Health Promotion and Interactive Technology

Theoretical Applications and Future Directions

Richard L. Street, William R. Gold, Timothy R. Manning

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136686214
• Edition: 1
• Topic: Languages & Linguistics
• Subtopic: Communication Studies
• Index: Languages & Linguistics

This book's purpose is to offer various perspectives relating to the development, effectiveness, and implementation of interactive computing technology for health promotion--programs and interventions aimed at improving various health-related outcomes such as involvement in care, quality of life, adherence, disease management, healthy lifestyle, and more. Its coverage includes:
*conceptual foundations for examining how characteristics of media, messages, and users relate to one another and how interactive media can effectively and appropriately promote health outcomes;
*examinations of the development, utilization, and evaluation of specific computer applications for health promotion featuring discussions of the theoretical rationale for the program, the targeted audience, research on the program's effectiveness, and implications for future program development; and
*analyses of critical issues such as potential benefits and limitations of technology on the delivery of care, institutional obstacles to the adoption of computing technology, and prospects for integrating information technology into the health system.

I

THEORETICAL PERSPECTIVES

1

Health Promotion and Interactive Technology: A Conceptual Foundation

Richard L. Street, Jr.
Texas A&M University and Health Science Center
Rajiv N. Rimal
Texas A&M University

A middle-aged man has difficulty keeping his diabetes under control. He goes to the clinic where a nurse educator suggests he either attend a week-long diabetes education class or schedule an appointment with a diabetes educator after receiving individualized instruction using “Living with Diabetes,” an interactive computer program. The multimedia program provides information on diabetes management and presents a series of problem-solving simulations (e.g., managing a hypoglycemic reaction, what to do on sick days). Because work and family commitments prevent his attendance at diabetes classes, he decides on the individualized instruction followed by an appointment with the nurse educator.

A woman is experiencing considerable stress and frustration in taking care of her elderly mother, who is suffering from Alzheimer’s disease. Her mother’s physician recommends that, at a modest cost, she rent a computer and modem so that she can access a computer network dedicated to care givers of people with Alzheimer’s disease. By using the network, she would be able to leave messages for the clinical staff, receive a response within 24 hours, search a library for information on caring for the elderly, schedule clinical appointments, and discuss her experiences with other care givers in the network through a bulletin board and electronic mail service.

In the two scenarios described the use of interactive technology for health promotion seems appropriate and appealing. It is hard to think that a brochure, videotape, telephone, or even a professional consultation would be as versatile or as efficient a means of providing such a variety of health information and services. Empirically, however, the question is largely unanswered: What media and forms of communication are the most effective for health promotion and patient education initiatives? On a broader level, this is the classical question researchers investigating media effects have been asking for over half a century. So far, the answer seems to be that the media used in health promotion interventions affect some of the people some of the time under some conditions (Flora, Maibach, & Maccoby, 1989; Rogers & Storey, 1987). The aim of this book is to unpack these processes with particular attention to interactive technologies. As a starting point, we begin our discussion with a working definition of interactive technology.

INTERACTIVE TECHNOLOGY DEFINED

In this chapter and throughout this book, the term interactive technology is used to refer to computer-based media that enable users to access information and services of interest, control how the information is presented, and respond to information and messages in the mediated environment (e.g., answer questions, send a message, take action in a game, receive feedback or a response to previous actions). Two technological features of interactive media are interactivity and modular components.

The concept of interactivity has been defined in a variety of ways (Rafaeli, 1988). For our purposes, Biocca (1992) offered a useful definition: Interactivity refers to “(a) the number and forms of input and output, (b) the level of responsiveness to … user actions and states, and (c) the range of interactive experiences (including applications) offered by the system” (p. 64). Two important capabilities created by interactivity are responsiveness and user control. User control refers to the extent to which the user of the system can participate in modifying the form and content of the mediated environment (Steuer, 1992). User control allows the user to determine what topics or services are selected, the order in which these selections are made, and the ways in which he or she can respond to information presented in the program or network. Responsiveness, on the other hand, refers to the extent to which a response takes into account the form, content, and nature of a previous action (Rafaeli, 1988). For example, a computer program that simply switches screens after a keystroke is more reactive than interactive. A more responsive program might generate a certain response (e.g., praise or corrective feedback) depending on previous information provided by the user (e.g., a correct or an incorrect answer to a question). A highly responsive program might be a game or simulation where the responses of the program are continually changing in form and content and are directly contingent on specific actions by the user (e.g., a person versus a computer chess game or a flight simulator).

