On 26th October I have the opportunity to act as a moderator in a symposium called Communication in health 2.0, organized by the Institute for Continuing Education (IDEC) and the University of Pompeu Fabra’s Science Communication Observatory (OCC). First of all, I would like to thank Vladimir de Semir, Gemma Revuelta and Clara Armengou for their invitation and their organization of the symposuum. I really think that University has a role as a hub to disseminate and research about this topic in collaboration with the rest of the actors (industry, healthcare providers, professionals, Government,…).

Act as a moderator gave me the opportunity to work on the Health Communication field as a framework of part of the research I have been doing and develop the first step towards the conceptualization of Health Mass-Self Communication.

Yesterday I had the pleasure to attend the defence of Ismael Peña‘ thesis Measuring digital development for policy-making: models, stages, characteristics and causes, “which deals about the digital economy and whether governments should help in its development for it might have a positive impact on the real economy and on the society at large”.

Dissertation supervisor: Tim Kelly

Composition of the committee:

President: Tim Unwin (University of London)
Secretary: Joan Torrent Sellens (UOC)
Members: Robin Mansell (London School of Economics)
Bruno Lanvin (INSEAD)
Laura Sartori (Università di Bologna)

Substitutes:
Gustavo Cardoso (Instituto Superior de Ciências do Trabalho e da Empresa)
Rosa Borge Bravo (UOC)

CONGRATULATIONS Dr. Peña-López. I’m proud to work with you in the same research group I2TIC.

This post will be for sure my longest post ever. I would like to share my thesis’s references. You could also find them at my personal references manager. Enjoy them!

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I have been reading and taking some wiki notes about ‘Pathways to the Doctor’ in the Information Age: the Role of ICTs in Contemporary Lay Referral Systems written by Nettleton and Hanlon. The article stars explaining the ‘clinical iceberg’ concept identified by social scientists (Last, 1963; Wadsworth et al., 1971) during the post-war years. This concept refers to how and why individuals do, or do not seek medical help. In 1973, Zola’s study of the reasons given by outpatients revealed that it was not symptoms per se that prompted people to seek help but rather it was their social circumstances. He identified five ‘distinct no-physiological’ triggers to the decision to seek medical aid’:

• the occurrence of an interpersonal crisis;
• the perceived interference of an illness with social relationship;
• ’sanctioning’ by another person that a visit is warranted;
• perceived interference whith physical activities;
• and temporalizing symptoms -’if its no better by Monday’ (p.58).

In other words medical and health advice was proffered and sought within what came know as the ‘lay referral system’ (Freidson, 1970). Sociologists therefore cast light on the informal health care work undertaken by lay people and demonstrated that in seeking formal health care professionals saw only the tip of the iceberg of illness (p.58).

Echoing Pickstone’s periodisations of medicine, Smith (2002) conceptualises a move from what he calls ‘industrial age medicine’ to ‘information age healthcare’:

Going over my notes, I have found points in common between the ‘clinical iceberg’ and ‘the long tail’ concept. But even in this ‘Information age health care’ Nettleton and Hanlon concluded that people’s pathways to care are rooted in their wider social circumstances, their particular health care needs and, in terms of gender at least, are structurally constrained. But somewhat paradoxically there seem to be two processes at work here. On the one hand there is a growing diversity of health care provision and use, and yet on the other hand the norms and values that underpin notions of health care use are concurrently contributing to reinforcement of the caution and conventionality. It appears that the Internet use is actually more contextually specific and so the circumstances of use tend to be both embedded and embodied.

My first approach to theoretical blueprint of Web 2.0 was Informationalism and the network society: a theoretical blueprint of Web 2.0. Via Fabio Giglietto Facebook I have noticed about an articled written by David Beer and Roger Burrows titled Sociology and, of and in Web 2.0: Some Initial Considerations.

Abstract
This paper introduces the idea of Web 2.0 to a sociological audience as a key example of a process of cultural digitization that is moving faster than our ability to analyse it. It offers a definition, a schematic overview and a typology of the notion as part of a commitment to a renewal of description in sociology. It provides examples of wikis, folksonomies, mashups and social networking sites and, where possible and by way of illustration, examines instances where sociology and sociologists are featured. The paper then identifies three possible agendas for the development of a viable sociology of Web 2.0: the changing relations between the production and consumption of internet content; the mainstreaming of private information posted to the public domain; and, the emergence of a new rhetoric of ‘democratisation’. The paper concludes by discussing some of the ways in which we can engage with these new web applications and go about developing sociological understandings of the new online cultures as they become increasingly significant in the mundane routines of everyday life.

I consider the article help us to a better understand of Web 2.0 buzzword.

I have checked again the notes from The Berkman Center for Internet & Society, Harvard Law School 2007 Summer Doctoral Programme Edition done by Ismael Peña and BERKMAN BUZZ. Probably what happened there is very close to a Web Science Research Initiative and the graphic below could be the framework of the Programme.

About Web Science Research Initiative

Since its inception, the World Wide Web has changed the ways scientists communicate, collaborate, and educate. There is, however, a growing realization among many researchers that a clear research agenda aimed at understanding the current, evolving, and potential Web is needed. If we want to model the Web; if we want to understand the architectural principles that have provided for its growth; and if we want to be sure that it supports the basic social values of trustworthiness, privacy, and respect for social boundaries, then we must chart out a research agenda that targets the Web as a primary focus of attention.

