stirling, 2002 OPC (Ontario Prevention Clearinghouse) Online Communities: [email protected] Connecting with Others http://www.opc.on.ca

Interactive Health Communication Special Topics Workshop February 25, 2002 Alison Stirling

Connecting with Others

• Asynchronous ways of communicating allow people to “talk” over a period of time. E-mail, for example, is asynchronous. • Synchronous ways of communicating require people to be in the same “place” at the same time. A telephone call is synchronous communication.

Connecting with Others: Tools

Asynchronous Synchronous • E-mail lists • Internet Relay Chat •Web forums (IRC) • Newsgroups (Usenet) • Instant Messaging, including chat • MUDs, MOOs, and other shared online “spaces”

3 Interactive Health Communication Workbook 36

Tools for Groups Across Time & Space

Inspiration from Lisa Kimball of GroupJazz. Online Community Toolkit

Mailing Lists: Introduction

•Electronic mailing lists combine the e-mail addresses of many users. • A message sent to a mailing list reaches every e-mail address on the list. • These lists can be used for discussion and debate, to publish newsletters, or to announce new services.

Mailing Lists: Introduction

A mailing list has at least two addresses: • An e-mail address that is used to send messages out to the list • An e-mail address that is used to tell the mailing list software to do something (e.g. subscribe or unsubscribe you) • Many lists also provide the e-mail address of a person who can help you with problems

6 Online Communities: Connecting with Others 37

Mailing Lists: OHPE Bulletin A one-way “announce” list

Mailing Lists: CLICK4HP A discussion list

To view archives and manage subscription see: http://listserv.yorku.ca/archives/click4hp.html 8

Mailing Lists: Topica One place to search for interesting lists

9 Interactive Health Communication Workbook 38

Mailing Lists: Topica Results from a search for lists on HP

Mailing Lists: How to Participate

• Read other people’s messages for a while before you start posting your own • Keep any introductory messages that are sent to you -- they’ll have instructions for unsubscribing yourself from the list • Don’t send attachments to a list • When replying, check the To: line!

Mailing Lists: Setting Up Your Own •Why? • What kind of list? • Who will run / maintain / support this list? • How much of a budget is there (if any)? • Test the list extensively with a few people before opening the list to everyone • Always ask before subscribing anyone

12 Online Communities: Connecting with Others 39

Web Forums: Introduction

• Web forums are discussion tools that are available on the World Wide Web and that are accessible through an Internet browser • A web site may have any number of these discussions – some sites have one general discussion that holds all topics; some have one discussion per topic (and many topics!) • Web forums can be public or limited-access

Web Forums: Volunteer Canada

Subject line Posted by with name and e-address, date In reply to - earlier message, name, date

Original message at top Reply follows

Reply Entry Box below

Web Forums: CyberIsle HotTalk

15 Interactive Health Communication Workbook 40

Web Forums: CyberIsle HotTalk

Web Forums: Sympatico Health Talk

18 Online Communities: Connecting with Others 41

Intranet: OHPRS Livelink

Web Forums: What Makes One Work? • Human support • Clear rules for participation • Consistent application of the rules • Relatively stable group of participants • Participants can start new topics • Tied to relevant, useful, and/or frequently- updated website content

21 Interactive Health Communication Workbook 42

Web Forums: Some Uses

• Discussion of other documents, which can be posted on the website for reference • Before conferences and meetings, for discussing updated information and holding preliminary discussions • After conferences and meetings, to follow up action items, finish incomplete discussions, and distribute notes

Newsgroups: Introduction

• Newsgroups are similar to mailing lists, but are kept on your ISP’s server (instead of being e-mailed to you) • They are generally open to everyone on the Internet • They are like electronic bulletin boards: you can read others’ messages, reply to them, and post your own messages

Newsgroups: Access via Google

24 Online Communities: Connecting with Others 43

Internet Relay Chat (IRC): Introduction • Internet Relay Chat (IRC) is similar to a teleconference call, except in IRC you type instead of talking. • Anything you type is seen immediately by others in the same virtual space, which is usually called a “channel”.

IRC: mIRC Software

IRC: mIRC Appearance

27 Interactive Health Communication Workbook 44

Instant Messaging: Introduction

• Instant Messaging allows you to send short messages, exchange files, or talk in real time by typing • This is currently what most people refer to when they mention “chat” • Common instant messaging programs include ICQ and AOL Instant Messenger

Instant Messaging: ICQ Message

Instant Messaging: ICQ Chat

30 Online Communities: Connecting with Others 45

Instant Messaging: Some Uses

• Send files to someone who has asked you for something. The sent file pops up on screen instead of hiding in their e-mail • Hold staff or board meetings in a chat session. Save the session log for easy creation of minutes • Hold scheduled public chats on pre- arranged topics

MUDs: Introduction

• Multi-User Dungeons (MUDs) and similar tools such as MOOs and MUSHes are online alternate-universe spaces containing characters, places, and objects. • You control a character with a persona you define, and can move about and interact with objects and other users in the space

MUD Software MUSHclient General Appearance

33 Interactive Health Communication Workbook 46

MUDs: Some Uses

• Collaborative document creation • Meetings • Conferences • Colloquia • Online education and training • Awards presentations •?

Questions?

Alison Stirling Health Promotion Consultant, OPC [email protected] 416-408-2249 x226 or Robyn Kalda [email protected] 35 Online Communities: Connecting with Others 47 Asynchronous Ways of WithConnecting Others Intranets, etc. Intranets, E-Conferences, E-Forums, Newsgroups olWa o tegh Weaknesses Strengths How What Mailing lists Tool topic (and many topics!) many topic (and ics; some have one discussion per general discussion that holds all top- discussions - some sites have one of these number any site have may browser. Internet an through A web Wide Web and that are accessible World the on available are tools that categoryThis contains discussion them, and post your own messages. and post your them, readcan others' messages, reply to like electronic you bulletin boards: oneveryone the Internet. They are to open generally are and you) server (instead of being e-mailed to ISP's your lists, are on kept but Newsgroups are similar to mailing every e-mail on address the list. mailing list reachesto a message sent A services. new announce ters, to or debate, newslet-sion and to publish for discus- used be lists can These e-mail users. addresses of many E-mail mailing lists combine the discussions of discussions of interest. to post and read you can accepted, andname password. After that is be somewhere to type user- in your will There name.) your under post is so nobody else can (This word. will receive a username a and pass- Usually, register you'll yourself and Web site that hosts the e-forum. WebUse your browser to go to the those that appeal, and off you go. and appeal, that those server, that from newsgroups mark news server, download a list of the of the ISP for name Ask your software. newsreader stand-alone acquire fully-featured more browser. your in ware Later, can you To start, theuse newsreader soft- e-mail regularly. tions carefully, your check then Followto you. the sign-up instruc- appeal ones that find http://tile.net to http://www.topica.com or good ones, or search ommend to rec- peoplejects. Ask you know of sub- variety a wide on available There lists of mailing are thousands without registering. read (but not post) discussions you disabled users. Some sites will let cial features that aid accessibility for spe- out. Some have easy to figure interest relatively you. Most are that hard on topics to find discussions already be familiarmay with, it's not Because they're on Web sites you Web- your is browser enough. You don't need any special software similar interests. connectit's others with with easy to Because they're arranged by subject, clog.doesn'te-mail - so your mation must deliberatelyyou look for infor- - to you comes available. Nothing There's a huge range subjects of for building relationships. of people,group are so they good fairlyinvolve a limited and stable newlearn any software. E-mail lists need to get ore-mail, so you don't for it. Mailing lists work through don't and look you need to go out Information comes straight youto - ing with a site. policies completely before register- to readvary widely; such be sure a problem. Sites' privacy policies have out how to get help if you ure site.another be difficult It can to fig- one on using quite different from using an on e-forum one site can be allThey work slightly differently, so etc. your e-mail. in made-up address) can lead to ads real or be set to use any can newsreader address (your e-mail Posting messages using your correct to visit exhortations sites. porn and ads of are full groups (many) Some e-mail address. work a use you if employer your not areyou representing yourself and it is must be sure address, clear you one, real from e-mailconsistently must post is difficult, as you nymity efforts.diligent Ano- management and require messages a day) (100+ Some very lists are high-volume Interactive Health Communication Workbook 48 Private spaces are difficult to pre- difficult are spaces Private racy; quite be can Content serve. common. pick-upsattempted are are New often subjects users of pranks. There's a certain amount of jargon to master. Several competing software prod- software competing Several to participants all requiring ucts exist, sameuse the one. It can be difficult hours. peak during connect to There's a fair number of commands of commands number fair a There's Some MUDs and jargon to master. to newcomers. friendlyare not very is anony- MUDs, some In everyone mous, to establish so can be difficult thator can build relationships con- MUD outside the tinue environment. Immediacy, anonymity (everyone Immediacy, uses a “nickname”pseudonym), or can discussions. You free-ranging start your own “channel” on any attopic any time, so you're not lim- alreadyited by what's there. Unlike IRC, you can easily control youwho to with. It is easy interact for chats private preserve and create planned and other meetings staff withainteractions known group. Common are products software easycurrently free, to obtain, and use. and quite intuitive to learn Because people's identity is dissoci- identity is people's Because ated from their online “persona”, spaces. very creative are MUDs of enjoy freedom the Many people through ainteracting persona. openMUDs up some very interest- / conferences for possibilities ing symposia. Download and install IRC software, such as mIRC. Connect to an IRC list of channels check the server, andavailable, join the ones that youinterest (or your start own). Download and install messaging install and Download Instant (ICQ and AOL software register, common), are Messenger and create ofother a list users you onwish to talk to. When people your list are online, you can send messages or with them. chat Some public to create you allows software “chat rooms” youwhere can chat on a subject of your choice with other people. interested It’s possible to use Telnet (which (which Telnet to use possible It’s to 95 and up) with Windows comes in MUDs, but most peo- participate special and install do download ple makes which software “client” MUD After installing easier. MUD activity client,the you connect to a MUD's and persona, your create address, begin. to a teleconference call, except in except call, teleconference to a of talking. you type instead Any-IRC immediately you type is seen thing same space, virtual in the by others “channel”. a called is usually which short messages, exchange files, or files, messages, exchange short talk in real time by typing. This is currently (June 2001) what most refer they to when people mention “chat”. Multi-User Dungeons, MUDs - MUDs Dungeons, - Multi-User Object-Oriented, and Multi-User Shared Hallucinations are online alternate-universe spaces containing characters, places, and objects. You control a character with a persona you define,andcan move about and with and users other interact objects space. in the Tool ChatRelay Internet similar (IRC) is Chat Internet Relay What How Strengths Weaknesses Instant Messaging you to send allows Messaging Instant MUDs, MOOs, and MUSHes Synchronous Ways of Connecting With Others Synchronous Ways Connecting with Others: 49 Concepts & Strategies

Electronic Strategy Development: What’s Your Plan? by Liz Rykert, 2000

In any on-line effort, there are essentially three things that you can do: Liz Rykert is principal for 1. provide information; MetaStrategies. More information can be found at: 2. look for information; and http://www.metastrategies.com 3. work together. Her ‘Primer’, which formed the There is a very different social dynamic underway in an on-line venue basic material for this section of meant for discussion than in one meant for simply storing and retrieving the workbook can be found on information. On-line tools can be configured to strategically capture and her website at support the effort underway. http://www.metastrategies.com/estrat/index.cfm?sec=5 In every case, it can be predicted that these three broad areas will not be operating in isolation; in fact, one should expect to see the convergence of Additional materials, including a these activities. By their nature, on-line venues are interconnected and literature review on online com- support relationships that tend to be interdependent. munities can be found at: In the face of continuously changing technological tools, methods and appli- http://www.metastrategies.com/estrat/index.cfm?sec=4 cations, this simple framework is intended to provide you with an orientation. So you can stop and ask yourself: “What am I trying to accomplish here?” and by understanding the range of tools available, feel more competent and be more able to plan the best approach. Information provision and group workspaces are central to any on-line effort; however, it is not enough to simply set up a discussion area and hope for the best. Early pilot efforts have revealed the need for ongoing social facilitation in on-line discussion spaces. The person who is responsible for animating discussion and supporting the participants to overcome technological barriers is at the heart of lively and successful efforts. Hence the creation of an electronic strategy which considers the real work of an organization, campaign or group puts the emphasis on the need for a plan. Too often we at Meta Strategies are asked to review an existing effort where thousands of dollars have been spent on web design, custom software development and private networked hardware solutions. Not once have the participants been asked: • What is involved in your day to day work? • How will the online venues support these demands? • What are the things that will not translate well into the online world? It is often the activities planned and carried out in communities, projects or workplaces that relate directly to the information found on-line. Finding quick and efficient ways to capture the information as it is generated can make a real difference. Placing content strategically on-line to take advantage of the interconnections can mean it is more likely that people will be able to find and access the information they are looking for. Conse- Interactive Health Communication Workbook 50

quently people build on the work of others. Each person needs to assume the shared responsibility of contributing to the collective knowledge of the group and posting information.

