Guest editorial

Citation

Williams, P. and Huntington, P. (2003), "Guest editorial", Aslib Proceedings, Vol. 55 No. 5/6. https://doi.org/10.1108/ap.2003.27655eaa.001

Guest editorial

About the Guest Editors Peter Williams and Paul Huntington are Research Fellows, both at the Centre for Information Behaviour and the Evaluation of Research, Department of Information Science, City University, London, UK.

We are witnessing a digital information revolution of enormous scale. For many people the Internet, digital interactive television, the touch-screen kiosk and mobile phone have resulted in the overnight transformation of an information-poor world into an information-rich one. We have moved from a world in which information needs were rarely ever effectively met – certainly not without a tremendous expenditure of effort and cost – to one in which they are "potentially" only too easily met. This has created something in the way of a culture shock – to both information intermediary and end-user.

All this is perhaps truer with regard to the provision of health information and advice than anything else. Indeed, it would be no exaggeration to say that health informatics, especially consumer health informatics, has pioneered the digital way. This special double issue of Aslib Proceedings provides proof of this. We publish here a dozen articles, which together show the leadership qualities of the field, its inter-disciplinarity and multi-disciplinarity and its methodological riches and robustness.

The articles selected here discuss a wide range of issues, from a number of different perspectives, utilising several radically different methodologies. Needless to say, given this spectrum, the authors came from a mix of subject backgrounds. These include information practitioners (Dandy), academic researchers (Williams, Berridge and Roudsari, Boudioni, Huntington), University lecturers (Nicholas, Hepworth, Jones, Joinson), and IT consultants (McWhirter). Many subject disciplines are represented too – perhaps highlighting the ubiquity and the complexity of health information. Naturally, there is a fair smattering of information science specialists, including those whose specialisms lie in information needs (Nicholas, Hepworth), education (Williams), bibliometrics (Lewison) and librarianship (Dandy). However, also represented are health specialists (Jones, Berridge and Roudsari, Boudioni), a computer log analyst (Huntington), a mass communication and journalism expert (Gunter), and two psychologists (Joinson and Banyard).

Before reviewing individual papers it is worth highlighting the range of methodologies used. They cover the full spectrum, from in-depth interviews with key health professionals (McWhirter, Dandy) and information users (Boudioni), to formal usability studies (Berridge) and statistical analysis (Huntington et al., Lewison). In between are survey findings from large-scale predominantly closed questionnaires (Nicholas et al.), free text open-ended online surveys (Williams et al.), psychological tests (Joinson and Banyard) and usability studies (Berridge and Roudsari). Multi-methods are featured by Gunter et al. (log analysis and questionnaires) and Dandy (library research and surveys). Jones, by contrast, provides an overview of research into the efficacy of providing patient information via touch-screen information systems.

Nicholas and colleagues lead with a broad examination of health on the Net via an online survey of Internet users' reported utilisation of the Web. The paper examines the characteristics of users of health information Web sites, for what they used online health sites and what were the perceived outcomes associated with using online health information.

Huntington et al. continue the theme of health Web site user types. The paper classifies user types according to three factors: site attributes most favoured, health topics most sought, and the health sites they visited. Clearly knowing what type of consumer uses a site is important, as this should inform menu structure and provide an understanding of why certain kinds of people visit certain sites. Web sites even in the same field will not appeal to all users. Much of this differentiation will come down to design and feel of the site, although site attributes and information needs also impact.

A predominant theme throughout many articles published here is that of information needs and how current technological systems can help meet these. Hepworth et al., for example, discuss the information needs of people with MS and how these might be met using particular Web authoring tools. They found that needs are multifarious, and that some individuals do not see information as the panacea to their problems. This is a useful wake-up call for the information specialists. In their study of the use of the Internet for health information, Williams et al. found a huge variation in reasons for going to the Net and in the roles of people who do so (i.e. as patient, intermediary professional or for general interest). Often users would be seeking information from a number of perspectives during the same search session.