When we discuss an agenda for a science of the Web, we use the term “science” in two ways. Physical and biological science analyzes the natural world, and tries to find microscopic laws that, extrapolated to the macroscopic realm, would generate the behavior observed. Computer science, by contrast, though partly analytic, is principally synthetic: It is concerned with the construction of new languages and algorithms in order to produce novel desired computer behaviors. Web science is a combination of these two features. The Web is an engineered space created through formally specified languages and protocols. However, because humans are the creators of Web pages and links between them, their interactions form emergent patterns in the Web at a macroscopic scale. These human interactions are, in turn, governed by social conventions and laws. Web science, therefore, must be inherently interdisciplinary; its goal is to both understand the growth of the Web and to create approaches that allow new powerful and more beneficial patterns to occur.”

Creating a Science of the Web
Tim Berners-Lee, Wendy Hall, James Hendler, Nigel Shadbolt, Daniel J. Weitzner
SCIENCE VOL 313 11 AUGUST 2006

Colliding Web Science

I have been working on my Wiki putting some notes about “Informationalism, networks, and the network society: a theoretical blueprint” written by Prof. Castells (Castells, M. (2004) The Network Society: a cross-cultural perspective. Edward Elgar, MA).

Prof. Castells defines Informationalism as “a technological paradigm based on the augmentation of the human capacity of information processing and communication made possible by the revolutions in microelectronics, software, and genetic engineering”. He proposes “that what specifies this paradigm in relationship to previous historical developments of information and communication technologies (such as printing, the telegraph or the non-digital telephone) are, in essence, three major, distinctive features of the technologies that are at the heart of the system”.

1. Their self-expanding processing and communicating capacity in terms of volume, complexity, and speed.
2. Their recombining ability on the basis of digitization and recurrent communication
3. Their distributing flexibility through interactive, digitized networking.

If we focus on point 2 I think we have the key of Web 2.0 buzzword. I will reproduce the paragraph where Prof. Castells tackle this issue (bold is mine):

Secondly, digital technologies are also characterized by their ability to recombine information on the basis of recurrent, interactive communication. This is what I call the Hypertext, in the tradition of Ted Nelson and Tim Berners-Lee. One of the key contributions of the Internet is its potential ability to link up everything digital from everywhere and to recombine it. Indeed, the original design of the world wide web by Berners-Lee had two functions, as a browser and as an editor (Berners-Lee, 1999). The commercial and bureaucratic practice of the world wide web has largely reduced its use, for most people, to be a browser and information provider, connected to an email system. Yet, from shared art creation to the political agora of the anti-globalization movement , and to joint engineering of networked corporate labs, the Internet is quickly becoming a medium of interactive communication beyond the cute, but scarcely relevant practice of chat rooms (increasingly made obsolete by SMSs and other wireless, instant communication systems). The added value of the Internet over other communication media is its capacity to recombine in chosen time information products and information processes to generate a new output, that is immediately processed in the net, in an endless process of production of information, communication, and feedback in real time or chosen time (Castells, 2001). This is crucial because recombination is the source of innovation, and innovation is at the roots of economic productivity, cultural creativity, and political power making. Indeed, while the generation of new knowledge always required the application of theory to recombined information, the ability to experiment in real time with the results of the recombination, coming from a multiplicity of sources, considerably extends the realm of knowledge generation. It also allows increasing connections between different fields of knowledge and their applications – precisely the source of knowledge innovation in Kuhn’s theory of scientific revolutions.

So if the people start using the Internet as a browser and as an editor, will they become Web 2.0 users? will they innovate? will they generate new knowledge?. To answer those questions we have to focus on the third feature of new information and communication technologies: Flexibility.

That allows the distribution of processing power in various contexts and applications, such as business firms, military units, the media, public services (such as health or distant education), political activity, and personal interaction.

And I wonder if flexibility is a feature of the health field specially if we are talking about the relationship of consumption which is based on asymmetric information and knowledge. Is this a possible context for Web 2.0? or are health and the Internet still Web 1.0?

The Internet and Health Communication. Experiences and Expectations edited by Ronald E. Rice and James E. Katz provides an in-depth analysis of the changes in human communication and health care resulting from the Internet revolution.Even though the dynamics of change of Internet technologies, the framework proposed by Rice still helps us to understand the intersection of the Internet and health.

As the author said:

“Clearly,the intersection of the Internet and health communication is a socially significant, ethically and politically consequential, dynamic and innovative, intriguing and interesting, and methodologically challenging arena”.

‘Jakob Nielsen’s Digital Divide: The Three Stages’ posted by Ismael Peña talking about Empowerment Divide and a conversation with him make me think about empowerment in health and the consequences of Internet in this topic.

Roma Harris and Tiffany Veinot wrote The Empowerment Model and Using E-Health to Distribute Information. In this working paper they tackle the issue of empowerment: definition, the social context of ‘Patient Empowerment, and the most interested part for me the critical perspectives on ‘patient empowerment’

The idea of ‘patient empowerment’ is based on underlying assumptions that bear further examination. These include the ideas that:

• patients want to be in control of their health and health care;
• it is good for patients to have choice and control;
• health care providers support patient effors to gain control;
• providing health information to patients ‘empowers’ them; and
• ‘informed’ and ‘empowered’ patients take better care of their health

In summary the authors raise the Patient Empowerment Paradox.

I think this paradox is also related with the problems of the importance of expert system in modern society explained by Giddens and the critique of information made by Lash. Taking into account those authors I wonder if Does Internet empower patients? physicians? hospital managers? politicians? and is there a rivality among agents for empowerment? (“more empowered ones implies less empowered others”)