The Literal and the Virtual A “snug fit” between on-line and off-line activities ensures that on-line resources are rooted in activities that are relevant to the participants. To maximize a snug fit, the people who are generating the information should be responsible for the preparation and posting of it on-line–whether this is in a discussion area, on a web site, or in an on-line searchable database. Where on-line efforts are not completely rooted in the “real” work of groups, they are seen as an add-on. Approaching the addition of on-line resources as a separate activity can result in web sites that are not updated regularly, in discussion areas that are barren of participants, and databases that are full of out-of-date information. Any effort will require management of the on-line effort to continuously monitor the relationship between the literal (tangible in time and place) and the virtual venues (those spaces or activities not limited by time and place). The responsibility for management should be designated to an individual or core group. Assuming the goal of seeing every participant connected and actively contributing, the considerations for managing the initial transition may be somewhat different than what may be expected over the long term. A designated on-line manager works with the big picture in mind. His/her role includes: • matching on-line activities with existing work flows • co-ordinating regular communication activities with the electronic venues • helping staff or participants to understand the value of the on-line venues

Synchronous and Asynchronous Venues Off-line venues tend to be synchronous in nature and on-line spaces tend to be asynchronous. Synchronicity is present as an influence on social process when people come together to do something at the same time and/or place. A group meeting, a conference, a workshop are all examples of synchronous activities. Technological examples of synchronous environments include a conference call, video conferencing, or Internet relay chat (IRC). A precon- dition for these activities is that each participant must be connected in some way for a given period of time. These interactions are by their nature time limited. Asynchronicity characterizes activities that occur in the absence of time and place. The addition of on-line spaces allows groups to work together without the barriers of time and place. In a country like Canada this is significant given the costs related to long distance travel or telephone/fax communication for instance. Connecting with Others: Concepts & Strategies 51

Asynchronicity as an influence on social process has some interesting impacts. People are no longer limited by the time they have set aside to work together. The work can happen over a period of hours, days or weeks and at the convenience of the person participating. This shift of control from the group to the individual makes it easier for people to participate in group efforts. Secondly, it allows people to consider their responses to a discussion that is not contingent on the moment. This means, for instance, the opportunity for sober second thought is available to participants before responding in a group setting. Asynchronous environments also pose some challenges to group process. Normally, when a group gathers for a period of time, they come with the understanding that there is a beginning, middle and an end to the activity. However, when one engages in group work in asynchronous environments, the notion of a beginning, a middle and an end are usually not assumed. Many groups turn to the use of on-line facilitation to: • help set the pace of the work; • pay attention to what the pace of work is; • generate time boundaries, if these are critical to the group accomplishing decisions or actions together; and • generate a feeling of momentum or movement within the on-line workspace.

Push and Pull Recent developments in Internet technology have seen the introduction of push and pull technologies. In developing your strategy you should focus on the need to tune into the directional flow information as it circulates online. Push and Pull are two ways to consider this among others. Push technologies are designed to push information out to consumers, not unlike a message on the television being pushed into our living rooms. Consumers can select the types of information they want pushed at them and can choose to turn off this service if they do not require it any more. Pull technology is used to pull consumers or participants to a common place on-line to deliver a message or to allow participants to interact in an on-line workspace. What is interesting about pull technology is the inherent motivation which is present in the participant to “go to” a place in order to find the information they are looking for or to join in a group activity for example. Which way the momentum is moving can be important to deciding on the type of tool to select. In addition to the choice of tool, reading the “currents” of on-line information flows can be critical to the success of an effort. Using a lense that will pick up currents and flow directions in off line activities can inform the strategic placement of information on-line. A read of the strategy is about assessing the relationship between the on-line and the off-line activities and the pace, direction, and tension which are generated as part of these relationships. Interactive Health Communication Workbook 52

New tools are combining push and pull. For example, some web-based conferencing systems will allow users to set a notification system to remind them by email (push) that a new message has been posted in a discussion area they are monitoring, hence pulling them back to the conference.

Pace Each on-line venue will have a unique culture and pace of work. The pace will be determined by the tools and settings used to create the on-line venue, by the people who are working there or, by how and when a web site is updated to ensure the information is fresh and reliable. The use of on-line facilitation is key to setting and maintaining a sense of momentum in a group workspace. In matching on-line strategies with those happening off-line, it is important to consider the differences in pace that will occur. This relates back to the notions of time and place and the differences between these constraints (or the absence of them) in on-line venues. For example, it can be important to define how and where decisions are made, or what the purpose of an on-line discussion is in relation to a planned face-to-face meeting. The electronic strategy needs to reflect the differences in the pace of work and to prepare participants for this.

Start Small and Let It Grow Just as a social or organizational change effort begins with a core of basic ideas and people motivated to engage, and then begins to grow based on the interests and needs within the community or workplace, so too should on-line venues. With continuous updating, regular reporting and on-going dialogue, the information found on-line can be relied on as accurate and up-to-date. Making materials available on-line makes them available to groups who may otherwise not know about them. Although the costs of publishing to the web are minute compared to printing and distributing materials in print or on video, these other resources should not be forgone. In fact, it is important to have materials available in print or in other formats to circulate among people. In deciding which non-electronic formats to use, consider which will be the most accessible and which will be the easiest to distribute, to ensure the greatest impact. The electronic domains allow and encourage the convergence of resources in digital formats. Video and audio streams can now be made available on-line to support the text and graphical images.

The Power of Transparency On-line venues add a degree of transparency to work, which has, until now, not been possible. Where groups of people are working together, the ability to refer to electronic resources, to track completion, to monitor group participation and to generate an archive of discussion and decisions means everyone is informed and aware of the issues as they arise. When people are asked to begin working together using electronic venues, they find, on the one hand, that it means many of the group communication requirements are met simply by working in an open system. On the other Connecting with Others: Concepts & Strategies 53 hand, errors or gaps become obvious. The management of gaps in knowledge involves seeing the gap as a learning opportunity and an opportunity for change. Looking to the literature and practice of learning organizations to inform this management approach is very revealing with respect to the increases in productivity, creativity and innovation. Transparency also produces a greater degree of accountability among the participants in a work effort. Groups have demonstrated a deeper level of trust, especially in hierarchical settings. There tends to be a lateralizing of power relationships and the creation of an environment which values equity in participation and learning when on-line workspaces are added.

Disintermediation Disintermediation refers to the simple notion of removing the middle. Consider the traditional hub model. The addition of an on-line workspace fills the middle with an interconnected web. In team settings this means the role of the coordinator changes from being one of receiving and distributing information to one of adding value to the social process underway. In settings where one person is likely to control the centre, one might anticipate some resistance. On-line venues are by their nature open systems and hence difficult to control. Disintermediation is an approach that works with the values and norms of the people present and allows everyone to participate in deter- mining how they will work together.

Opportunities for Continuous Learning On-line discussions are in and of themselves “learning communities.” In other words, when people with a common interest come together for the purpose of exchanging information and engaging in dialogue, they are in a setting that supports learning on a continuous basis. In fact, when groups and communities can learn from each other and the experts in a way which is respectful of the time and energy it takes to contribute effectively to change, they are likely to result in better outcomes. Based on extensive firsthand experience with training and supporting people to adopt the use of on-line resources and joint workspaces, the training implications of on-line venues are important. People report that they learn some things during day-long training sessions, but it is the peer-to-peer learning on a continuous basis that sticks. Training to get on-line and access the tools of the Internet is best provided by those who are local and can be accessed on demand, as required, especially for technical support. Train-the-Trainer and on-line facilitation coaching is best accomplished over time with a skilled facilitator in a live venue doing real work. Interactive Health Communication Workbook 54

Summary So what is your plan? Here is a cascading set of steps to help you think it through: • Involve a broad range of potential participants and key decision-makers • Consider the activities • Decide where to start • Determine the pace • Factor the social process impacts • Plan the transitions with support and training • Identify the evaluation methods and measures • Anticipate the degree of privacy • Pay attention to the boundaries • Draw it our for yourself Learning to apply an electronic strategy and to let it grow as the work progresses is at the core of understanding how to approach the addition of on-line venues. Change of any kind infers new knowledge, learning, adjustment and an assumption of improved outcomes. We need to shake off our beliefs about fixed change and recognize the need to be continuously adapting to our environments. On-line venues hold promise as reasonable and reliable resources for us to use to assist us in managing change on a continuous basis.

References This primer reflects a summary of the concepts contained in Working Together On-line co-authored by Liz Rykert and Maureen James, published by Web Networks, Toronto, 1997. http://community.web.net/wto In addition credit for reference to the notions of social process are attributed to Sam Lanfranco, York University, Toronto and Senior Policy Analyst, Bellanet Secretariat, IDRC. http://www.bellanet.org Finding the Information You 55 Need: A Tutorial for People Working in Health Promotion

by Penney Kirby, 2002 Ontario Health Promotion Resource System Finding the information you [email protected] need: a tutorial for people www.opc.on.ca working in health promotion This presentation has 3 hand- and public health outs. You can find these hand- outs after the slides, starting on page 76. Presented by Penney Kirby Ontario Health Promotion Resource System [email protected] February 25, 2002

What kind of information do Health Promoters need?

• What media works for reaching rural teens about HIV prevention? • Who has done a social marketing campaign targeting men 50-65 on heart health? • When is the most effective time to give women information about mammograms? • What programs have worked to remind seniors to take their medication?

Why is it difficult to find information?

• Not enough time in workday • Too much information / information overload • Requires specialized knowledge to search • A lot of information is inaccessible - e.g unpublished reports • Lack of organization support of information gathering and sharing • Once found, information is difficult to manage • Information not available right when it is needed • Multidisciplinary nature of the field - sociology, nursing, anthropology, psychology, medicine, education, environmental or public policy Interactive Health Communication Workbook 56

But why is it important to have the information?

• Build your program on what has been proven to work. • Adapt programs to your particular situation. • Institutions and funders request evidence of literature review and knowledge of similar work. • Avoid duplication. • Compare you results with others. Modify your program to increase success. • Add to the body of knowledge of health promotion.

Tools to connect you with the information you want

• World Wide Web search engines • Web-based databases • Bibliographic databases - e.g. PubMed, ERIC, Psyclit • Information professionals • Libraries within your institution • University, College and Public Libraries • Colleagues that have an interest in finding and sharing knowledge

Planning your search strategy

Use a tool such as Search strategy worksheet to help you organize your thinking and develop your search strategy Finding the Information You Need: A Tutorial for People Working in Health Promotion 57

Useful search techniques

• Pearl growing - Find a small piece of very relevant information and build your search on how it has been catalogued, what articles and books it cites or what Web sites it points to.

• Successive searching - Start with a very broad question and define it more narrowly as you go along. This is very useful if you aren't sure what you are looking for or where to start.

