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Not every site needs a wiki: A conceptual framework for health Websites [4 Cr2 1100 Witteman]


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Not every site needs a wiki: A conceptual framework for health Websites [4 Cr2 1100 Witteman]

  1. 1. Witteman, H. et al.: Not every site needs a wiki: A conceptual framework for health Websites <ul><li>This slideshow, presented at Medicine 2.0’08 , Sept 4/5 th , 2008, in Toronto, was uploaded on behalf of the presenter by the Medicine 2.0 team </li></ul><ul><li>Do not miss the next Medicine 2.0 congress on 17/18th Sept 2009 ( ) </li></ul><ul><li>Order Audio Recordings (mp3) of Medicine 2.0’08 presentations at </li></ul>
  2. 2. Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites
  3. 3. Purpose <ul><li>Increasing complexity of Web </li></ul><ul><li>Different applications, different </li></ul><ul><ul><li>focus </li></ul></ul><ul><ul><li>key functions </li></ul></ul><ul><ul><li>strengths </li></ul></ul><ul><ul><li>weaknesses </li></ul></ul><ul><li>Toward an ontology </li></ul>
  4. 4. Origins
  5. 6. CMC HCI
  6. 7. Whirlwind Tour!
  7. 9. Community <ul><li>Preece (2000, p.10) defined online communities as consisting of: </li></ul><ul><ul><li>&quot; People , who interact socially as they strive to satisfy their own needs or perform special roles, such as leading or moderating. </li></ul></ul><ul><ul><li>A shared purpose , such as an interest, need, information exchange, or service that provides a reason for the community. </li></ul></ul><ul><ul><li>Policies , in the form of tacit assumptions, rituals, protocols, rules, and laws that guide people's interactions. </li></ul></ul><ul><ul><li>Computer systems , to support and mediate social interaction and facilitate a sense of togetherness.&quot; </li></ul></ul>
  8. 11. Individuals and Identity <ul><li>Membership rules </li></ul><ul><ul><li>Criteria to join? (e.g.,, private groups/forums) </li></ul></ul><ul><li>Profiles, signatures </li></ul><ul><ul><li>Community norms, expectations </li></ul></ul><ul><ul><li>Implications for further participation (Bonniface & Green 2007) </li></ul></ul><ul><li>Social identity </li></ul><ul><ul><li>Key to engagement (Sandaunet 2008) </li></ul></ul><ul><li>Different identities for different life roles </li></ul><ul><ul><li>SNS implications on future employment (Cain 2008) </li></ul></ul><ul><li>Managing converging and diverging identities </li></ul><ul><ul><li>Identities blur across domains, e.g. access to medical librarian in Second Life (Seeman 2008) </li></ul></ul>
  9. 13. Connections <ul><li>Formal (SNS ‘friends’, blogroll) or less formal (recognition) </li></ul><ul><li>Key aspect of SNS </li></ul><ul><li>Social support site: multidirectional support is necessary for the effective functioning of the community (Bonniface & Green 2007) </li></ul><ul><li>Sense of belonging may be associated with status within the group, and status may be indicated indirectly by connections (Stets & Burke 2000) </li></ul><ul><li>Integral to collaboration </li></ul><ul><ul><li>Collaboration = f (vested interest in problem, perception of interdependence with other stakeholders) (Langsdon 1991) </li></ul></ul>
  10. 15. Authorship <ul><li>Individual authorship vs. collective/abstract </li></ul><ul><li>Static vs. fluid </li></ul><ul><li>Anonymity </li></ul><ul><ul><li>Can be helpful </li></ul></ul><ul><ul><ul><li>E.g. stigma (van Uden-Kraan et al. 2008, Seeman 2008) </li></ul></ul></ul><ul><ul><li>… but also has potential for negative effects </li></ul></ul><ul><ul><ul><li>People more likely to lie, tell harsh truths (Whitty 2008) </li></ul></ul></ul><ul><ul><ul><li>Difficulty in negotiating gaps between anonymous online experiences and 'real-life' identified actions </li></ul></ul></ul><ul><li>Social identification with author(s) </li></ul><ul><ul><li>Key to trust (Sillence 2007) </li></ul></ul><ul><li>Implications for collaboration </li></ul><ul><ul><li>When individual contributions are recognized as such, groups are more cooperative (Cress & Kimmerle 2007) </li></ul></ul>
  11. 17. Authority <ul><li>Literature on communities, online or otherwise, makes reference to rules, norms, structures (Wood & Gray 1991), policies, tacit assumptions, rituals, protocols, rules, and laws (Preece 2000, p.10) </li></ul><ul><li>Formal authority, &quot;the right to decide,&quot; vs. real authority, &quot;the effective control over decisions.&quot; (Aghion and Tirole 1997) </li></ul><ul><ul><li>Formal authority: editing privileges, moderator status </li></ul></ul><ul><ul><li>Real authority: being an opinion leader within the community. </li></ul></ul><ul><ul><li>Spreading formal authority = increased participation, communication by lower ranking members of an organization </li></ul></ul><ul><li>Different models may affect participation rates and user satisfaction in a tradeoff relationship, and may also have varying results for different subgroups of users (Krowne & Bazaz 2004) </li></ul>
