not every site needs a wiki: a conceptual framework for health websites [4 cr2 1100 witteman]

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Witteman, H. et al.:Not every site needs a wiki: A conceptual framework for health Websites

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Holly Witteman & Laura O’Grady

Medicine 2.0 | September 4, 2008

Not Every Website Needs a Wiki:

A Conceptual Framework for Health Websites

Not Every Website Needs a Wiki: A Conceptual Framework for Health Websites

Medicine 2.0: Social Networking and Web 2.0 Applications in Medicine and Health | September 4, 2008 | Holly Witteman3

Purpose

Increasing complexity of Web

Different applications, different

focus

key functions

strengths

weaknesses

Toward an ontology



Origins



CMC HCI



Whirlwind Tour!



Community

Preece (2000, p.10) defined online communities as consisting of:

"People, who interact socially as they strive to satisfy their own needs or perform special roles, such as leading or moderating.

A shared purpose, such as an interest, need, information exchange, or service that provides a reason for the community.

Policies, in the form of tacit assumptions, rituals, protocols, rules, and laws that guide people's interactions.

Computer systems, to support and mediate social interaction and facilitate a sense of togetherness."



Individuals and Identity

Membership rules

Criteria to join? (e.g. ganfyd.org, sermo.com, private groups/forums)

Profiles, signatures

Community norms, expectations

Implications for further participation (Bonniface & Green 2007)

Social identity

Key to engagement (Sandaunet 2008)

Different identities for different life roles

SNS implications on future employment (Cain 2008)

Managing converging and diverging identities

Identities blur across domains, e.g. access to medical librarian in Second Life (Seeman 2008)



Connections

Formal (SNS ‘friends’, blogroll) or less formal (recognition)

Key aspect of SNS

Social support site: multidirectional support is necessary for the

effective functioning of the community (Bonniface & Green 2007)

Sense of belonging may be associated with status within the group,

and status may be indicated indirectly by connections (Stets & Burke

2000)

Integral to collaboration

Collaboration = f (vested interest in problem, perception of interdependence with other stakeholders) (Langsdon 1991)



Authorship

Individual authorship vs. collective/abstract

Static vs. fluid

Anonymity Can be helpful

• E.g. stigma (van Uden-Kraan et al. 2008, Seeman 2008) … but also has potential for negative effects

• People more likely to lie, tell harsh truths (Whitty 2008)• Difficulty in negotiating gaps between anonymous online experiences and

'real-life' identified actions Social identification with author(s)

Key to trust (Sillence 2007) Implications for collaboration

When individual contributions are recognized as such, groups are more cooperative (Cress & Kimmerle 2007)



Authority

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)

Formal authority, "the right to decide," vs. real authority, "the effective control

over decisions." (Aghion and Tirole 1997)

Formal authority: editing privileges, moderator status

Real authority: being an opinion leader within the community.

Spreading formal authority = increased participation, communication by lower ranking members of an organization

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)



Authority (cont.)

Participation in online communities can both reproduce and challenge existing power structures

E.g. mothers of children with rare genetic conditions (Schaffer et al. 2008)

• Reconfigured authoritative knowledge about their children's conditions• Became critical of the standard processes of scientific research and medical

care• 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

• Maintaining authority or expertise in an eHealth community can be time-consuming and exhausting work

E.g. bipolar adults (Canal et al. 2008)

• Largely reproducing biomedical discourse E.g. women discussing birth experiences and options (Witteman et al., in

progress)

• Explicitly questioning knowledge/professionalism of health care providers



Dialogue and Dissent

Proxy for representation of (the complexity of) different points of

view

Skeptics may be better convinced by complex information

Acknowledgement of uncertainty may result in a, "fading trust in

expert knowledge," (Klingemann & Bergmark 2006)

Also depends on individual and cultural factors

Different countries have been classified as having different levels of comfort with uncertainty and tolerance for ambiguity (Zahedi et al. 2001)



Collaboration

Key theme of Web 2.0

eHealth literature: "allows individuals to publish, collaborate and share experiences with other like-minded individuals or groups," (Deshpande & Jadad 2006), "the latest generation of Web-based collaborationware," (Kamel Boulos et al. 2006), "it's the spirit of open sharing and collaboration that is paramount," (Giustini 2006), "online collaboration and sharing among users … a social phenomenon which harnesses the collective contributions of all participants," (Editors, J Vis Commun Med, 2007) "new collaborative Internet applications," (McLean et al. 2007), "better supports group interaction and fosters a greater sense of community in a potentially ‘cold’ social environment" (Kamel Boulos & Wheeler 2007), and, "improved communication and collaboration between people via social-networking technologies," (Eysenbach 2008).



Collaboration

"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." (Wood & Gray 1991)

May look different for different types of applications

Requires participation



Dialogue vs. Collaboration

wikis

discussion forums and listservs

blogs

blog networks

social networking

rating systems

photo/audio/video sharing

primarily(consensus-oriented)

collaboration

primarily(discourse-oriented)

dialogue



Information (Input)

Narrative vs. points/numbers/tables

Individual experiential vs. generalized

Generic vs. tailored

Detailed vs. vague

Images and other media



Organization (Presentation)

Chronology

Synchronous vs. asynchronous

Location/layout on page

Linear vs. nonlinear



Reorganization (Output)

Aggregate (e.g. ratemds.com, thebirthsurvey.com,

PatientsLikeMe.com)

Mashups

Interactivity

Intended audience

Site-level characteristics



Putting it all together …

Nine elements grouped within two pillars

Tradeoffs

Differences between individual users

Differences between individual sites



Discussion/Conclusions

Fluid boundaries

Pitfalls in grouping by type of

application

No ‘one size fits all’ Website or

application

Different designs, communities

function differently



Acknowledgments: Funding, Image Credits

Funding Photos from flickr.com licensed under Creative Commons courtesy of users:

artologCrash SoloDarren HesterDBarefootDeathByBokehfensterbmejaaronjahdakinemisterbissonmonoglotniallkennedyoutlier's eyepenmachineSeether AlphaTrois Têtes (TT)

not every site needs a wiki: a conceptual framework for health websites [4 cr2 1100 witteman]

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