As opposed to a single component (e.g., a brochure or videotape), interactive media are comprised of individual modular units that are linked together through programming. Modular components enable the program to utilize a diverse array of databases (animation, narration, graphics, text, motion pictures, music) within a single device or link together a variety of services (e.g., electronic mail, library data banks) within a single network. Thus, rather than making a single presentation in a predetermined linear sequence, interactive computing enables users to access different parts of the program and move with relative ease from one domain to another (Dede & Fontana, 1995).

HOW CAN INTERACTIVE TECHNOLOGY BE USED FOR HEALTH PROMOTION?

There are basically three types of computer applications pertinent to health promotion and patient education. First, many programs are developed to provide an information environment so that a user can learn about a particular health topic. The primary assumption here is the link between enhancement of knowledge and improvement in health. Although numerous studies and mass media campaigns have established this link (see, for example, Chaffe & Roser, 1986; Singer, Rogers, & Glassman, 1991), the unique aspect of interactive technology is its ability to promote active learning, information seeking, and individualized knowledge by allowing users to select information on topics of interest, access multiple modes of information (e.g., video demonstrations, stories, statistics), and direct their own path through the program (Dede & Fontana, 1995; Kahn, 1993). We use the term information environment to refer to programs of this sort because the user has a sense of presence within the media and can actively explore the information.

The primary goal of the program described in the chapter opening first scenario was to provide a self-directed tutorial enabling the user to acquire more knowledge about a health or medical issue—diabetes management in this case. In addition to learning, these types of programs may accomplish other objectives as well, such as reducing the user’s anxiety about a condition or treatment (e.g., taking insulin injections) and motivating the user to enact certain behaviors (e.g., changing dietary habits). Represented in this book are interactive programs providing information environments pertaining to health crises (e.g., AIDS, breast cancer; chapter 5, this volume), asthma and diabetes in children (chapter 6, this volume), and patient involvement in medical decision-making (chapter 7 and 8, this volume).

Although much less utilized, interactive technology also can provide simulation environments for problem-solving and practicing disease-management skills. Compared to information environments, simulation environments are more reality-based in that they attempt to represent lifelike situations and experiences. A simulation environment might function like a video game where the user encounters various problematic situations or exigencies. For example, a program on diabetes management might simulate the beginning of a day where the person using the program could choose something to eat for breakfast, and then open a window to examine the food’s effect on blood sugar. Then, placed in the context of driving to work, the user might unexpectedly have a flat tire that leads to stress and unexpected exertion. The program then signals that the user is having a hypoglycemic reaction. The user would then choose an action (e.g., drink fruit juice), see if this produces the desired effect, and then continue with the simulated day. With multimedia technology, these simulations can be produced in a very interesting, entertaining, and lifelike manner. Lieberman (chapter 6, this volume) and Manning (chapter 4, this volume) discuss the potential of simulation environments for helping users acquire a sense of self-efficacy and develop problem-solving skills.

Theoretically, the importance of a simulated environment in promoting health is based on its potential to act as a powerful source of self-efficacy (Bandura, 1977; Strecher, De Vellis, Becker, & Rosenstock, 1986) and to offer opportunities for practicing problem-solving skills (Dede & Fontana, 1995). Although performance accomplishments comprise the primary source of self-efficacy, simulations of real-world events can be created with interactive technologies that, although not real life, are nonetheless lifelike and thus provide a vicarious learning environment that resembles direct experience. Thus, simulation environments have the potential to personalize the experience, emphasize individual responsibility, and promote internalization of the knowledge and application of skills (Dede & Fontana, 1995). Of course, information and simulation environments can be integrated so that a user not only can learn about a health condition and its management, but also have opportunities to apply this knowledge to an array of hypothetical situations.