  12. 18. Authority (cont.) <ul><li>Participation in online communities can both reproduce and challenge existing power structures </li></ul><ul><ul><li>E.g. mothers of children with rare genetic conditions (Schaffer et al. 2008) </li></ul></ul><ul><ul><ul><li>Reconfigured authoritative knowledge about their children's conditions </li></ul></ul></ul><ul><ul><ul><li>Became critical of the standard processes of scientific research and medical care </li></ul></ul></ul><ul><ul><ul><li>Perceived benefit of online sources of health information is to be able to 'speak the language' of health care providers and therefore be treated as more of an equal by physicians </li></ul></ul></ul><ul><ul><ul><li>Maintaining authority or expertise in an eHealth community can be time-consuming and exhausting work </li></ul></ul></ul><ul><ul><li>E.g. bipolar adults (Canal et al. 2008) </li></ul></ul><ul><ul><ul><li>Largely reproducing biomedical discourse </li></ul></ul></ul><ul><ul><li>E.g. women discussing birth experiences and options (Witteman et al., in progress) </li></ul></ul><ul><ul><ul><li>Explicitly questioning knowledge/professionalism of health care providers </li></ul></ul></ul>
  13. 23. Dialogue and Dissent <ul><li>Proxy for representation of (the complexity of) different points of view </li></ul><ul><li>Skeptics may be better convinced by complex information </li></ul><ul><li>Acknowledgement of uncertainty may result in a, &quot;fading trust in expert knowledge,&quot; (Klingemann & Bergmark 2006) </li></ul><ul><li>Also depends on individual and cultural factors </li></ul><ul><ul><li>Different countries have been classified as having different levels of comfort with uncertainty and tolerance for ambiguity (Zahedi et al. 2001) </li></ul></ul>
  14. 25. Collaboration <ul><li>Key theme of Web 2.0 </li></ul><ul><li>eHealth literature: &quot;allows individuals to publish, collaborate and share experiences with other like-minded individuals or groups,&quot; (Deshpande & Jadad 2006), &quot;the latest generation of Web-based collaborationware ,&quot; (Kamel Boulos et al. 2006), &quot;it's the spirit of open sharing and collaboration that is paramount,&quot; (Giustini 2006), &quot;online collaboration and sharing among users … a social phenomenon which harnesses the collective contributions of all participants,&quot; (Editors, J Vis Commun Med, 2007) &quot;new collaborative Internet applications,&quot; (McLean et al. 2007), &quot; better supports group interaction and fosters a greater sense of community in a potentially ‘cold’ social environment&quot; (Kamel Boulos & Wheeler 2007), and, &quot; improved communication and collaboration between people via social-networking technologies,&quot; (Eysenbach 2008). </li></ul>
  15. 26. Collaboration <ul><li>&quot;Collaboration occurs when a group of autonomous stakeholders of a problem domain engage in an interactive process, using shared rules, norms and structures, to act or decide on issues related to that domain.&quot; (Wood & Gray 1991) </li></ul><ul><li>May look different for different types of applications </li></ul><ul><li>Requires participation </li></ul>
  16. 27. Dialogue vs. Collaboration primarily (discourse-oriented) dialogue wikis discussion forums and listservs blogs blog networks social networking rating systems photo/audio/video sharing primarily (consensus-oriented) collaboration
  17. 30. Information (Input) <ul><li>Narrative vs. points/numbers/tables </li></ul><ul><li>Individual experiential vs. generalized </li></ul><ul><li>Generic vs. tailored </li></ul><ul><li>Detailed vs. vague </li></ul><ul><li>Images and other media </li></ul>
  18. 35. Organization (Presentation) <ul><li>Chronology </li></ul><ul><li>Synchronous vs. asynchronous </li></ul><ul><li>Location/layout on page </li></ul><ul><li>Linear vs. nonlinear </li></ul>
  19. 37. Reorganization (Output) <ul><li>Aggregate (e.g.,, </li></ul><ul><li>Mashups </li></ul><ul><li>Interactivity </li></ul><ul><li>Intended audience </li></ul><ul><li>Site-level characteristics </li></ul>
  20. 46. Putting it all together … <ul><li>Nine elements grouped within two pillars </li></ul><ul><li>Tradeoffs </li></ul><ul><li>Differences between individual users </li></ul><ul><li>Differences between individual sites </li></ul>
  21. 52. Discussion/Conclusions <ul><li>Fluid boundaries </li></ul><ul><li>Pitfalls in grouping by type of application </li></ul><ul><li>No ‘one size fits all’ Website or application </li></ul><ul><li>Different designs, communities function differently </li></ul>
  22. 53. Acknowledgments: Funding, Image Credits <ul><li>Funding </li></ul><ul><li>Photos from licensed under Creative Commons courtesy of users: </li></ul><ul><ul><li>artolog </li></ul></ul><ul><ul><li>Crash Solo </li></ul></ul><ul><ul><li>Darren Hester </li></ul></ul><ul><ul><li>DBarefoot </li></ul></ul><ul><ul><li>DeathByBokeh </li></ul></ul><ul><ul><li>fensterbme </li></ul></ul><ul><ul><li>jaaron </li></ul></ul><ul><ul><li>jahdakine </li></ul></ul><ul><ul><li>misterbisson </li></ul></ul><ul><ul><li>monoglot </li></ul></ul><ul><ul><li>niallkennedy </li></ul></ul><ul><ul><li>outlier's eye </li></ul></ul><ul><ul><li>penmachine </li></ul></ul><ul><ul><li>Seether Alpha </li></ul></ul><ul><ul><li>Trois Têtes (TT) </li></ul></ul>