Joinson and Banyard look at information seeking and use from the discipline of psychology. The authors argue that people may be more willing to seek potentially threatening information on the Internet than they would in "real life". In the study reported, participants with varying levels of alcohol intake and plans for change chose four alcohol-related articles to read, using either the World Wide Web (WWW) or pen and paper. Results showed that drinkers not currently reducing their drinking were more likely to seek diagnostic, potentially threatening anti-drinking information via the WWW compared with when seeking paper-based information. Results suggested that there seems to be an effect of medium on information seeking – with modes of information seeking having a level of identifiability attached, people seem to behave in a socially desirable manner (i.e. seeking anti-drinking information). Second, the current health behaviour and plans for change lead to different information-seeking motivations, which may well also interact with medium.

Many of the contributors look at the other side of the "needs" coin – how to provide most effectively the information that is required. Boudioni reviews the availability and the use of touch-screen systems for accessing a range of information in different settings, in particular from socially excluded groups. She also identifies factors, which determine usage and contribute to successful usage. These include a simple interface that takes into account the computer skills and the educational level of possible users, and a screen design to allow for easy navigation within and between menu hierarchies. Jones's research indicates that more thought is needed with regard to the format and content of the information and to providing customised information based on patient records.

McWhirter looks at the potential of using television sets at hospital bedsides to provide patients with access to health information. The author admits that it is not clear what sort of appetite patients have for consuming and absorbing health information while in a hospital bed, and what difference it will make if the information is provided in text, audio or video form. The interesting conclusion reached is that radio might be a more effective and efficient way of providing people with access to health information than as text or by using videos.

Gunter and colleagues present research exploring the early take-up of a pilot digital interactive television (DiTV) health information service (Living Health). Over one third of cable network subscribers visited the digital health TV site at least once during a 20-week pilot period. The user profile was oriented towards older men and young adult women. Use of the service was predicted by users having a young child, being in a low-income neighbourhood, and having a special interest in a health condition. Over half of users consulted the service in connection with a GP visit. The Department of Health in the UK has made a major investment in testing the potential of DiTV as a health information platform. The early indications are that this is a platform with promise. Longer-term commitment and observation will indicate how effective this technology can be in relation to a range of different health information and advisory functions and how best it can be utilised to benefit public health care and the health profession.

Dandy examines the availability of, and access to, information concerning individuals' end-of-life health situations. The study revealed much public confusion and ignorance about how people can influence the medical treatment they receive when seriously or terminally ill. She suggests that there was an urgent need for Government initiatives to provide more information on patient rights in relation to consent forms and advance statements.

Berridge and Roudsari take yet another angle on the theme of health information seeking and provision. Their paper evaluates the usability of a computer-aided learning tool for the education of patients with diabetes – diabCAL. This was subject to rigorous evaluation at various stages during development, including an evaluation of navigation and evaluation of system content. Tests were conducted by technical experts and users, and findings of the final evaluation study, conducted by patients, confirmed that diabCAL was acceptable to most users – that is, interesting and perceived to be useful – even to those with little previous computer experience.

Lewison shows the unique contribution of bibliometrics to the field in a paper that examines UK papers in cancer research in order to identify the individual factors that influence the impact category of the journals in which they are published, using multiple regression analysis.

Finally, drawing all these studies, reports and commentaries together, there are a number of important issues. First, information need is complex, with people seeking information for a variety of purposes and in a number of different roles (Williams et al.). A salutary lesson is that, for many people, this activity is not the No. 1 priority with regard to their health (Hepworth et al.). Seeking information depends upon a number of issues, such as perceived privacy (Joinson and Banyard), availability and clarity of information (Dandy), navigating systems (Boudioni). Some optimism was expressed, however. Digital TV seems to be reaching groups of health consumers that other electronic systems miss (Gunter et al.) and other initiatives, such as hospital bedside services and more widely deployed touch-screen systems, may extend the reach yet further (McWhirter, Jones). Berridge and Roudsari show that careful formative testing and involvement of (potential) users lead to excellent systems, easily accessible, which meet real needs. In sum, the papers offer much food for thought (and action), some optimism, and many questions. We hope they prove useful.

All papers in this special issue were solicited on the basis of the expertise of the authors and the relevance of their work to the field of health informatics. They were refereed by the special editors and the Editorial Board during the period l June to l July 2003.

Peter Williams and Paul Huntington