Yet another application of interactive technology is the creation of computer networks that enable a user to access (e.g., with a home computer and a modem) other people and computers in the network. By utilizing the network, the user can exchange messages with other people linked to the system, solicit medical advice and information from experts, and access medical libraries and other databases in the system or on the World Wide Web. The woman taking care of her elderly mother (described in the second scenario earlier) might use such a system to share her experiences with other care givers, leave a message for a health care provider, peruse an electronic bulletin board for announcements, access articles on care giving, and even schedule a clinical appointment.

The potential advantage of computer networks is that they offer a means for providing, within a single system, a variety of health-related resources including information, interaction with providers, social support, and decision support (Brennan, Moore & Smyth, 1995 Gustafson et al., 1993). In fact, although stand-alone programs currently offer the most interactive, most complex, and most sensory vivid information and simulation environments (e.g., on CD-ROM and hard drives), it is likely that networks will one day provide access to these multimedia environments as bandwidth technology improves and becomes more readily available in homes, offices, health clinics, and community centers. Using computer networks to deliver health services is a topic addressed in three chapters in this book (chapters 5, 9, and 10, this volume).

IS INTERACTIVE TECHNOLOGY A FEASIBLE AND EFFECTIVE MEDIUM FOR HEALTH PROMOTION?

A Comparison to Other Media

One way to answer this question is to identify media features that can enhance the effectiveness of health promotion initiatives and then examine how interactive technology fares on these dimensions, compared to more traditional methods of health promotion (e.g., professional consultation, videotape, printed material, telephone library). There are at least six features of health promotion media that may enhance their effectiveness—interactivity, networkability, sensory vividness, modifiability, availability, cost and ease of use.

Table 1.1 compares several types of media in relation to these features. As can be seen, interactive media fare well compared to other media. The potential advantages of interactive technology stem from its two defining characteristics: interactivity and modular components. Interactivity allows the user to act on the program to control its course, direction, and presentation of content. By so doing, the user utilizes the information or system in accordance with his or her individual needs and interests (Kahn, 1993; Skinner, Siegfried, Kegler, & Strecher, 1993). Interactivity also may facilitate involvement because the user actively participates in the experience by choosing services or topics to view, selecting videoclips to watch, repeating topics or services if desired, and responding to information in the system (Kozma, 1991). Some research has shown that interactivity enhances interest, active information processing, and satisfaction with a message (Dede & Fontana, 1995; Rafaeli, 1988; Schaffer & Hannafin, 1986), which in turn contributes to the effectiveness of persuasive and educational materials (Chaffe & Roser, 1986; Petty & Caccioppo, 1986; Webber, 1990).

TABLE 1.1
A Comparative Analysis of Various Health Promotion Media

Interactive media also can be used to create a computer network that enables the user to access databases (e.g., medical libraries, recorded experiences of others) and to communicate with others linked to the system (e.g., health care providers, others confronting similar health problems). As several chapters in this volume demonstrate, computer networks can offer a more efficient and effective means of providing access to social support, medical expertise, and assistance in making health-related decisions than do more traditional media such as telephones and face-to-face contact (chapters 5, 7, and 8, this volume).

The use of modular components in interactive media offers additional advantages. First, the components of the program can include multiple modalities of delivering information (e.g., text, narration, motion picture, graphics, music). A program that uses an array of media components creates a more vivid presentation because the receiver experiences more sensory stimulation (e.g., sight, sound, color, movement, reading) during message processing (Biocca, 1992; Steuer, 1992). The use of multiple channels also enables the program to accentuate and reinforce informational content (e.g., using both narration and motion picture to describe how to conduct breast self-examination). Sensory vividness and information enhancement appear to be two reasons why health promotion materials that present information th...

Table of contents

• Cover
• Title page
• Copyright page
• Contents
• Preface
• About the Editors and Contributors
• Part I Theoretical Perspectives
• Part II Using Interactive Technology to Improve Health
• Part III The Future of Interactive Technology for the Promotion of Health
• Author Index
• Subject Index