This book is the result of a major five‐year study of digital consumer health information services in the UK between 2000 and 2005, carried out by a research team at the Centre for Information Behaviour and the Evaluation of Research (CIBER), now based at University College London. The Department of Health, concerned by the lack of knowledge about how the general public was responding to the rapid increase in resources available to them in digital form (including web sites, kiosks and digital TV), and the impact of this on their interactions with the National Health Service (NHS), commissioned an evaluation of these resources and their use. This was, as the authors note, a major undertaking, and one that set out to fill a significant gap in existing knowledge concerning the value of digital consumer health information resources, namely, what consumers actually do when confronted with so much digital freedom and choice in the health field, and “how this manifested itself in information‐seeking terms”.
Within this broad aim the study was set up to investigate wider issues related to the impact of these new resources on health professionals, any impact on health inequalities, and the importance of authority in determining the value and impact of resources. Consumer attitudes to health information in digitised and other more traditional formats were also investigated, in terms of consumer satisfaction and health outcomes.
The literature review succinctly covers the key issues in the provision of consumer health information, territory familiar to any health information specialist, but necessary to set the groundwork for the in‐depth research to follow. The three main chapters of the volume report on the detailed investigations of the research team into the use made of three kinds of digital consumer health information, and the factors affecting the use and effectiveness of each one. The first type of digital information source examined was health kiosks, the main focus being the inTouch with Health kiosks (InTouch with Health is a commercial company which describes itself as the largest provider of online information in the UK, and has close links with the NHS). The kiosks use a PC‐based touch screen interface, keyboard and rollerball, and are placed in pharmacies, hospitals and doctors’ surgeries. There is a brief section on NHS Direct kiosks at the end of this chapter, as a comparison with the main findings. The second type of interface is consumer health web sites – three leading UK sites are investigated: SurgeryDoor (also an InTouch with Health service), which includes information from the NHS, the Health Education Authority and the Red Cross. This was the lead investigation, supplemented by smaller studies of NHS Direct Online, and MedicDirect, run by a consortium of doctors. The third interface investigated was Health Digital Interactive television (DiTV) a series of four pilot projects funded by the Department of Health and offering health advice and information through digital TV.
These three services were all evaluated by the same detailed criteria, roughly covering the size and nature of the audience, ease of access, and anticipated health outcomes. The different approaches taken to the provision of information (access, format, resources, interactivity etc.) in the four digital TV pilot projects, and in the kiosk and web information services, as well as any impact of these factors on the size and breadth of the audience, and users' satisfaction with the services were assessed. In addition the range, quality and appropriateness of the information offered was considered for each format, along with some final measures of usefulness, benefits, outcomes and trust, and its potential impact on national health services (its clinical accuracy is taken somewhat for granted, the providers assumed to be using authoritative sources. Some experts would quibble at this).
In each case the authors use a complex range of methods, including what they describe as “deep log analysis” – a mixed‐methods approach making extensive use of transaction log analysis as well as postal, online and exit questionnaires, focus groups, interviews, observation and action research. This makes the volume, as the authors state, “data‐rich”, for which they make no apology, claiming that this is what is missing from the whole digital health debate, and that the book “should be used as a resource to support decision‐making and innovation”.
Following three massive chapters on the three interfaces being investigated, three final chapters, covering digital platform comparisons, barriers and inequalities, and conclusions, start to pull all this weight of data together. This is very necessary – the volume is indeed “data rich”, and to some extent “data indigestible”. The contents are as significant as the authors claim – a massive project that has produced research findings of considerable significance, and deserving a wide audience. But it is indeed dense, and perhaps not as well presented as it might have been. Tables are not always clear in the way they present data, and both tables and text hard to follow. Better tables and more extensive highlighting of key findings would help readers find what is most relevant to their own circumstances in the extensive amount of data presented here. This is important if the value of the research is to be realised, that is, in terms of having an impact on the design and content of digital consumer health services currently in use or in development.
The key findings emphasise some aspects of information seeking in the consumer health domain that have been known for some time – that individuals vary greatly in the kind and amount of information sought, in their ability to access and digest information supplied, and in their attitudes to health care providers. Factors such as age, gender, ethnicity, education and income continue to have the same impact in the digital world as they do in the physical world. Thus it is not surprising that for some individuals these digital services provide a welcome and trustworthy source of anonymous and helpful information, while for others they appear to have little appeal. What is new is the identification of factors that affect the uptake in the service, digital television having more impact than either consumer health web sites, whose effective use is beyond the ability of many people, and consumer health kiosks, whose usage fell considerably short of what was hoped for. This makes it all the more a pity that the Department of Health's experiments with DiTV (as well as the kiosks) have not been continued, and, although the Internet is a good source of information for more educated and health aware users, there is still less on offer for those from lower socio‐economic backgrounds. Anything that can reduce this ongoing inequitable access to high quality consumer health information, and therefore high quality healthcare, needs to be addressed urgently. However, the larger question of the link between the provision of consumer health information and health status, and the impact of such services on the inequities in health status of less advantages sections of the population, is a much more difficult question, and the data presented here do not really provide adequate evidence to support the study objectives related to health outcomes.
All in all, this is a valuable monograph, full of data of interest to the researcher, and methods that could be usefully applied elsewhere. It also contains important information for policy makers. Some of it will need to be repackaged and presented in more digestible chunks for the wider audience of health information providers that it deserves to reach. In one way it fails to heed its own lesson – the value of information lies as much in its accessibility as its quality.