The two steps that will meet many of your needs

1. Search the Canadian Health Network Website (covers information from Canadian non-profits and government bodies)

2. Search PubMed (covers articles published in health journals) Interactive Health Communication Workbook 58

Searching the Canadian Health Network Website: a tutorial for people working in health promotion and public health

Presented by Penney Kirby Ontario Health Promotion Resource System [email protected] February 25, 2002

The CHN/RCS Website Resources are features a searchable aimed at consumers database of thousands and health of health resources. intermediaries. These resources are selected from the Websites of Canadian organizations and government.

There are 26 subject specific sub-sites. Finding the Information You Need: A Tutorial for People Working in Health Promotion 59

The Health Promotion sub-site has resources of interest to health promotion and public health professionals.

One of these resources is a set of frequently asked questions about Health Promotion.

There are 396 English resources in the Health Promotion database. You can browse or narrow your search. Interactive Health Communication Workbook 60

You are planning a program for youth and tobacco. Visit the Tobacco sub-site and do a guided search for resources.

There are 199 resources in the CHN database on tobacco. You may browse these or narrow your search.

Here the search has been narrowed to Tobacco and Health Promotion tools. 21 resources found.

Each entry includes the title of the resource, a description, and the name of the organization that produced the resource. Clicking on a title takes you directly to the resource. Finding the Information You Need: A Tutorial for People Working in Health Promotion 61

Scroll down the page until you find a resource that interests you then click on the title.

You are now linked directly to the document on the Website of its author organization. From here you can chose to continuing exploring this organization’s Website or return to CHN and continue searching the database.

Another way to search CHN is using the A-Z List of subjects. The index allows you to do a very focussed search on a particular subject. It is a powerful search tool that allows you combine up to five search terms. Interactive Health Communication Workbook 62

Browse through the A to Z list to select search terms.

Each term will appear in the green box as you select it. When you have finished selecting terms, click the 'Search' button to see the results.

This search for social marketing retrieved 19 records. Finding the Information You Need: A Tutorial for People Working in Health Promotion 63

You can also do a keyword search from the Search page.

Here are the 43 program evaluation documents in the database.

In order to demonstrate the value of CHN to Canadian Health Promoters we can contrast search results on the topic of teens and smoking when using CHN versus using a general search engine. Interactive Health Communication Workbook 64

351,472 results found. I had to scroll through 7 pages of search results until I found my first link to a Canadian Government site and then 5 more screen until I found my first Canadian non- profit. Much better to find 38 Canadian government and health organization resources on CHN.

Searching exercise Search the CHN database for resources that can help you... 1. Plan a education program on heart health for women. 2. Give to your senior clients to encourage healthy eating.

This is a guided search from Heart Health, then limiting to Women and finally Health Promotion Tools. Some of the resources in Heart Health and Women may also be useful. Finding the Information You Need: A Tutorial for People Working in Health Promotion 65

This is a guided search in Seniors and Healthy Eating. Interactive Health Communication Workbook 66

Searching PubMed: a tutorial for people working in health promotion and public health

Presented by Penney Kirby Ontario Health Promotion Resource System [email protected] February 25, 2002

What is PubMed? http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

• PubMed is a free, Web-based database of health literature developed by the National Library of Medicine (USA) • PubMed provides bibliographic citations (author, title, and journal references) and abstracts to articles from over 4,000 journals published in 70 countries. It currently has 11 million records dating back to 1966. • Journals that are indexed in PubMed can be found in university or college libraries, hospital libraries and in large public libraries.

• PubMed is a good place to search for articles published in journals, you will not find unpublished research or reports. • PubMed covers health literature internationally but most records are from English language sources or have English language abstracts. • PubMed contains citations, and abstracts, not full-text articles. Often having the abstract is good enough. • Full-text articles can be obtained for free through the Web from a few journals (e.g. BMJ), for a fee from some journal Websites or through College, University or large Public libraries. Finding the Information You Need: A Tutorial for People Working in Health Promotion 67

PubMed's home page:

a black bar that provides access to other Entrez databases

a query box where you enter your search terms

a features bar with access to additional search features

a sidebar with links to PubMed's Help, other PubMed Services and related resources

PubMed’s own excellent tutorial - very thorough and interactive

How to use PubMed

• PubMed is designed to work for a wide variety of search skills. • You can begin searching simply by entering your search terms in the query box and click on limits. Interactive Health Communication Workbook 68

PubMed provides you with a selection of commonly used search limitations

For ages I selected Aged For languages I selected English

To limit the timeframe I selected date entered into PubMed as in the last year

After selecting the limitations click GO to execute the search Finding the Information You Need: A Tutorial for People Working in Health Promotion 69

Results are displayed in batches of 20. To see more 328 citations retrieved. select another page.

The retrieved citations are displayed in the default summary format. This includes the author, title, and source information.

One way to make a search more precise is to use MeSH or "Medical Subject Headings." MeSH is the authority list of subject terms used in PubMed. In the previous exercise because “Aged” was a drop down option under ages we know that Aged is the authorized term in PubMed, not elderly.

The MeSH Browser lets us explore what the MeSH terms are for our search.

Testing to see if elderly is a MeSH term. Interactive Health Communication Workbook 70

MeSH has mapped the term to aged, as we saw in the drop down box when setting limits. MeSH also provides a definition of the term and its placement in the “tree” of terms.

I am now checking falls in the MeSH browser to see if it is an authorized term.

MeSH maps falls to multiple terms. The top one, accidental falls, best matches my meaning.. Finding the Information You Need: A Tutorial for People Working in Health Promotion 71

Back at the search screen I input my search.

Because the limits box is checked I am limiting my search to Aged therefore I do not need to put Aged in the query box.

Putting in the short form of a field name after the search term in square brackets limits the search to that field. Here only the MeSH Heading field will be searched for accidental falls.

I can browse my results and click on the titles that interest me.

The citation comes up in abstract format which allows me to really judge if the article is of interest. PubMed abstracts are usually extensive and can sometimes provide enough information for your needs. Sometimes there will not be an abstract, either because the record is so new or the journal doesn’t abstract. Interactive Health Communication Workbook 72

After browsing the records I realized I would like to narrow my search to the effects of physical activity on the incidents of falls. I check the MeSH browser to get the standardized term - exercise - and add it to my search query.

After clicking on go I retrieve 13 citations.

I click on the boxes to the left of the citations I want to save. Finding the Information You Need: A Tutorial for People Working in Health Promotion 73

I choose to save them in Abstract format and then click save.

This opens a box which asks me what to do with the records I saved. I opt to save the records to my computer.

I have a folder on my computer called my Medline searches so I can keep them all together. I give the search a name that describes my search strategy and click save. Interactive Health Communication Workbook 74

I can then open up my search results in Word or another word-processing program and print them if I wish.

Review on saving citations

Step 1: Place a checkmark in the box to the left of the citations you want. Step 2: Use the Display pull-down menu to select a format. Choose Medline format if you are downloading the file into bibliographic software. Choose Abstract format to see the Abstract. Click Save. A “Save As” window opens. Step 3: Save the file into a folder you will remember and choose a meaningful filename. Click Save.

Bibliographic software

If you or your organizations does a fair amount of bibliographic searching you may want to consider buying bibliographic software. • Download database records • Develop your own searchable database • Create instant bibliographies •Customize records Finding the Information You Need: A Tutorial for People Working in Health Promotion 75

Bibliographic software brands

•EndNote •ProCite • Reference Manager • All from ISI ResearchSoft http://www.isiresearchsoft.com/rshome.asp

• PAPYRUS from Research Software Design http://www.rsd.com/ Interactive Health Communication Workbook 76

Search strategy worksheet

1. Write down your questions. Try to be as specific and detailed as possible.

2. What are the ideas that make up your question? Focus on nouns. Do not include common words such as the, and, about, of, etc.

3. For each of the ideas in #2, identify any synonyms for the words you have written down. Example - youth, teens, young adults.

4. For each of the words in #3, identify any other word forms or spellings for the words you have written down. Example - teenagers Finding the Information You Need: A Tutorial for People Working in Health Promotion 77

5. How do your ideas fit together?

Idea 1Idea 2Idea 3Idea 4

Idea

Synonyms

Word forms or spellings

Subject terms (authorized subject terms)

Note: your Ideas (columns) relate to each other in a AND relationship and your synonyms, word forms or spellings and subject terms relate to each other in an OR relationships. Example - youth or teens or teenager and tobacco or smoking or cigarette. This is the basic of Boolean Search Logic.

6. What depth of knowledge do you need (general idea or technical detail)?

7. What scope and limits (time period, geography, and population groups)?

8. When do you need the information? Interactive Health Communication Workbook 78

9. How much time and skill do you have?

10. What resources can help you? (students, other staff, etc.)

11. What do you want to find?

Type of information Tools

Articles Bibliographic databases – e.g. PubMed, ERIC, Psyclit

Books Library catalogues, www.amazon.com

Reports and unpublished papers Web, Canadian Health Network

12. What search tools will you use?

13. Are there any limitations of your search that are important to note? Finding the Information You Need: A Tutorial for People Working in Health Promotion 79

Tips for Bibliographic Searching

Steps in database searching 1. Define what it is you want to know. This is your search question. 2. Generate a group of words or phrases that are related to your search question. These are your search terms. 3. Determine how comprehensively and widely you want to search and select a database or databases that covers those areas. Note what areas or journals are not included in these databases so that you know the limits of your search. 4. Do a few searches using your search terms. Select articles that are relevant to your search question and note their subject headings. You may want to add these words or phrases to your search terms. 5. Perform your searches. 6. Evaluate your results. You may need to refine your search in order to be more on topic or to fill in gaps. 7. Download or print the results.

General searching tips 1. Start with a few references that are relevant and check how they are indexed (what subject terms are assigned) in the database. Build your own search strategy using these terms. 2. Start broad and then later narrow your search. Do not begin by limiting your search terms just to the subject field but also search in the title and abstract fields. 3. Keep a record of your search strategy in case you have to replicate it or use it as a resource to build other searches. Keep a record of search terms that you use frequently. 4. Pay special attention to review or meta-analysis articles or reports because they often provide useful overviews and also extensive bibliographies. 5. Take the time to read the searching tips for the database. These tips can often save you time and effort and make your searches more precise. Of particular importance are the ways to limit search results (years, languages, population groups, etc.), combine search terms (for example Boolean operators such as and, or, not) and save and download searches. Interactive Health Communication Workbook 80

This is a copy of the OHPE Ontario Health Promotion E-Mail Bulletin E-Mail Bulletin from July, #166.1 July 21, 2000 2000.

To view and search the past How to find high quality Canadian health promotion OHPE Bulletins on the Internet resources through the Canadian Health Network Web site go to http://www.ohpe.ca http://www.canadian-health-network.ca/ Ontario Health Promotion E-Mail Bulletin 1(800) 263-2846 ext 226 OR (416) 978-0522 E-mail: [email protected] By Penney Kirby, Content Development Specialist Internet: at the Canadian Health Network http://www.opc.on.ca/ohpe/ ohpeflyr.htm

A. Introduction The purpose of this bulletin is to provide a general overview of the Canadian Health Network (CHN) Web site. I will focus on describing the value of the Web site for locating high quality Canadian health promotion resources. I recently led a session at the Health Promotion Summer School on bibliographic searching for health promotion literature. This session was based on my experiences as a librarian providing Internet and bibliographic searching services to numerous health promotion organizations. I encouraged people to search PubMed, HealthPromis and other bibliographic databases and also suggested searching the CHN Web site. MEDLINE and HealthPromis are excellent resources for locating articles that have been published in peer-reviewed journals, but they do not provide access to the wealth of information produced by Canadian non-profit organizations - and these resources are often the most relevant. More and more organizations are sharing resources through their Web sites. The CHN site can provide you with direct access to these resources in a much more precise and effective manner than general Internet search engines can. For more information on searching MEDLINE and other bibliographic databases see OHPE Bulletin #105.1 Searching for Health Promotion Literature at http://www.ohpe.ca Please note that the CHN Web site provides access to health promotion resources in both French and English. The links and examples I have provided are relevant to English content however most of the tips are also relevant to the French side of the site at http://www.reseau-canadien-sante.ca/customtools/homef.html

B. About the Canadian Many of you will have already heard of the Canadian Health Network or Health Network your organization may already be a partner. The Canadian Health Network (CHN) ( http://www.canadian-health-network.ca/ ) is a federal initiative, funded by Health Canada. It includes over 550 Canadian non-profit organi- Finding the Information You Need: A Tutorial for People Working in Health Promotion 81 zations, government, community-based organizations, universities, and libraries. To view a complete list of CHN partner organizations see http://www.canadian-health-network.ca/html/partners/partnerliste.html The mandate of CHN is to provide Canadians with “Health information you can trust” by providing access to resources produced by Canadian organizations that have been selected by CHN and conform to CHN’s criteria for quality and relevance. Currently this mandate is being achieved through the CHN Web site, however other modes of access are envisioned for the future. The intended audience for CHN is the Canadian public, health care professionals and others interested in health promotion. The scope of CHN’s information activities is health promotion and disease prevention.

