Identifying and categorizing health 2.0 websites: a quality management approach

Background: The internet is a global health information resource (Hardey, 2008). Users have direct and relatively convenient access to health information (Eysenbachet al, 2002). Concurrently, Health Care provision across Europe is going through a transition from a disease-centered model, where treatment decisions are made almost exclusively by physicians based on clinical experience, to a patient-centered model where patients are active participants in the decision making process about their own health. The Internet is crucial in supporting this movement for both consumers, by giving people access to diverse health information, and policy makers, with technological innovations enabling implementation of an integrated service delivery (Karkalis & Koutsouris, 2006). However, the quality of information available to consumers in an unregulated environment, and the capacity of consumers to handle the information raise an extensive debate as to whether or not the internet can, not only, enable, but also, undermine consumer autonomy (Laing et al., 2010). Attempts at regulating information quality have met with varied success. The transition from Web 1.0 (read only version) to Web 2.0 (read-write version)(Hardey, 2008). Health 2.0, which combines web 2.0 and the health domain, has led to further opportunities and concerns, however, user-generated content in health 2.0 websites fall out of scope of current certifications and schemes. It is unregulated information in an essentially unregulated environment. Nonetheless, the fact that users can collaborate on sharing health information online leads to some interesting possibilities for information quality control. Objective: As part of a wider project, this study seeks to identify policy approaches and mechanisms used by health 2.0 websites to handle the quality of information, both from a more traditional top-down approach and those emerging from a ‘bottom up’ approach. Secondly, to categorize and compare websites of both first and second generation on their quality management approaches. It aims to provide a categorisation of policy approaches and mechanisms used as a background to the assessment of the determinants of their performance. Method: This research utilizes a case study methodology to understand quality control approaches within the real-life context (Yin, 1984, p. 23). An extensive review of handling online information quality literature within and outside the health sector helped formulate the research questions, and the need to understand better the role of mechanisms currently in place. A purposive sample of health 2.0 websites was selected on the basis of typicality, perceived ability to confirm or disconfirm emerging categories, to introduce maximum variation and those perceived as either extreme or critical cases. Analysis included preparation of matrices of categories and cross-case comparison for patterns. Results and conclusions: Quality management mechanisms vary from on several important dimensions. For example, level of moderation (none-high, formal-informal), use of reputations systems and use of voting mechanisms. Combinations of web 2.0 tools and user participation are utilized to handle quality issues. Based on our identified dimensions we present a categorization of Health 2.0 websites. Implications for policy makers and websites managers are suggested