Medicine is increasingly concerned with improving public health. This often implies motivating people to change behaviors and practice better health habits ( healthy eating, exercise, smoking cessation). The theoretical foundations for these models of behavior change are preventative but not truly participatory. There is more concern with metrics than with the lived experience of patients. In this talk we introduce the web as a medical device not simply a medium of exchange, by bringing together Health Web Science, a formulation for 21st century medicine, and behavioral change theory. We ask data analysts to aim to develop new metrics to help answer these questions and inform policy makers.

1. Why are some Health Related
Websites Successful
(at Health Behavior Change)?
Sunday June 12, 2016
Joanne S Luciano, PhD, Predictive Medicine, Inc., USA
Eva Kahana, PhD, Case Western Reserve, USA
Grant P Cumming, MD, NHS Grampian UK
David A Molik, Cold Spring Harbor Laboratories
INFORMS International Conference
Hilton Waikoloa Village
June 12, 2016 – June 15, 2016
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2. Objective
To identify what is needed to understand what makes a
website successful at helping people to adopt healthier
lifestyles that will improve their health and how to
evaluate the components and outcome.
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3. Behavioral
Science
Health
Web
Science
Triangulation of 3 concepts
1. Health Web Science
2. Formulation of 21st
Century Medicine
3. Behavioral Science
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Formulation
21st

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1/3 world’s population use the Web [1]
80% look for health information online [2]
• Studies impact of the Web on health and wellbeing
• Aims towards a preventative, participatory, personalized,
and predictive (P4) model of healthcare.
• Posits P4 can be achieved by the leveraging of the Web’s
data, resources and nature.
• Studies the evolving social, political, economic, policy
health related questions that emerge as a result of the use
of the Web.
Health Web Science (HWS)
[1] Miniwatts Marketing Group 2012
[2] California Healthcare Foundation, Fox, S. 2011

5. What’s the role of the Web in
the Health Care Ecosystem?
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http://images.slideplayer.com/11/3229620/slides/slide_10.jpg
The Web plays many roles
across the entire spectrum
from basic life science
research to mobile devices
in remote areas of the
world.
Health Web Science
studies the role of the Web
across all these areas.
http://images.slideplayer.com/11/3229620/slides/slide_10.jpg

6. Meet Health Web Science
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This monograph is a call to action.
It is an urgent request to help find
solutions to problems facing healthcare
globally.
The discipline of Health Web Science
explores role of the World Wide Web in
the human healthcare and wellbeing
ecosystem.
HWS studies how the web drives and is a
product of discussions, technologies,
policies, problems, and solutions.
Joanne S. Luciano, Grant P. Cumming, Eva Kahana, Mark D. Wilkinson, Elizabeth H. Brooks, Holly
Jarman, Deborah L. McGuinness and Minna S. Levine (2014), "Health Web Science", Foundations and
Trends® in Web Science: Vol. 4: No. 4, pp 269-419. http://dx.doi.org/10.1561/1800000019

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Formulating 21st Century Medicine
P4 + Cn – (i-DMT) =H
PROACTIVE Co-CREATION CROSS PLATFORM CHANGE
This isn’t correct; it’s a start.

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The World Wide Web
• Directly influences conscious behavior (Kahneman, System 2) through imparting information
• Indirectly influences unconscious behavior (Kahneman, System 1) through social interactions
• “co-conscious” interactions are the emergent collective consciousness of the networ
The Web and Human Behavior Influence Health Outcomes
HWS seeks to understand the dynamics
of these behavioral influences in order
to support users in achieving better
health outcomes

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Towards Evaluation (part 1)
Contribution to Individual Behavior change that improves heath
Stages of Change
The stages of
change can be used
with any difficult
change. When
people learn about
the stages of
change, they can
come to understand
that changing the
behavior is a
process. It's
difficult, and others
have been there too.
The Transtheoretical Model (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992)
The Transtheoretical Model

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The Focus of today’s talk is on the role of the web in helping people
to change their behavior to improve their health.
http://www.menopausematters.co.uk/
http://www.toiletfinder.org/
http://www.health-e-space.com/index.php?
option=com_content&view=article&id=406:nappy-
care-and-
nappies&catid=149:postnatal&Itemid=375
If you build it they will come – not necessarily!
Successful
Used Worldwide
Surveys validated
Usefulness of information
Somewhat Successful
Used in N Scotland
Surveys validated
mindset changed:
Motivating factor:
Environmental
reduction in landfill
Not Successful
Not Used