The CHN Web site features original content in both official languages and a C. The CHN Web Site searchable database which provides access to resources that reside on partner Web sites. The Web site includes 26 Health Centres which can be viewed on the left bar of the English homepage (http://www.canadian-health-network.ca/customtools/homee.html). Each of the Health Centres provide users with a set of “Frequently Asked Questions” (FAQs) which have been specially prepared for CHN by expert partner organizations. The “Essentials” feature on the Centres pages point the user to resources or organizations that are extremely important to the topic, for example, on the Children’s page, the Guide to Federal Programs and Services for Children and Youth (http://www.hc-sc.gc.ca/hppb/childhood-youth/guide/guide.htm) A number of other features available on the Health Centres highlight resources of particular interest. The database that runs behind the CHN Web site allows site users to search and retrieve records that have been expertly indexed. Currently there are over 6,000 records in the CHN database. Each record represents and describes a resource that resides on a CHN partner Web site. As noted above, before each record is created the resource is checked to ensure it meets quality criteria. For more information on CHN’s Approach to Quality Assurance please see http://www.canadian-health-network.ca/html/about/ qae.html or What to look for in a health promoting Web site http://www.canadian-health-network.ca/html/help/checklist2.html As an example of how the CHN database can be used, I recently did a search from the Cancer Centre for Health Promotion Tools and retrieved 12 records. I then read the abstracts provided in the records and clicked on the titles of the resources I was interested in. After clicking on a title I left the CHN site and viewed the resource on the Web site of the organization that had produced the resource. Interactive Health Communication Workbook 82

Below is an example of what a CHN record looks like, with labels: TITLE: Living with sunshine ABSTRACT: Presents a teaching resource on sun protection for grades one through three. Lessons cover what skin is and why it needs protecting; the positive and negative effects of sun on skin; and how to protect the skin with shirts, hats, and sunscreen. Includes background information for the teacher. ORGANIZATION THE RESOURCE IS FROM: Source: Canadian Cancer Society (CCS) Having the abstract allows users to quickly judge if the resource is of interest to them. The Guided Search feature on each Health Centre page is a good way to start your search of the CHN database, as long as your search falls within the topic or demographic group category. For example, you could browse for health promotion resources from the Healthy Eating Health Centre. At the Guided Search page (get there by visiting one of the Health Centres and clicking on “Guided Search”) you can choose to browse all the records that have been indexed with the topic or group of the Centre (time-consuming but sometimes very helpful in giving you a broad overview of what is available) You can also choose to narrow your search by selecting from the left bar Group/Topic, Resource Type or Province/Territory. For tips on using Guided Search see http://www.canadian-health-network.ca/html/help/guidedtipse.html?rand=63313.88 Health promotion professionals will often want to narrow their Guided Search results by using the Resource Type category. Selecting Health Promotion Tools (left side bar from the Guided Search page) will limit your results to resources that have been indexed as supporting the work of health promotion. These will often be resources written specifically for professionals who are working on health promotion planning, policy, etc. Selecting Organizations will retrieve a set of records that describe CHN partner organizations within that topic area. Finally, Policy and Research will retrieve policy papers and analysis. For example, from the Sexuality/Reproductive Health Centre I limited my search to Health Promotion Tools and retrieved 45 resources, including this one below: Folic acid health communication campaign http://www.opc.on.ca/beststart/pract_prod/folic_acid/folic.html Details the rationale, activities, resource needs and recommendations for an Algoma Best Start social marketing campaign designed to promote folic acid supplementation among women of childbearing age. Includes sample public service announcements, a newspaper quiz and articles, and a poster. (Source: Best Start) Finding the Information You Need: A Tutorial for People Working in Health Promotion 83

Another way to search the CHN site is to use the list of subject headings D. Searching the CHN that have been assigned to records. Searching the site in this way allows Web Site Using the you to develop a more precise search that is not limited to the topics of the A-Z Subject Headings Health Centres. The A-Z Subject list is available on the site at http://www.canadian-health-network.ca/custom tools/azindex.asp?currLetter=A&promptKey=1

There are also search tips at http://www.canadian-health-network.ca/html/help/aztipse.html The terms below are a set of subject headings I have identified as of particular interested to those working in health promotion. The number after the term is the number of records currently in the English database which will be retrieved if you search the A-Z index by this term.

Community development 30 Community health 57 Health care restructuring 22 Health education 57 Health status 33 Media literacy 16 Partnerships 21 Policy making 31 Preventive medicin 5 Program evaluation 34 Program planning 31 Quality of life 26 Risk behaviours 12 School health education 17 Social marketing 41 Workplace health promotion 14

If these terms interest you, select them from the A-Z Subject list and view the records. http://www.canadian-health-network.ca/custom tools/azindex.asp?currLetter=A&promptKey=1

Two Health Centres are of particular interest to those working in health E. The Health promotion. The Health Promotion Health Centre provides a starting point Promotion And to find strategies, approaches, and activities that help people to lead Determinants Of healthier lives and create healthier communities http://www.canadian-health-network.ca/1health_promotion.html Health - Health Centres Through this centre you can view the Health Promotion FAQs, prepared by The Centre for Health Promotion, University of Toronto http://www.canadian-health-network.ca/html/faq/chntopiccategory_9e.html 1. What is health promotion? 2. What is health? 3. Is health promotion the same as population health? Interactive Health Communication Workbook 84

4. What are the key milestones in the development of health promotion? 5. Who is involved in health promotion? 6. What are the key values in health promotion? 7. What are the key action areas in health promotion? 8. What are some of the key skill sets involved in health promotion? 9. What are the broad determinants of health? 10. Where does health promotion happen? Another Health Centre of particular interest is the Determinants of Health - Health Centre http://www.canadian-health-network.ca/1determinants_of_health.html . This Centre provides information on income level, housing, education, relationships with friends and family, and other determinants of health. There are currently 171 Determinants of Health resources in the CHN database! This Centre also has a set of FAQs that were prepared by the Canadian Council on Social Development at http://www.canadian-health-network.ca/html/faq/chntopiccategory_7e.html 1. What makes people healthy? 2. Why do people in some countries live longer than they do in others? 3. Are poor people less likely to be healthy than rich people? 4. How is working related to health? 5. How do relationships with others affect people's health? 6. Can experiences in early childhood affect a person’s health during adulthood? 7. How does education affect health? 8. What can be done to influence the determinants of health? 9. What affects health more-germs and viruses, or the environment? 10. Where can I learn more about the determinants of health?

F. And Finally… The CHN Web site is a useful tool for those interested in health promotion who would like to strengthen their knowledge and programming by accessing information produced by Canadian organizations. It is also a useful tool to find out what others across the country in Health Promotion are doing. Browse the site and use the database to find resources. * * * * * * * * * * * * * * * * * * * * * * To view and search the past OHPE Bulletins on the Internet go to http://www.ohpe.ca. Your brief news, resources and CONTRIBUTIONS are Welcome!! Send to [email protected] * * * * * * * * * * * * * * * * * * * * * * Ontario Health Promotion E-Mail Bulletin 1(800) 263-2846 ext 226 OR (416) 978-0522 E-Mail: [email protected] Internet: http://www.opc.on.ca/ohpe/ohpeflyr.htm Internet & E-Health Landscape: 85 Why Use The Web For E-Health Promotion

by Shawn Chirrey, 2002 Project Manager, Youth Affiliate Internet & E-Health Landscape: Canadian Health Network Why use the Web for E-Health Promotion TeenNet Project, University of Toronto Shawn Chirrey, MA, MHSc Project Manager, Youth Affiliate Canadian Health Network

TeenNetProject,UofT

z Internet History & Growth z E-Health Trends z Future Trends on the Internet

History & Trends of the Internet:

Where We’ve Been:

z A Brief History of the Internet z Where we’ve come from

Phases of the Internet & Computers:

z 1960s – Building the Wheel – 1969 – ARPANET developed by US Dept of Defense z First packet switched network z Two Nodes (UCLA & Stanford) z 1970s – Networking the Nerds – 1972 – E-mail developed & ARPANET at 23 Nodes z 1980s – Serving the Suits – 1986 – NSF Net (National Science Foundation) z 5 Universities and expanded rapidly z Development of many technologies at core of today’s Internet

(Adapted from Nerds 2.0.1 – PBS Documentary) Interactive Health Communication Workbook 86

Phases of the Internet & Computers (cont’d):

z 1990s – Wiring the World – World Wide Web (1990) z Tim Berners-Lee develops software leading to the WWW z Develop at the CERN (European Laboratory for Particle Physics) to allow for ease in browsing Internet Resource (http://www.cern.ch) – Web Browsers (1992) z MOSAIC (pre-cursor to Netscape) developed by National Center for Supercomputing Applications z Graphic use explodes and 1 Million computers are connected worldwide z Standards and development continue through the work of the W3C Consortium (http://www.w3.org) z 2000s – Wireless Web, High Speed & Integration

Snapshot of the Web of 1994:

z Few People Knew about the Net (40% Aware) z Few People Had Access (10% of North American Households) z Few People Embraced It or Any Communications Technology (66% No E-Mail; 70% No Pagers, 60% No Voice-Mail) z No Business Role for the Internet Yet

Snapshot of the Web of 1994 (Cont’d):

z Some computer companies just starting to come on board with web IT presence (1993 – IBM, Compaq, Apple) z Internet Access was hard to get z Internet Speed was SLOW

(Source: Carol & Broadhead, CIH 2000) Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 87

The Current State of the Internet

Where It’s At:

Current Trends on the Internet

Audience

z Number of years it took to build an audience of 50-Million for: z Radio – 38 Years z Television – 13 Years z Cable - 10 Years z Internet – 5 Years z Wireless Web (Internet based Cell Phones) – 2 Years z 10 Million Audience z Netscape (3 Years) z Hotmail & Napster (<1 Year) z Every 100 days the number of Internet Users Doubles (Sources: Techserver,June 17, 1998; Forrester Research, 1999)

Growth of the Web

z Rapid Growth of the World Wide Web z1993 – 50 Websites z1999 – 500 to 600 Million Websites z2001 – Estimated at over 1 Billion

(Source: NUA , 1999) Interactive Health Communication Workbook 88

How Many People are On the Internet – Today:

August 2001 November 2000

(Users in the millions) z World Total 513.4 407.1 z Africa 4.2 3.1 z Asia/Pacific 144 104.9 z Europe 154.6 113.2 z Middle East 4.7 2.40 z Canada & USA 180.7 167.12 z Latin America 25.33 16.45

(Source: Estimate by NUA)

How Worldly is The WWW?

z Year 2000 – Number of International Users surpassed the number of North American users for the first time. z By August 2001: z 180.7 Million - Users in North American VS z 332.7 Million - Users outside North America

z By 2003 Chinese will surpass English as the most commonly used language on the Net (Sources: NUA, 2000; Carol & Broadhead, CIH 2000)

How Many Canadians

Percentage of Canadians with Internet Access: 70 z In 1995, 17% 60 z In 1998, 55% 50 z In 2000, 70% 40 30 Percentage z By 2003, it will level off at 20 85% (Source: Statistics Canada, 1999; 10 Angus Reid, 2000) 0 199519982000 Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 89

Where Do Canadians Have Access

z In 1998 – When Only 55% had Access, they were using it: – 19% Work & Home Access – 19% Home Only Access – 14% Work Only Access

z Gap between those having work access versus at home was eliminated between 1997 & 1998.

(Source: Statistics Canada, 1999)

The Closing of the Digital Divide

z In 1999 the typical Internet user – high income, university education, ages 18 to 34 z By 2000 Low Income Canadians (<$40K) access Increased: – 49% in 2000 VS. 30 % in 1999 – 63% increase between 1999 & 2000 z High Income Canadian (>$60K) still have a sizeable lead with 90% access in 2000 z Digital Divide in the US will grow in next few years z Feb 2002: US reports 143 million people, or 54% of the total population, are now online in the US, up 26% on last year (Angus Reid, 2000; Us Dept of Commerce 2001)

Canadian User Profile: The Shifting Landscape

z Access amongst persons with with High School Education (HSE) have Access – In 1999 51 % – In 2000 growth rate of 55% for HSE from 1999 z Versus a growth rate of only 18% for Post- Secondary Education and 8% for those with a University Degree, since 1999

(Angus Reid, 2000) Interactive Health Communication Workbook 90

Canadian User Profile : Shifting Landscape (Cont’d)

z Women 66% Vs. Men 73% (Vs. 9% gap in 1999) z Ages 35 to 54 have 75% Access (increase of 39% from 1999) z Ages 18 to 34 (the Dot-Com Generation) have 83% access z Regular Users (> 1 hour/week) have grown with 52% (in 2000) Vs. 41 (in 1999) z 76% of Canadians survey say that the Internet has had a major impact on their lives

(Angus Reid, 2000)

Canadian Internet Trends

z The average online Canadian family spends – Over 32 hours using the Internet every week, and – Over 1,600 hours online per year, reports z 51% of the parents said they always or sometimes go online with their children. z 57% have guidelines on when and how the computer can be used, and z 48% place time limits on computer use by their children. (Source: CyberAtlas/Ipsos-Reid, Feb 2002 – Poll of 750 online families with children 18 and under)

Canadian Internet Trends (Cont’d)

z 72% said telecommuting has allowed them to spend more time with their family. – 59% have bought online, – 57% have used online banking services. z Almost half of the parents polled said their children have some influence on the purchase of new technology for the home z 56% said their children have taught them at least some of what they know about the Internet. z Over 50% of online Canadian families said they would bring their PC rather than their telephone or television if they were to be stranded on a desert island. Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 91

Teen Internet Trends

Internet Access By Canadian Youth

z 70% General Population in Canada z 70% Teens in US z 95-99% Teens in Canada (Access versus have accessed) z 70-75% Street Youth in Toronto (Initial finding from TeenNet research) z Quantity of Access Versus Quality of Access

(Sources: Angus Reid, 2000; Grunwald, 2000; Stats Canada, 1999; TeenNet, 1999; Environics 2001)

Canadian Teens Online

z 33% of Canadian Teens (12-17) on the Net, spend less time watching TV since they started logging on z 9.3 hours/week on-line average (same as TV) z 85% of Teens indicate that the Net helps them to learn z 33% of Teens wish they had more time to use the Internet at School (Youth Culture, 2000) Interactive Health Communication Workbook 92

Canadian Teens Online (Continued)

z 55% of Teens “shop” on-line but only 10% have purchased anything on-line – The road block was not lack of a credit card, but cost barriers (such as US exchange rate, customs duties and taxes) or in some cases parents won’t let them z 51% of Teens want the Internet to be monitored and policed z 22% of Teens usually go online with another person

(Youth Culture, 2000)

Reasons Teens Go Online

z 83% E-mail z 68% Looking for Specific Information and Research z 51% Games z 40% Chat Rooms

(PriceWaterhouseCoopers Survey, 1999)

Reasons Teens Go Online Among Teen Internet Users

Reasons Teens Go Online Primary Reason z Send/receive e-mail 83% 44% z Research/get information 68% 19% z Play games 51% 10% z Use chat rooms 40% 10% z Download music/videos 38% 6% z Send electronic greeting card 31% 0% z Shop 26% 2% z Read news/sports/other 23% l4% z Other 19% 5% (Source: E-Retail Intelligence System® Internet Users Consumer Panel, April 2000, PricewaterhouseCoopers LLP) Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 93

Net Use by Canadian Youth

z 85% of Canadian Teens use the Net Regularly (Over 3 Million Youth)

z 95% of Canadian Parents believe the Net to be a great learning Tool

(Youth Culture Study, 2000)

Who Is On The Web

z Largest Growing Groups On the Net: z 1998 - Seniors 60+ z 1999 - Tween Girls z 2000 - Women In General (especially Teens and 55+) - Canadian Low Income Families - Cellular phone users (Europe/Asia leading over North America) z 2001 – Families – Canadian Families

Tweens Online

z Female Tweens (Girls 12 to 15) are the fastest growing groups on the Net currently z In 1996, 54% were online z 1999, that figure jumped to 87% z About 55% have their own e-mail accounts z About 10% have their own web pages

(Source: Teenage Research Unlimited (TRU), 2000 - US) Interactive Health Communication Workbook 94

E-Health

z History of Consumer Health z Growth of E-Health z E-Health Usage & Users z E-Health Issues & Trends

History & Growth of Consumer Health Movement

z 1935 Alcoholics Anonymous formed (first Self-Help group) z 1960s Growth of Self-Help & Birth of Women’s Health Movement z 1970s Birth & Growth of Consumer Health Movement

History & Growth of Consumer Health Movement (Cont’d):

z 1980s Development of Self-Help Clearinghouses across North America, Europe & Asia z Online self-help groups develop through online computer services (i.e.BBSs, Compuserve, E-mail) prior to Internet z 80&90s Consumer Health Information Service (CHIS) centres open across North America z 90s Birth of E-Health & Growth of Online Self-Help Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 95

Most Poplar Online Content:

Growth of Leading Content Groups (in millions)

1997 1998 1999 Annual Growth Rate

News 17.9 29.2 53.5 22% Shopping/Product Info 11.2 29.5 45.9 24% Travel 15.1 27.0 39.6 10% Health & Medicine 12.0 17.3 34.7 34%

(Sources: Cyber Dialogue, 2000)

Searching for Health Online

z E-Health is the fastest growing content area being used by those online – Growth rate of 34% per year z Twice the rate of the overall growth rate of the Net (17- 22%) z By 2001 it will out rank news, shopping and travel z 70 Million users searched the web for Health Information in 2000 z Over 15,000 Sites dedicated to Health z 48% of adult Americans online (34.7 million) used E-Health resources in 1999 (Source: Cyber Dialogue 2000, 1999; Berger, 2001)

E-Health Usage in Canada

z 22% of adult Canadians overall have gone online for e- health z 50% of Consumers and 73% of Doctors who are online in Canada have used the net for e-health z Canadians’ prefer Canadian Websites, of online health info seekers: – More than 50% Have gone to Health Canada Site and – 27% have used the Canadian Health Network z 20% of Canadians online have used Medscape & Medline (research oriented database sites)

(Source: PWC/CMAJ, 2000; Berger, 2001) Interactive Health Communication Workbook 96

Frequency of Going Online for Health Information

What Type of Users seek E-Health

z Boomers? z No: – “Sandwich generation” just doesn’t Have time – Average age 44 of Boomers is less then average age of that of the average: z prescription drug users 52%, z exp. Hospitalization 49% & z seeing medial specialists 47% z Sure to be biggest growth audience in the next 5-10 years but not currently (Sources: Cyber Dialogue 2000, California Health Care Foundation, 2000)

E-Health Seekers

z GenXers (18-34) – Greatest growing market of potential users of E- Health in the coming years – Interested in prevention content (fitness, nutrition, women’s health and prevention in general)

(Sources: Cyber Dialogue 2000, California Health Care Foundation, 2000) Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 97

E-Health Seekers in Canada

% E-Health Users %Online

Seniors 55% 7% Age 15-24 31% 72% Age 25-44 51% 56%

Women vs Men (47% vs 36%)

Info Quality - Canadian Consumers & Doctors:

z 79% of E-Health users said resources needs to be improved z 33% of Consumers using e-health discuss them with their doctors z 84% of Doctors have been presented with e-health resources z 47% of Doctors have frequently review these materials – Of those 32% found them to be of good quality z 36% of Doctors give online info to their patients – Of these 51% are doctors online & 26% are non-online doctors

What Are People Looking For from E-Health?

z In the US, amongst Health Information Seekers: z 76% are interested in online sources for doctor evaluations, z 72% are interested in similar sources for hospital evaluations. z Only 33% of the total health web sites even have doctor and hospital information. z Some HMOs now using “infoscriptions” & online doctor consultations (Source: Cyberdialoge, 1999) Interactive Health Communication Workbook 98

E-Health Seekers

z What types of Medical Information People are looking for: – 83% Search for medical literature – 67% Description of disease – 38% Clinical trials – 26% Support groups z Preferences of online health seekers – 71% Medical Professional sites – 39% Non-profit Web sites – 32% Consumer Web sites – Commercial and pharm. Web sites arrive in last position (Source: HON, Feb/March 2001 – International Survey – Respondent Composition: 54% US, 26% Europe, 5% Canada, 4% South America; 51% Female, 49% Male; 50% Consumers, 50% Medical Professionals)

“Shortcomings” of Telehealth

z 83% Accuracy of information z 79% Trustworthiness z 76% Availability of information z 72% Findings things z 68% Privacy z 67% Security of electronic commerce

Less critical issue facing the Internet z Commercialisation/advertising; Censorship; Government regulation; Not adapted to disable or impaired people; Intellectual property/copyright (Source: HON, Feb/March 2001)

Patient E-Health Preferences

z Patients prefer to have access to more complex information z 77% Seek out information from medical professionals sites z 64% Discuss their internet findings with their physician z 82% Search for information on drug z 14% Buy drugs online z 43% Use the Internet to seek 2nd opinion z 33% Have used occasionally on-line medical consultation services z 14% Use the email to consult with their own physician (Source: HON, Feb/March 2001) Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 99

What Are People Looking For from E-Health?

z Amongst Canadians, what people would like to see from e-health: – 84% Doctor questions and consultation – 83% Make appointments – 58% Referrals to specialists – 41% Prescription referrals (Source: HON, Feb/March 2001)

Consumer Obstacles to Web Use for E-Health (Skills Satisfaction)

z Lack of time (46% North America; 53% Europe) z Dissatisfied with info quality (33% NA; 34% Europe) z Inadequate tools (19% ; 25%) z Insufficient IT training (24%; 19%) z Search tools + Ease of use (57%; 50%) z Relevance matches (52%; 63%) z Speed (32%; 47%) z Quality of description (35%; 44%)

(Source: HON, Feb/March 2001)

Medical Professional Obstacles to Web Use for E-Health

Medical professionals Satisfaction with skills z Obstacles to Web use z 60% Lack of Time z 26% Dissatisfied with info quality z 24% Inadequate tools z 29% Insufficient IT training z 54% Search tools + Ease of use z 26% Relevance matches z 52% Speed z 43% Quality of description

(Source: HON, Feb/March 2001) Interactive Health Communication Workbook 100

What Are People Are Looking For from Health Info?

z Amongst Canadians in the last year: – 53% sought health info from their family physicians – 22% from the Internet z Primary Source of Health Info? – 33% Doctor – 9% Internet – 29% (when combined with other media)

What Are People Looking For from E-Health?

z Amongst Americans, what people would like to see from e-health: – 88% access to Doctor’s Office – 82% personalized info on diseases and conditions – 82% access to expert panels to respond to questions – 73% illness support groups – 70% health risk assessments – 58% e-mail reminders of refills/appointments – Evaluation comparisons of health care providers (76%) and insurers (59%)

Self-Help Online

z Self-Help & Self Care are merging more online z 25% of Health Information Seekers have joined an online support group z One study found online support groups more helpful than doctors, for z convenience, z emotional support, z cost-effectiveness and z in-depth support.