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P4+Cn-(-iDMT)=H
Menopause Ma6ers Health-e-Space (Nappies) Toilet Finder
Personalized No No No
Preventative Yes No No
Participatory Yes No Yes
Predictive No No No
Community
Co-Development Yes Yes Yes
Crowd Wisdom Yes No Yes
App (Smart Phone) No No No
Website (Desktop) Yes Yes Yes
TV No No No
Phone No No No
Health
Behavior ? Yes ?
Outcome
Empowerment: Knowledge to
enquire with Health
Professionals
Change in Mindset: Would
consider resuable diapers
Improve Psychological Well being -
stop bladder leash and get people
out and about
Environments N/A
Yes: less landfill No: Energy to
wash and dry
Yes (reduce urinaIon in street)
Policy ? Not now
Encourage local authoriIes to
invest in public toilets
Costs ?
?
Individuals save money and
environment
- toilet +tourism +local economy
+health improvement
STAGE OF CHANGE
SUCCESS Yes Somewhat No
LESSONS LEARNT InformaIon Useful Environment values Needs to be mobile
Towards Evaluation (part 1)
Contribution to Health Outcome - Ecosystem

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Towards Evaluation (part 2)
Contribution to Individual Behavior change that improves heath
Stages of Change
The stages of
change can be used
with any difficult
change. When
people learn about
the stages of
change, they can
come to understand
that changing the
behavior is a
process. It's
difficult, and others
have been there too.
The Transtheoretical Model (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992)
The Transtheoretical Model

13. Commencement
— Radical changes in healthcare and a global health care
crisis demand our attention
Develop
— New metrics for evaluating health outcomes and website
performance (rather than 0.5% improvement in
performance on existing algorithms)
— Starting point
— design web pages to align with stages of change
— Quickly assess stage of use and and direct to appropriate
stage and direct to appropriate page
— Evaluate outcomes (how?)
— Research questions
— How do we get beyond metrics to measure health
outcome improvement?
— How do we know where in the ecosystem the change
needs to be made?
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14. Take Away Messages
1. The Web’s potential to directly benefit human health
through individuals is limitless. We need to figure
out how to use it.
2. Health Web Science research is a great opportunity
for research into new tools and metrics to help
determine how to use the Web effectively.
3. Policy is key. We need laws to help, so when you’re
thinking about your analysis resulting in actionable
insights, think about how to inform the lawyers who
write health policy. What can your analysis show that
will help get the right laws written? How can we
produce overwhelming evidence that radically
changes the laws and increase healthy behaviors?
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15. We
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Grant Cumming Eva KahanaDavid MolikJoanne Luciano
Dedication and Acknowledgements. This talk is dedicated to MyHawiiHostel for providing affordable accommodations, the
owners, staff, guests and others who provided a wonderful environment where I could think and discuss the ideas presented
here. Thanks to the organizers for inviting me and INFORMS for their support.
Thank all of You!

16. Multidisciplinary International Team
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Joanne Luciano, Multidisciplinary Scientist, Enable
Health and Wellbeing through Knowledge Technology.
Formerly on the faculty of Rensselaer Polytechnic
Institute (RPI) and Harvard Medical School (HMS).
Founder Predictive Medicine, Inc. jluciano@predmed.com
Grant Cumming, Medical Doctor, NHS Grampian,
Honorary Professor, University of the Highlands and
Islands, AB24 2ZN, Aberdeen, United Kingdom,
grant.cumming@nhs.net
David Molik,Computational Developer, Cold Spring
Harbor Laboratories, One Bungtown Road, Cold Spring
Harbor NY 11724, United States of America,
dmolik@cshl.edu
Eva Kahana,Distinguished University Professor and The
Pierce T. and Elizabeth D. Robson Professor of the
Humanities, Case Western Reserve University, Mather
Memorial Building 231B, Cleveland OH 44106, United
States of America, eva.kahana@case.edu

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Instruments for Web Study – what works and what doesn’t,
i.e. when to use technology, policy, transparency?
• Enable data to be found
• Make the metadata available for use by others
• Study the data in context using metadata
• Aggregation and presentation of observations enable
a feedback mechanism for preferable futures.
A health Web Observatory is a system that gathers and
links to health data on the Web in order to answer
questions about the Web, the users of the Web and the
way that they affect each other within the context of
healthcare.
Health Web Observatory (HWO)

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Health Web Science (WS)
Web Science is about investigating how human behavior co-constitutes
the Health Web. People who impose regulations, engineer the Web,
produce content, or even just click on links change the Web how other
people will see it. Vice versa, what people see and do on the Web will
change their behavior. Health Web Science is about understanding this in
its relation to human health.
Adapted from SteffenStaab

20. Times have changed
— Aging population (end of life costly)
— More people with chronic illnesses (increased cost),
— The end of the blockbuster era (decrease in
revenues, increase in drug development cost)
— Need lower drug development cost
— Personalized Medicine (right treatment to the right
patient at the right time)
— Improved patient response to treatment (Evidence
Based)
— Web and Mobile
— The technology (ubiquitous, monitor)
— Patient engagement increasing
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Photos: http://www.flickr.com/photos/sepblog/4014143391/
http://allthingsd.com/files/2013/07/photo-12.jpg
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