(Sources: Cline & Haynes 2001, HBE; Grandietti, HEJ 2000) Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 101

Teen E-Health Trends

Teens & E-Health

z Youth 15-24 get ``a lot'' of health information online and a significant proportion of youth are acting on what they find. z 25% of 15-24 Year Olds. – Seeking health-related information as much as they are downloading music and playing games online and – More often than shopping online z Nearly 40% say they have changed their own behavior because of information they found on the Web

z (Source, Kaiser Family Foundation, 2002)

Teens & E-Health (Cont’d)

z 50% of online youths have searched the Web for information on specific diseases – such as cancer or diabetes and sensitive, youth-oriented topics, such as HIV (news - web sites)/AIDS (news - web sites), birth control, and sexually transmitted diseases, are also popular. z 25% looked up information on broader health issues – weight issues, mental health, drugs and alcohol, and violence. Interactive Health Communication Workbook 102

Teens & E-Health (Cont’d)

z ``Confidentiality is so important and at this point most young people have faith that the Internet offers them that confidentiality,'' z Majority of youth who surf for health info do it a few times a year, but nearly four in 10 do so at least once a month. z Among those surveyed 90% have gone online and 75% have Internet access from their home.

Teens & E-Health (Cont’d)

z About 17% said they would trust health information found on the Web ``a lot'' while 40% said they would trust it at least ``somewhat.'' z interest about health issues on the Web -- raises a series of questions, including the quality of the information available and targeted at this age group. z Among 15 to 17 year-olds who were looking for health information online, nearly half said they have experienced being blocked from sites that they said were non-pornographic due to filtering.

Future Directions of Information Technology

Where We Are Headed Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 103

Trends Effecting the Internet

• Bandwidth Demand • New Users, New Connection Methods (cable, ADSL), New Bandwidth Demanding Software Applications • Bandwidth Explosion • New innovations in Fiber Optics and Reuter technologies is increasing bandwidth availability rapidly • Voice Into Data • All voice phone calls will be moving through Internet technologies of Fiber Optics, TCP/IP and Reuters • Collapse of Cost • Flat free prices and paying for one’s bandwidth (not for phone or internet connection) will be the norm in 5 years (Source: Carol & Broadhead, CIH 2000)

Technology Trends Affecting the Internet

z Wired Homes z Home Networks will be common in New Homes being built z The IP Chip (Internet Protocol Chip) z Internet connectivity being built into all new devices and appliances from TVs to Home Stereos and Microwaves to Burglary Systems z Nano-Cycles z Increasingly rapid product life-cycles and replacement z Market and Consumer Empowerment z Consumers are and will exert great pressures on companies to meet their specific needs. Increased control over market success. (Source: Carol & Broadhead, CIH 2000)

Shift to Open Source

z The Open Source (OS) Movement will continue to rapidly grow in the coming decade z Includes: Linux, FreeBSD, and BEOS operating systems z Based upon open-source code and GNU licensing that encourages development of Free and adaptable programs. z The Cathedral (Microsoft) versus the Bazaar (Linux) models of developement z Netscape moved to open source format in 1999 z Allows people to build adaptable and cheap interfaces for Internet appliances and wireless devices Interactive Health Communication Workbook 104

Phone & Internet Merging

z 2.6 Billion minutes of calls were made over the Internet in 1999 (12 Times the total for 1998) z North American long-distance carriers will deploy 6.8 million miles of optical fiber cable in 2000, four times the 1997 amount

(Sources: Probe Research; KMI Corp.)

Wireless & Cell Technology “The PC Era is Over” Lou Gerstner, IBM, CEO (1999)

Mobile / Cell Phone Usage

z Worldwide: z 1990 – 11 Million Users z 1999 – 500 Million Users z 2003 – 1 Billion Users (Surpassing for the first time ever projections for PC users worldwide) (Source: Shift Magazine, 2000) Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 105

Projections of Internet Users

YEAR 2000 2002 2005 USA (millions) Internet Users 135 169 214 Wireless Internet Users 21883 Wireless Internet User Share 1.3% 10.4% 39.0% W. Europe (millions) Internet Users 95 148 246 Wireless Internet Users 7 59 168 Wireless Internet User Share 7.5% 39.8% 68.3% Worldwide (millions) Internet Users 414 673 1,174 Wireless Internet Users 40 225 730 Wireless Internet User Share 9.6% 33.5% 62.1%

(Source: eTForecasts, 2001)

World Wide Leader In Cell Phone Use? z Not North America z Not Japan or Hong Kong z Surprisingly, Northern Europe (Scandinavia) z Finland in particular is leading the pack z Cell Lines now outnumber land lines z More then 60% of the population have cell phones (highest ratio in the world) z 150% saturation amongst target audience (Ages 14-40) (Source: Shift Magazine, 2000)

Cell Phone Facts

z 1/3 of all 911 calls in the US in 1999 came from Cell Phones z Globally E-commerce conducted over wireless devices will generate 14 billion transactions annually by 2004 (Source: Cellular Telecommunications Industry; Strategy Analytics) Interactive Health Communication Workbook 106

The Technology Allowing the Cell-Web Crossover

z WAP (Wireless Application Protocol) – a set of technology standards that allow access to stripped down Internet Content through the latest generation cell phones. z WML (Wireless Markup Language) – the language for developing web-pages for WAP phones (the HTML for wireless).

WAP Websites

z In North America there are 20-30 WAP accessible web sites available to cell phone subscribers z In Northern Europe (Finland) there are over 100 WAP accessible web sites and over 200 online information services (ranging from stock quotes to anonymous chat to personal web pages)

Keeping Current on Technology Trends and the Net

z Good sources for keeping up in the world of Information Technology (IT) z Benton Foundation (http://www.benton.org) – Organization that follows IT and community trends/impacts z Cyber Dialogue (http://www.cyberdialogue.com) – US Organization that tracks online health consumer trends z NUA (http://www.nua.org or http://www.nua.ie ) – Irish organization that is the World leader in surveys of Net users z Slash Dot (http://www.slashdot.org) – Bible for all things Open Source & new technology z Shift Magazine (http://www.shift.com) – Canada’s answer to Wired (Good IT coverage) z Wired (http://www.wired.com) – Good old stand by on technology trends Internet & E-Health Landscape: Why Use The Web For E-Health Promotion 107

Technology & E-Health Trends

z Health On the Net Surveys (http://www.hon.ch/Survey/analysis.html) z Kaiser Family Foundation (http://www.kff.org)

What Else Does the Future Hold

“80% of the Technologies that we will still be using 20 Years from now have yet to be invented”

- Quote made by many Futurists

(Source: Carol & Broadhead, CIH 2000) Interactive Health Communication Workbook 108 Assessing the Quality of Web Sites 109 and Applications

by Larry Hershfield, 2002 The Health Communication Unit [email protected] Assessing the www.thcu.ca

Quality of and Websites and Shawn Chirrey, Applications Manager, Youth Affiliate Canadian Health Network Larry Hershfield Shawn Chirrey 100 College Street Room 213 The Banting Institute University of Toronto Toronto, Ontario M5G 1L5 Tel (416) 978-0522 Fax (416) 971-2443 February 26, 2002 E-mail: [email protected] www.utoronto.ca/chp/hcu/

Overview of presentation

Introduction Quality defined Quality assessment Small group task and debriefing

Quality Defined Interactive Health Communication Workbook 110

THCU's exemplary health communication web tour

http://www.utoronto.ca/chp/hcu/ihctour.html

Quality: The “What” and the “How” of it?

What »Information Science » Health Promotion

How » Creative Execution, generally » Interactive Medium, specifically

Criteria

Content of site Design and aesthetics Disclosure of authors, sponsors, developers Currency of information Authority of source Ease of use Accessibility and availability Links Attribution and documentation Intended audience Contact addresses or feedback mechanism User support Miscellaneous

From Kim et al: http://www.bmj.com/cgi/content/full/318/7184/647 Assessing the Quality of Web Sites and Applications 111

Usability

60% - 2/3 of the time, web users can not find the information they seek.

“3 strikes and you’re out” Rule.

(Source: User Interface Engineering, 2000)

Quality Assessment

Approaches to Quality Assessment: » Content vetting by site managers (e.g. CHN) » Seal of Approval (e.g. HON Code) » Providing the Tools for Appraisal & Digital Literacy (e.g. CHIS)

CHN health info quality checklist

Is the resource credible? Is the content suitable? Is the information relevant to you? Is the resource timely? Is there clear and adequate disclosure? Are there clear caution statements? Is the site user-friendly?

www.chn-rcs.ca/html/help/netinfoe.html Interactive Health Communication Workbook 112

CHN health promoting criteria for web sites

HP is about having more control over, and being able to improve, our health Organizations offering health information on the Web can support this in 3 ways, by: » Providing the right content (the “what”) » Supporting health promoting processes (the “how”) » Being based on health promotion values

www.chn-rcs.ca/html/help/netinfoe.html

HON: code of health website conduct

Authority Complementarity Confidentiality

Attribution www.hon.ch Justifiability Transparency of Authorship Transparency of Sponsorship Honest in Advertising & Editorial Policy Assessing the Quality of Web Sites and Applications 113

Small group task

Assume you were looking for information on Cholesterol and took three routes: » You went to the CHN (www.canadian-health-network.ca) site and searched on “cholesterol” and went to the top site (http://www.canadaegg.ca/english/nutrit/consumer/resources/cholclues-e.pdf) » You went to the HON site (www.hon.ch), searched for HON sites on cholesterol, and went to the top site (http://hin.nhlbi.nih.gov/cholesterol/) » You went to Google (www.google.com), searched for cholesterol, and went to the top site (http://www.focusoncholesterol.com/Script/Main/hp.asp) » You are now at the site. Take a look around. What steps would you take to assure this is quality information. Take them. Are you assured? » Be prepared to discuss what you learnt, what you struggled with, and what you would do in real life to assure quality. Interactive Health Communication Workbook 114 Phases & Stages of 115 Web Site Design

by Oonagh Maley, 2002 Phases of Website Design Project Coordinator, Te e n N e t

Phase 1 Pre-production ¾Website Planning Phase 2 Production ¾Content Design ¾Site, Interface & Interactivity Design ¾Prototyping ¾Usability & Functionality Assessments Phase 3 Post-Production ¾Ongoing Maintenance & Evaluation

Phase I: Pre-Production

100 College Street Room 213 Part I The Banting Institute University of Toronto Toronto, Ontario M5G 1L5 Tel (416) 978-0522 Fax (416) 971-2443 E-mail: [email protected] www.utoronto.ca/chp/hcu/

Phase 1: Pre-Production: Website Planning

A. Determine your audience B. Define the goals of the project C. Decide what tools you will use D. Identify what resources you have Interactive Health Communication Workbook 116

Phase 1: Pre-Production: Understanding Your Audience

Existing Research ¾ Market stats, studies (web use, health info, audience trends, issue & content specific research) ¾ Previous needs assessments ¾ Your own agency/organization based data Competitive Analysis ¾ What other websites are there for this audience? ¾ What works? What doesn’t? ¾ What will be common or unique to your website? Additional Research ¾ Focus Groups ¾ Working Groups ¾ “Expert Advisors”

Phase 1: Pre-Production: Defining Project Goals

¾Ask of the Website: • What is the purpose? • Why are you developing it? • How do you want users to use the website? • What do you want users to come away with? • How does it fit with existing programs? • How does it fit with existing needs?

Phase 1: Pre-Production: Defining Project Goals

¾Purpose of site: • Promote an agency/organization/program/event • Encourage use of a service • Provide information about health risks, etc. • Provide a health promotion program on-line Existing or new? Education and training Support programs for clients Phases & Stages of Web Site Design 117

Phase 1: Pre-Production: Defining Project Goals

What policies will guide site development and use? ¾Copyright ¾Literacy ¾Technical (browser level, plug-ins, etc) ¾Privacy

Phase 1: Pre-Production: Tools & Resources

Appropriate Tools and Technology ¾ Choose the appropriate technology for your audience (e.g., plain HTML, online order form, Flash animation, etc.) Available Resources ¾ Budget, in-kind resources, on-staff, contract & volunteer ¾ What content will you need to produce & Who will do it? ¾ What content do you have in other formats that can be reused? (e.g., publications, brochures, presentations, etc.) Levels of Authority ¾ Who needs to approve what ¾ Working with committees

Phase II: Production

100 College Street Room 213 Part II The Banting Institute University of Toronto Toronto, Ontario M5G 1L5 Tel (416) 978-0522 Fax (416) 971-2443 E-mail: [email protected] www.utoronto.ca/chp/hcu/ Interactive Health Communication Workbook 118

Phase 2: Production:

A. Content Design B. Interface Design C. Adding Interactivity

Phase 2: Production: Content Design

Content Design ¾ Content (actual writing) ¾ Design elements that serve to communicate Content (vs. site interaction) Also Includes: ¾ Interactive communication features, such as: discussion board, chat, online conferencing. ¾ Developing a metaphor for the site (i.e, cyberisle) ¾ Interactive content features, such as: flash animations, streaming video & audio.

Phase 2: Production: Content Design

Organize Your Content ¾What do you have? ¾What needs to be altered? ¾What needs to be created? ¾What resources do you have to develop content ¾Who do you have to work on content?

Content is Time Consuming Phases & Stages of Web Site Design 119

Phase 2 – Production: Interface Design

1. Navigation 2. Site Design & Presentation 3. Prototyping

Phase 2 – Production: Site Navigation

Common design elements: ¾Splash Page (branding, unique URL) ¾Index Page (main page, list of options, some content or content samples) ¾Second Tier Pages (content itself, outlines with hyperlinks) ¾Third Tier Pages (longer content)

Phase 2 – Production: Site Navigation (cont’d)

Linear (menu)

Hierarchical

Organic (hyper-text centric, non-linear) Interactive Health Communication Workbook 120

Phase 2 – Production: Site Navigation (cont’d)

Web pages are not usually organized sequentially Organization determines how easy it is to find information & determines the choices users are given Goals: Clarity, simplicity and ease of use

Phase 2 – Production: Interface Design

Good Organization ¾ How will users find information? ¾ How will the information fit overall structure? Need for Consistency ¾ Do navigation controls look and behave similarly throughout? ¾ Do similar sections offer similar features? ¾ What norms & practices will web users bring to your site? ¾ How can you integrate and reinforce those norms in your site design?

Phase 2 – Production: Site Interactivity

Interactive Features: ¾ Discussions, Audio-video files, links, personalization options, magazine, e-mail newsletter (push & pull) Degree of choice is the most important level of interactivity ¾ Gives users control over the sequence and pace ¾ Allows them to choose what they want to look at, what they don’t Range of Interactivity ¾ Simple linear progression to virtual environments ¾ Degree of interactivity depends on project goals, timelines and budget Phases & Stages of Web Site Design 121

Phase 2 – Production: Prototyping

Does NOT have to be elaborate Represents what user sees on each screen Decision making tool - usability and accessibility Demonstrates the flow of information How navigation elements will work Blueprint for production stage

Phase 2 – Production: Pre-Testing

Pre-Testing Factors & Foci: Usability & Accessibility Design & Content

Phase 2 – Production: Usability & Accessibility:

Touchstones to website design & evaluation Akin in importance to Validity & Reliability in Statistics Interactive Health Communication Workbook 122

Phase 2 – Production: Pre-Testing for Usability

Usability – measuring the quality of a user’s experience when using & navigating a website Usability Factors (www.usability.gov): ¾Ease of learning ¾Efficiency of use ¾Memorability ¾Error frequency & severity ¾Subjective satisfaction

“3 Clicks and Your Out” Rule

68% of users visit sites looking for just one specific piece of information If a person does not find it in three clicks they are gone Solutions ¾ Clean and clear navigation ¾ Install a search feature and/or site map ¾ Keep track of your logs to see where and how long people are on your site

(Sources: User Interface Engineering, 2000; Jupiter Communications, 2000)

Phase 2 – Production: Pre-Testing for Accessibility

Accessibility – is it able to be accessed and “got to” Concept typically associated with disabilities Needs to be looked at in the broadest sense: ¾Technically (design, browser, speed of connection) ¾Language & literacy levels ¾Across broad or specific demographic & user groups Phases & Stages of Web Site Design 123

Usability & Accessibility Links:

Jakob Nielsen www.useit.com NCI (Nat’l Cancer Institute) www.usability.gov STC Usability SIG stc.org/pics/usability/index.html Usability First www.usabilityfirst.com WebMonkey www.hotwired.com/webmonkey W3C www.w3.org or www.w3.org/WAI/ Yale Style Guide info.med.yale.edu/caim/manual/index.html

Phase III: Post-Production

100 College Street Room 213 The Banting Institute University of Toronto Toronto, Ontario M5G 1L5 Tel (416) 978-0522 Fax (416) 971-2443 E-mail: [email protected] www.utoronto.ca/chp/hcu/

Phase 3 – Post Production

Ongoing Maintenance & Evaluation ¾Often most neglected phase, ¾Yet has the greatest consequences on your site in the long-term Dissemination ¾Face-to-face through existing channels ¾Online channels (i.e. search engines, online promotion, push technologies) Interactive Health Communication Workbook 124

Phase 3 – Post Production (Cont’d):

Evaluation ¾Evaluating your site visits and outcomes

¾Website Evaluation workshop (www.utoronto.ca/chp/hcu) Maintenance ¾Update & add content ¾Correct errors and dead links ¾Improve site design ¾Respond to visitor feed back

Key Issues

Technical Terms Writing for the Web Insider Tips & Golden Rules

100 College Street Room 213 Links & Resources The Banting Institute University of Toronto Toronto, Ontario M5G 1L5 Tel (416) 978-0522 Fax (416) 971-2443 E-mail: [email protected] www.utoronto.ca/chp/hcu/

Technical Terms and Know How:

Important to know some terms of the trade: Server Environment (Windows NT/2000, Unix/Linux/BSD) & Software (NT Server, Apache) SGML (HTML , DHTML, WML) CSS JAVA Script (JAVA, Applets, Java Beans) CGI/Perl Server Side Scripting (ASP, JSP, PHP) Databases (SQL, MySQL, Cold Fusion) Interactive (Flash, Shockwave, Real Player, Quick Time, Window Media Player) Phases & Stages of Web Site Design 125

Differences Between Print & Web Design

Dimensionality ¾Print: 2-Dimensional & a big canvas ¾Web: 1 Dimensional & N Dimensional • Scrolling and Hyper-linking Experience Navigation ¾Print: Flipping pages ¾Web: Navigation is what it is about • Links, map of where they are going, visualization of your location, information architecture

Differences Between Print & Web Design (Cont’d:)

Response Time, Resolution, & Canvas Size ¾ Print: Superior in terms of speed, type and image quality, & the size of the visible space ¾ Web: The web will catch up in the next 10 years •For now less graphics, smaller graphics, shorter text (since it is unpleasant to read online), less fancy typography (since you don't know what fonts the user has installed), and less ambitious layouts. Multimedia, Interactivity, and Overlays ¾ Print: Can be visually stunning ¾ WEB: Wins out in user engagement through interactive design elements

Differences Between Print & Web Design (Cont’d:)

Respect & Relish the Differences Anything that is a great print design is likely to be a lousy web design. ¾ Print design is based on: • letting the eyes walk over the information, • selectively looking at information objects and • using space to make page elements enhance and explain each other. ¾ Web design functions by: • letting the hands move the information (by scrolling or clicking); • information relationships expressed through interaction and user movement. (Source: http://www.useit.com/alertbox/990124.html ) Interactive Health Communication Workbook 126

4 Rules for Writing for the Web:

Be succinct: Use only 50% of the text you would have used in a regular publication Write & design for scanning: don't require users to read long continuous blocks of text Use hypertext to split up long information into multiple pages Be familiar in look and feel because web users are used to similar site designs

(Source: www.useit.com/alertbox/9703b.html )

Golden Rules & Insider Tips

100 College Street Room 213 (Speed, Quality, $) The Banting Institute University of Toronto Toronto, Ontario M5G 1L5 Tel (416) 978-0522 Fax (416) 971-2443 E-mail: [email protected] www.utoronto.ca/chp/hcu/

Time , Quality, & Cost

Finding a balance Typically in situations where you can only afford two ¾ Time & Quality ¾ Time & $ ¾ Quality & $ Phases & Stages of Web Site Design 127

Options & Costs

In House Agency MIXED or ISP Hosting $ Ï $ Initial Ð $ (server) People Ï Expertise Ð Expertise Control Ï Control Ð Control

Design & $ Ð $ Ï$ Programming People Ï Expertise Ð Expertise Control Ï Control Ð Control

Maintenance $ Ï $ Ð $ People Ï Expertise Ð Expertise Control Ï Control Ð Control

Top 10 Mistakes of Web Management

1. Not identifying Website Goal 2. Designing for Your Managers 3. Site Structure = Your Org-chart 4. Outsourcing to Multiple Agencies 5. Not Budgeting for Maintenance

Top 10 Mistakes of Web Management

6. Treating the Web as Secondary Medium 7. Wasting Linking Opportunities 8. Treating Intranet & Internet the Same 9. Confusing Market Research & Usability 10. Underestimating the Strategic Impact of the Web (don’t just treat it as a virtual pamphlet, whole new way of doing work)

(Source: Jakob Nielsen, www.useit.com/alertbox/9706b.html ) Interactive Health Communication Workbook 128

Online Resources

HCU Resources www.utoronto.ca/chp/hcu and www.utoronto.ca/chp/hcu/hpss.html Good, Bad & Ugly - www.oit.pdx.edu/~kerlinb/workshops/webdesign/ Jakob Nielsen www.useit.com NCI (Nat’l Cancer Institute) www.usability.gov STC Usability SIG stc.org/pics/usability/index.html Usability First www.usabilityfirst.com WebMonkey www.hotwired.com/webmonkey W3C www.w3.org or www.w3.org/WAI/ Yale Style Guide info.med.yale.edu/caim/manual/index.html

Audience Analysis Links (Web Use, Health Info Online, Audience Trends)

Ad Council www.adcouncil.org Angus Ried www.angusried.com or www.angusreidinteractive.com Cyber Atlas cyberatlas.internet.com GVU’s W3 Surveys www.cc.gatech.edu/gvu/user_surveys Jupiter Comm. www.jup.com MediaMetrix www.mediametrix.com Netratings www.netratings.com Nielson www.nielsenmedia.com NUA www.nua.ie or www.nua.ie/surveys PriceWaterhouseCoopers www.pwchealth.com Stats Canada www.statcan.ca Evaluating the Impact 129 of Your Web Site

by Cameron Norman, 2002 TeenNet Project & Department of Public Health Sciences Faculty of Medicine, University of Evaluating the Impact of Your Toronto. Website

Cameron Norman TeenNet Project & Department of Public Health Sciences Faculty of Medicine, University of Toronto

Beginning With the End in Mind

• Clarify the program’s purpose, goals and anticipated outcomes • Ensure the proper steps are taken to get to the impact evaluation point (don’t put the cart before the horse) • Determine your research capabilities (technological and scientific)

Conventional vs. e-Health Programs: Program Delivery • Set hours of operation • 24/7 , 365 days/year • Geographic • Worldwide reach boundaries • Inconsistent delivery • Consistent delivery methods methods • Referrals are integral • Referrals optional • No physical cues • Physical Cues Interactive Health Communication Workbook 130

Conventional vs. e-Health Programs: Role of Consumer • Relationship with • Relationship with provider is defined; provider unclear; personal impersonal • Provider ø Consumer • Provider ÷ Consumer • Complex skills • Few skills needed to required to access access services service • Literacy assessment is • Literacy assessment possible very difficult

Conventional vs. e-Health Programs: Methodology • Traditional evaluation • Traditional evaluation training sufficient training insufficient • Comparable programs • Few comparable available programs • Exposure to • Exposure to intervention difficult intervention can be to measure measured • No established • Established standards standards

Key Factors Influencing Your Evaluation • Intended Audience – Consumers (Public vs. Professional) – Internal vs. External

• Goals: What is the purpose of your website? – Information – Linking Consumers to Resources – Behaviour Change – Multiple Purposes Evaluating the Impact of Your Web Site 131

Key Factors Influencing Your Evaluation • Resources: What resources (human, financial and physical) do you have available? • Stakeholders: Who should be involved? Do they support the evaluation?

Points to Consider in Evaluating IHC Efforts (Physical Resources) • Network speed / connection speed • Processor speed • Operating system (e.g., Windows, Mac) • Web browser version • Plug-in availability or capability • Access limiting software (e.g., firewalls) • Server capabilities

Points to Consider in Evaluating IHC Efforts (Human Resources) • User’s familiarity with technology • User’s physical limitations (e.g., colour blindness) • Access point issues (e.g., privacy) • Technical support (on and off site) for evaluation Interactive Health Communication Workbook 132

Case Study One: Canadian Health Network • http://www.canadian-health-network.ca

• Research Questions: – What is the purpose of this site? – How do we know if it is achieving its purpose? – What methods can we use to understand the impact of this site?

Case Study Two: ?

• What is the purpose of this site? • How might we evaluate this site?

Additional Issues

• Ethical use of research findings – Consumer preferences – Utilization-focused evaluation – Sustainability – Replicability • Communicating findings Web Site Traffic – Part 1: 133 Evaluating the Use of Your Web Site

by Dave Haans, 2002 Department of Public Health Sciences, University of Toronto and Part I - Evaluating the Use of Your The TeenNet Project. Web Site

Dave Haans Department of Public Health Sciences University of Toronto

February 26, 2002

Evaluating the Use of Your Web Site

z Now that you’ve built it, who’s coming to your site? z What are some methods you can use to find out how (and how much) your web site is being used? z Picking the best method for your situation z Privacy and ethical considerations

Methods of Web Site Use Analysis: 1. Stand-alone Counters

What it is: z A simple display on a single page which counts the number of times the page has been accessed z Made possible by a small bit of programming added to a web page Pros: z Most are free and easy to implement; MS FrontPage has a selection z Many different styles to choose from z Resides on your own server – no privacy or ethical concerns z Can be implemented by any experienced web developer Cons: z Limited info – usually only number of ‘hits’ to the page it’s installed on z Gives you access information for that page only Interactive Health Communication Workbook 134

Methods of Web Site Use Analysis: 2. Hosted Counters

What it is: z More of a service than a simple counter z Requires a small bit of HTML programming added to your web page that invisibly directs your visitor’s browser to their server Pros: z Very cheap, easy to implement z Many different services to choose from z Can be implemented by any web page programmer z Usually, greater amount of information than stand-alone counters Cons: z Gives you access information for one page only z A third party also knows who’s visiting your site and may sell those data z A web page with a hosted counter is usually slower to load

An Example of a Hosted Counter: What visitors see on your page

Methods of Web Site Use Analysis: 3. Hosted Web Stats Packages

What it is: z More of a service than a simple stand-alone counter z Like the hosted counters, requires a bit of HTML code added to a page Pros: z Usually free z Easy to implement z Generally, much more information than counters

Cons: z Gives you access information for one page only z A third party also knows who’s visiting your site and may sell those data z A web page with a hosted stats package is usually slower to load Web Site Traffic – Part 1: Evaluating the Use of Your Web Site 135

An Example of Hosted Web Stats: What visitors see on your page

An Example of Hosted Web Stats: What you see when you click the link

An Example of Hosted Web Stats : What you see when you click the link Interactive Health Communication Workbook 136

Listening to Your Server: Main points

z Every web server logs all accesses to the server z Accesses can be analyzed to provide information about the use of your site z Summarized access information can contain: – Number of visits / hits / files – Date and time of visits – Location of visitor’s computer – Time spent in site – Where visitors traveled in your site – Many other statistics depending on which method you use

Web Server Access Log File: What’s collected?

Access Log Component Description ppp23.chass.utoronto.ca Computer accessing the site

buddy Username (not in all cases) [08/Feb/2002:13:33:01 – Date/Time Stamp, Time Code 0400]

"GET Server instruction, filename and /1Graphics/teennetlogotext HTTP type .gif HTTP/1.1"

200 HTTP code 2615 # of bytes transferred

Methods of Web Site Use Analysis: 4. Stand-alone stats packages

What it is: z A stand-alone program that summarizes web server logs Pros: z Much more information than counters or hosted stats, not tied to one page z Resides on your server, usually works automatically z Self-contained z Information stays on your server, so ethical and privacy concerns are minimized z Cheap (usually free) Cons: z More difficult to implement than previous solutions (more technical) z Usually not all that customizable z Usually, no control over how stats are calculated Web Site Traffic – Part 1: Evaluating the Use of Your Web Site 137

An Example of Stand-alone Stats: ‘Perl WebStats’ - 1

An Example of Stand-alone Stats: ‘Perl WebStats’ - 2

An Example of Stand-alone Stats: ‘Perl WebStats’ - 3 Interactive Health Communication Workbook 138

An Example of Stand-alone Stats: ‘Analog’ - 1

An Example of Stand-alone Stats: ‘Analog’ - 2

Methods of Web Site Use Analysis: 5. Custom statistics

What it is: z Analysis of web server logs using custom programming Pros: z Much more information than counters or hosted stats, not tied to one page z Completely customizable z Information stays on your server, so ethical and privacy concerns are minimized z User database(s) can be used to add much more to the analysis Cons: z More difficult to implement than previous solutions (much more technical) z High start-up and maintenance costs z Requires knowledge of statistics packages (SAS, for example) and direct access to server Web Site Traffic – Part 1: Evaluating the Use of Your Web Site 139

An Example of Custom Statistics: SAS graphics output - 1

An Example of Custom Statistics: SAS graphics output - 2

An Example of Custom Statistics: SAS graphics output - 3 Interactive Health Communication Workbook 140

An Example of Custom Statistics: SAS graphics output - 4

An Example of Custom Statistics: SAS graphics output - 5

Ethical and Privacy Issues: Protecting your users

Three Main Considerations:

1. Your audience (age, gender). 2. The information on your site (is it sensitive information?). 3. Your resources (financial, availabilty of technology and labour). Web Site Traffic – Part 1: Evaluating the Use of Your Web Site 141

Ethical and Privacy Issues: Your Audience

z Children require more protection than adults z Adults may not want their visit to your site to be tracked by an unknown third party z It helps to have a privacy policy – but it’s more important to follow it (not all companies do)! z Review the privacy policy of any third party involved; if you feel it’s not adequate, choose another company z Commonsense is the key here!

Ethical and Privacy Issues: The Information On Your Site

Is the information on your site sensitive? --(for example, HIV/AIDS info)-- z Third parties may use this information to add to the data they have on your users to their databases z This could lead to unintended consequences for the user – Spam email, for example

Ethical and Privacy Issues: Your Resources

z Cost is probably a main consideration for your project z However, it shouldn’t supercede the protection of your web site’s users So… z Stand-alone statistics packages limit harm to users, and can be very cost-effective (usually, a one-time-only charge to install) z However, use a free, easily installable hosted counter or stats package if these issues aren’t major concerns Interactive Health Communication Workbook 142 Web Site Traffic – Part 11: 143 Increasing Traffic to Your Web Site

by Dave Haans, 2002 Department of Public Health Sciences, University of Toronto and Part II - Increasing Traffic to Your The TeenNet Project. Web Site

Dave Haans Dept. of Public Health Sciences University of Toronto

February 26, 2002

Search Engine Positioning

z What is it? – A collection of methods designed to make your site more visible when people use search engines to try to find the information on your site – It is not simply submitting your site to ‘thousands’ of search engines! – Takes a user-centric approach to make it easier for your visitors to find you

Why is Search Engine Positioning Important?

z Oft-repeated statistic is that well over 80% of users find information using search engines z Most users don’t go past a few pages of search results z If your site isn’t “search engine friendly,” you’re losing an opportunity for search engines to help you attract more visitors z Search engine positioning is the cheapest way to get more traffic on your site Interactive Health Communication Workbook 144

Search Engine Positioning: Focus on Search Engines

z Which search engines are most important? – Northern Light – All The Web – AltaVista – Google – HotBot – Lycos – MSN

Search Engine Positioning: Focus on Search Engines

z How do search engines rank by number of hits returned? – Google – All the Web – Wisenut – Northern Light – HotBot – AltaVista – MSN – Teoma – DirectHit

From: http://searchengineshowdown.com/stats/size.shtml

Search Engine Positioning: Focus on Search Engines

z How do search engines rank by traffic generated? – Yahoo 36% – Google 16% – Excite 9% – AltaVista 9% – Overture 9% – MSN 8% – AOL 5% – Lycos 5% – HotBot 2% – Fast 1%

From: http://www.searchengineposition.com/ Web Site Traffic – Part 11: Increasing Traffic to Your Web Site 145

Search Engine Positioning: How Search Engines Work

z Search Engines send out Spiders to index the text (and other documents) on your site – they travel from top to bottom of your page’s code – they index both visible and invisible text – they look for: title, text visible by browser, meta tags, linked text, emphasized text

Search Engine Positioning: What Search Engines Like to See

z Stark, plain, relatively ugly pages using lots of text and text links z Small pages (spiders won’t index all the content in large pages) z Relevant keywords and text z Text placed higher on page

Search Engine Positioning: What Search Engines Like to See z Title: Especially important. Should be 5-10 words and unique for each page For example: – SmallCity Health Department Home Page: Answers to your health questions z Highlighted text – Search engines rate emphasized text higher than plain text, so make sure you emphasize text containing your keywords, such as in headers, text links, etc. Interactive Health Communication Workbook 146

Search Engine Positioning: What Search Engines Like to See

z Meta tags: invisible text; description and keyword meta tags most important (usually only ones indexed): – – z Alt tags: keywords in image alt tags: –

Search Engine Positioning: What Search Engines Don’t Like to See

z Pages with complex tables or formatting z JavaScript or other programming in the page z Non-relevant keywords or text z Graphical links only z Redirect to other pages z Web site content in Flash z Frames z “Under Construction” signs and text z Poor grammar and/or spelling z Broken links z Overly repeated words (“sex sex sex sex sex sex”)

Search Engine Positioning: How to Start

z Think like someone trying to find the information on your site z Pick two or more main keywords and/or phrases you think they will use to try to find your site (not organization name!) z Use a program like WebPosition or TopDogg to find out how high your site comes up when searching for those terms (can be manually done, as well, by searching for those terms on the main search engines) Web Site Traffic – Part 11: Increasing Traffic to Your Web Site 147

Search Engine Positioning: How to Start z Other sources for keywords: WebPosition, a Thesaurus, brainstorming, surveying target audience, or your web server referer log (if available): http://search.yahoo.com/bin/search?p=sex+quizzes -> / http://www.lechateau.ca/teen/main.asp -> / http://www.gopartyhearty.com/chatroomsteenagers.html -> / http://pt.femalelife.com/default.asp?PageId=811 -> / http://search.yahoo.com/search/ca?p=Teenagers+and+smoking -> / http://www.lechateau.ca/teen/main.asp -> /

Search Engine Positioning: Exercise z Browse to: http://www.quicktaxweb.ca

– Select View | Source from browser menu

Search Engine Positioning: Exercise: QuickTaxWeb

Meta tags: Intuit's QuickTaxWeb - Canadian Online Tax Preparation Software Interactive Health Communication Workbook 148

Search Engine Positioning: Exercise: QuickTaxWeb

Comment tags:

Search Engine Positioning: Exercise: QuickTaxWeb

Scripts confined to external files: