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date: 20 September 2017

Ehealth Communication

Summary and Keywords

Ehealth, also known as E-health, is a relatively new area of health communication inquiry that examines the development, implementation, and application of a broad range of evolving health information technologies (HITs) in modern society to disseminate health information, deliver health care, and promote public health. Ehealth applications include (a) the widespread development of specialized health information websites (often hosted by government agencies, health care systems, corporations, professional societies, health advocacy organizations, and other for-profit and nonprofit organizations); (b) the widespread use of electronic health record (EHR) systems designed to preserve and disseminate health information for health care providers, administrators, and consumers; (c) an array of mobile health education and support applications that have often been developed for use with smartphones; (d) mobile health behavior monitoring, tracking, and alerting equipment (such as wearable devices and systems imbedded in vehicles, clothing, and sporting equipment); (e) interactive telemedicine systems for collecting health data and delivering health care services remotely; (f) interactive adaptive tailored health information systems to support health education, motivate health behaviors, and to inform health decision making; (g) online social support groups for health care consumers, caregivers, and providers; (h) health promotion focused digital games to engage consumers in health education and train both providers and consumers about health promoting procedures; (i) dedicated computer portals that can deliver a variety of digital health information tools and functions to consumers, caregivers, and providers; and (j) interactive and adaptive virtual human agent systems that can gather and provide relevant health information, virtual reality programs that can simulate health environments for training and therapeutic purposes, and an ever-increasing number of digital applications (apps) for addressing a range of health conditions and activities. As information technology evolves, new ehealth applications and programs are being developed and introduced to provide a wide range of powerful ehealth systems to assist with health care and health promotion.

Ehealth technologies have been found by many researchers, practitioners, and consumers to hold tremendous promise for enhancing the delivery of health care and promotion of health, ultimately improving health outcomes. Many popularly adopted ehealth applications (such as health websites, health care portals, decision support systems, and wearable health information devices) are transforming the modern health care system by supplementing and extending traditional channels for health communication. The use of new ehealth applications enables the broad dissemination of relevant health information that can be personalized to the unique communication orientations, backgrounds, and information needs of individuals. New ehealth communication channels can provide health care consumers and providers with the relevant health information that they need to make informed health care decisions. These ehealth communication channels can provide this information to people exactly when and where they need it, which is especially important for addressing fast-moving and dangerous health threats. Yet, with all the promise of ehealth communication, there is still a tremendous amount of work to be done to make the wide array of new ehealth applications as useful as possible for promoting health with different audiences. This article describes the current state of knowledge about the development and use of HITs, as well as about strategies for improving ehealth communication applications to enhance the delivery of health care and the promotion of public health.

Keywords: health information technology (HIT), ehealth, artificial intelligence (AI), electronic health record (EHR), interactive virtual human agents, digital feedback systems, interactive decision support systems, video games, evaluation research, community-participative research

The Growth and Development of Ehealth Communication

There has been tremendous and rapid growth in the development, introduction, and adoption of HITs in modern society, both in the United States and around the globe. The concerted academic study of the development, application, and influences of health information technology (HIT) is often referred to as ehealth communication (Ahern, Kreslake, & Phalen, 2006; Atkinson & Gold, 2002; Kreps & Neuhauser, 2010; Pagliari et al., 2005). The expansion of ehealth communication research and practice has paralleled the emerging information revolution, which has touched all aspects of modern life with new digital forms of communication for banking, shopping, entertainment, entertainment, information dissemination, governance, and now for health care and health promotion (Eysenbach, 2001; Kreps & Neuhauser, 2010; Neuhauser & Kreps, 2003).

Ehealth communication technologies hold tremendous promise for enhancing the delivery of health care and promoting health by making relevant, timely, and accurate health information and support widely available to guide health decision making (Kreps & Neuhauser, 2010; Neuhauser & Kreps, 2003; Strecher, 2007). With the rapid growth of ehealth communication technologies, there has also been corresponding growth in the body of published scholarly research and commentary concerning the development, implementation, application, and influences of ehealth communication systems. This expanding body of research literature examines the potential uses and influences of ehealth communication to support health care, health promotion, and health risk prevention and response.

An increasing number of studies are providing evidence that ehealth intervention can have strong positive influences on improving the delivery of care (Buntin, Burke, Hoaglin, & Blumenthal, 2011; Caffery, Farjian, & Smith, 2016; Chaudhry et al., 2006; Schoen et al., 2016), reducing medical errors (Peris-Lopez, Safkhani, Bagheri, & Naderi, 2013; Saranto, Mykkänen, & Miettinen, 2013; Singh, Naik, Rao, & Petersen, 2008), and influencing the adoption of healthier behaviors related to tobacco use (Abroms, Padmanabhan, Thaweethai, & Phillips, 2011; Chen et al., 2012; Danaher et al., 2015; Fjeldsoe, Marshall, & Miller, 2009), alcohol dependence (Bewick et al., 2013; Gustafson et al., 2011), nutrition (Neve, Morgan, Jones, & Collins, 2010; Vandelanotte et al., 2016), exercise (Davies et al., 2012; Vandelanotte et al., 2016; Vandelanotte, Spathonis, Eakin, & Owen, 2007), safer sex (Bailey et al., 2011; Burns, Keating, & Free, 2016; Noar & Willoughby, 2012), and screening for serious health problems (Collins, Currie, Bakken, Vawdrey, & Stone, 2012; Sanchez et al., 2013; Yabroff, 2008).

By and large, the literature illustrates the tremendous potential of ehealth to improve the delivery of health care and the promotion of health. However, the growing body of research also identifies significant communication challenges that must be addressed in the design and implementation of ehealth communication applications in order for these HITs to be optimally effective. Some of the major challenges to health information systems that have been identified as needing to be addressed include:

  • Enhancing access to HITs by populations who need relevant health information

  • Improving understanding of the health information provided via ehealth systems by many diverse users

  • Increasing the relevance, utility, and applications of health information provided via ehealth systems to different audiences

  • Customizing the health information provided via ehealth systems to the specific health concerns of users

  • Making ehealth systems interactive so that users can ask questions, receive answers, and provide feedback about the systems

  • Making ehealth systems interesting, engaging, dramatic, and fun to use for different audiences (Kreps & Neuhauser, 2010; Neuhauser & Kreps, 2003).

The Breadth and Depth of Ehealth Communication Inquiry

Ehealth communication encompasses the development, adoption, and implementation of a broad range of important new HIT tools and applications. Examples of ehealth applications include the following:

  • The widespread development of specialized health information websites (often hosted by government agencies, health care systems, corporations, professional societies, health advocacy organizations, and other for-profit and nonprofit organizations)

  • The widespread use of electronic health record (EHR) systems designed to preserve and disseminate health information for health care providers, administrators, and consumers

  • An array of mobile health education and support applications that have often been developed for use with smartphones

  • Mobile health behavior monitoring, tracking, and alerting equipment (such as wearable devices and systems embedded into vehicles, clothing, and sporting equipment)

  • Interactive telemedicine systems for collecting health data and delivering health care services remotely

  • Interactive, adaptively tailored health information systems to support health education, motivate health behaviors, and to inform health decision making

  • Online social support groups for health care consumers, caregivers, and providers

  • Health promotion–focused digital games to engage consumers in health education and train both providers and consumers about health promoting procedures

  • Dedicated computer portals that can deliver a variety of digital health information tools and functions to consumers, caregivers, and providers

  • Interactive and adaptive virtual human agent systems that can gather and provide relevant health information

  • Virtual reality programs that can simulate health environments for training and therapeutic purposes

Perhaps the most pervasive and ubiquitous of the many ehealth communication applications developed, however, is the widespread introduction and proliferation of online health information websites. These websites have the potential to provide health care consumers with access to a tremendous amount of relevant health information concerning the different health concerns that they may face and the health concerns that their loved ones may confront (Beckjord et al., 2007; Gallant, Irizarry, & Kreps, 2007, Shepperd, Chamock, & Gann, 1999). Many sites often provide both diagnostic information (helping consumers to interpret troublesome symptoms) and therapeutic and prognostic information (helping consumers evaluate health care strategies for remediating health problems). Many health information portals, such as the websites sponsored by U.S. federal health agencies, including the Department of Health and Human Services (Healthfinder), the National Library of Medicine (Medline Plus), and the Centers for Disease Control and Prevention (Diseases and Conditions), offer the public extensive information about the latest comprehensive health information concerning major diseases, health risks, treatments, and clinical research. Surveillance research conducted by the Pew Research Center’s Internet and American Life Project, as well as by the National Cancer Institute’s Health Information National Trends Survey (which tracks the public’s use of online information), suggests that searching for health information via health websites is one of the primary communication activities conducted via the World Wide Web today (Fox & Duggan, 2012; Fox & Jones, 2008; Hesse et al., 2005).

There has been rapid growth in the use of online social support networks by health care consumers and caregivers. A large body of research has shown that online support groups often provide participants with much-needed health information and support (Bender, O’Grady, & Jadad, 2008; Eysenbach, Powell, Englesakis, Rizo, & Stern, 2004; Ginossar & Nelson, 2010; Hesse, Arora, Burke, Beckjord, & Finney Rutten, 2008; Rimer et al., 2005; Wen, McTavish, Wise, Gustafson, & Kreps, 2011; Wright & Bell, 2003). In fact, online support groups have been found to be preferred over in-person support groups due to the ability of online support group users to connect with relevant others over long distances, the convenience of being able to access social support from home (particularly for home-bound patients), and the high level of anonymity provided by online support groups (Bender et al., 2008; Wen et al., 2011).

Evidence is accumulating about the potential benefits of using interactive health decision support systems and tailored interactive health education programs to promote health and influence health behaviors (Bock, Graham, Whiteley, & Stoddard, 2008; Campbell & Quintiliani, 2006; Jibaja-Weiss, Volk, Kingery, Smith, & Holcomb, 2003; Noar, Harrington, & Aldrich, 2009; Rimer & Glassman, 1998). These adaptive and interactive health information systems are used by both health care providers and health care consumers to make complex health-related decisions by identifying the treatment options that are most likely to provide the best overall outcomes for individual consumers.

Tailored interactive health information systems have been found to be particularly effective in promoting and sustaining health behavior changes by providing users with pertinent and highly motivational health information (Hawkins et al., 2011; Jibaja-Weiss et al., 2003; Whitten, Kreps, & Eastin, 2005). Digital feedback systems that enable consumers to monitor their health behaviors and outcomes (often referred to as the quantified self), such as monitoring blood sugar levels, heart rate, exercise, nutrition, and the results of laboratory tests, can help enhance personal awareness and reinforce healthy behaviors (Schulz, 2010; Schulz, Rubinelli, & Hartung, 2010).

Major medical centers, clinics, hospitals, and health maintenance organizations are increasingly employing health care system web portals to communicate with their constituents (both consumers and providers) (Cho et al., 2010; Gallant et al., 2007). These portals often provide users with access to health information, appointment scheduling, prescription medication refills, medical records, and test results, as well as the ability to exchange messages with health care providers (Shepperd et al., 1999).

There has been steady growth in the use of telehealth programs by health care delivery systems (sometimes referred to as telemedicine) that combine video, telecommunication, and computer technologies to connect health care consumers and providers, often over great distances. There is abundant evidence showing that these telehealth programs can effectively extend and supplement traditional in-person health care delivery systems, while also promoting care coordination and helping to reduce health care costs (Chamberlain, 1994; Darkins et al., 2008; Dávalos, French, Burdick, & Simmons, 2009; Harris, Kreps, & Dresser, 2007; Matusitz & Breen, 2007; Schover et al., 2012).

In recent years, there has been strong encouragement from the U.S. government for health care delivery systems (hospitals, clinics, and other health care practices) to adopt and implement EHR systems. However, adoption of EHRs has been relatively slow in the United States compared to other developed nations, despite growing evidence from the research literature suggesting that EHRs can reduce medical errors, enhance health outcomes, and improve health care system efficiency (Abdekhoda, Ahmadi, Dehnad, Noruzi, & Gohari, 2016; Krist & Woolf, 2011; Krist et al., 2012; Mair et al., 2012; Nambison, Kreps, & Polit, 2013; Wen et al., 2011).

Online and mobile health communication devices are being increasingly used to provide consumers with health information and support, with some notable successes in influencing relevant consumer health behaviors, including diet, smoking, alcohol use, exercise, and medication use (Bates et al., 2001; Bennett & Glasgow, 2009; Castelnuovo & Simpson, 2011; Fox & Duggan, 2012; Graham & Abrams, 2005; Gustafson et al., 2011; Kreps, 2012; Neuhauser & Kreps, 2010; Neuhauser et al., 2013; Person, Blain, Jiang, Rasmussen, & Stout, 2011). Several other promising new ehealth applications include the use of virtual reality simulations for health education, video games for health education and promotion, and virtual interactive human agents (typically using avatars) to provide health information, collect health information, and to provide therapeutic support (Bickmore, Bukhari, Vardoulakis, Paasche-Orlow, & Shanahan, 2012; Bickmore et al., 2010; Eng, 2005; Huang, Morency, & Gratch, 2011; Lieberman, 2006; Lisetti et al., 2012; Morie, Haynes, Chance, & Purohit, 2012; Pfeifer & Bickmore, 2012; Rizzo et al., 2011; Vardoulakis, Ring, Barry, Sidner, & Bickmore, 2012). Social networking platforms, such as Facebook and Twitter, have also been used with some success as ehealth communication tools for health promotion efforts (Hawn, 2009; Fox & Jones, 2008; Marketing Leadership Council, 2012).

Challenges to the Effective Use of Ehealth Communication Applications

Ehealth communication applications show great potential for helping to increase consumer and provider access to relevant health information, enhance quality of health care, reduce health care errors, increase collaboration, and encourage the adoption of healthy behaviors (Kreps & Neuhauser, 2010). Yet, with the growth of new and exciting HIT opportunities comes the daunting responsibility to design ehealth tools that communicate effectively with a diverse array of health care consumers, providers, and policymakers. These tools must be designed to communicate the right information needed by different audiences effectively, at the right time, in the right place, and in the best ways to guide health care and health promotion. Ehealth tools need to be interactive, interoperable, easy to use, engaging, adaptable, and accessible for diverse audiences (Kreps, 2013).

Concerns have been raised in the literature about the relative quality of health information acquired by consumers via the Internet and the abilities of many consumers to understand clearly the complex health information that they gather online, especially for those consumers with limited education and low levels of health literacy (Chang et al., 2004; Ginossar & Nelson, 2010; Hesse, Arora, Burke, Beckjord, & Finney Rutten, 2008; Kreps et al., 2007; Piette et al., 2012). The rapid growth of the Internet has produced numerous health-related websites that may not provide the latest and most accurate health information to the public public (Atkinson & Gold, 2002; Cassell, Jackson, & Cheuvront, 1998). Some of these websites are offered by commercial concerns that are more interested in enticing consumers into buying their products than in providing useful health information (Eysenbach & Kohnler, 2012). Consumers must carefully evaluate the sources of online health information, as well as the accuracy and timeliness of the information, to make sure that the information provided is valid and reliable. It is important for consumers to become sophisticated users of online information and develop computer literacy, in order to know what online health information is most accurate and appropriate for guiding their health decisions (Bodie & Dutta, 2008; Eysenbach & Kohnler, 2012). Ferguson and Frydman (2004) refer to these sophisticated users of online health information as e-patients.

Additional critical issues raised in the relevant literature concerning ehealth include making sure that all the people who need health information have access to HITs, know how to use the available technology, and can understand the information provided via these ehealth tools (Kreps & Neuhauser, 2010; Neuhauser & Kreps, 2003, 2010; Shepperd, Chamock & Gann, 1999; Whitten et al., 2005). There also must be strategies developed to preserve information privacy for consumers and protect consumers from the predatory use of ehealth tools to sell unwarranted and untested health products and services (Kreps & Neuhauser, 2010).

While many health care consumers and providers now understand that communication is a central social process in the provision of health care delivery and the promotion of public health, they do not always recognize that effective communication is a complex and fragile human process that demands strategic design, careful monitoring, and responsive adaptation.

This is particularly true in the development and implementation of new HITs. Often, it appears that ehealth designers are more enamored with the technical elegance and innovation of new information technologies than with the utility of these tools for health care consumers and providers (Kreps & Neuhauser, 2013). Are the technologies easy for these audiences to understand and use? Do new ehealth tools fit comfortably within the policies, practices, and technical infrastructure that are built into existing health and social systems? Are new ehealth tools affordable and accessible for all intended audiences? Are the messages delivered on ehealth programs designed so that diverse populations of users can understand and apply the health information provided? Are the information systems adaptive, interactive, and self-correcting? Do ehealth programs provide interesting, relevant, and engaging information for users? Too often, the answers to these questions are disappointing. Ehealth tools must be designed to complement other health communication channels, be easy for health care professionals to use, and communicate effectively with diverse audiences of consumers (Kreps & Neuhauser, 2013).

Ehealth Communication Research Directions

There is a tremendous demand to conduct in-depth and rigorous evaluation research to assess the influences of ehealth programs on the diverse audiences that use them and on relevant health outcomes (Atkinson, 2007; Bates & Wright, 2009; Catwell & Sheikh, 2009; Kreps, 2013; Lilford, Foster, & Pringle, 2009; Rigby et al., 2009). Good evaluation research is needed to guide the development and refinement of ehealth communication tools and program (Kreps, 2013). In the rush to develop and implement new HITs, the communication needs and expectations of the users of these systems have not always received adequate attention (Gustafson et al., 2009; Laakso & Tandy, 2011). To enhance the usability of HITs, there have been concerted efforts to promote the use of community-participative ehealth research to promote user-centered design of ehealth products and programs (Neuhauser, 2011; Ginossar & Nelson, 2010; Neuhauser & Kreps, 2011; Neuhauser et al., 2013).

Such community participative research has been successfully used to design, implement, and sustain effective ehealth communication interventions concerning a number of health issues (Ginossar & Nelson, 2010; Hawkins et al., 2011; Neuhauser et al., 2013; Van Bogaert, Hawkins, Pingree, & Jarrard, 2013). Evidence-based design of ehealth communication programs will help guide effective future applications of HITs for health care and health promotion (Rigby et al., 2009).

Discussion of the Literature

The professional literature on ehealth communication is relatively young, spanning just a few decades and mirroring growing interests in the development and implementation of health information systems. We are currently in the midst of an information revolution, fueled by the growth of powerful new HITs that hold tremendous promise for enhancing the delivery of health care and the promotion of health (Kreps & Neuhauser, 2010). Published scientific examinations of the development, implementation, and application of new HITs have helped to increase understanding of the potential uses of ehealth communication to support health care, health promotion, and health risk prevention and response.

The development, adoption, and implementation of a broad range of new ehealth applications, such as health information websites, online social support networks, interactive EHRs, health decision support systems, tailored health education programs, health care system web portals, mobile health communication devices, and advanced telehealth applications, have been chronicled in both the scholarly and professional health information and communication literature. Major scholarly journals that report important ehealth communication research and commentary include:

  • Journal of Medical Internet Research

  • Journal of Health Communication

  • Health Communication

  • Journal of the American Medical Informatics Association

  • Patient Education and Counseling

  • International Journal of Healthcare Information Systems and Informatics

  • Methods of Information in Medicine

  • Telemedicine and Ehealth

  • Journal of Telemedicine and Telecare

  • Telematics and Informatics

  • Journal of Computer-Mediated Communication

Gaddi, A., Capello, F., & Manca, M. (Eds.). (2014). eHealth, care and quality of life. New York: Springer.Gustafson, D. H., Brennan, P. F., & Hawkins, R. P. (Eds.). (2007). Investing in e-health: What it takes to sustain consumer health informatics. New York: Springer.Lewis, D., Eysenbach, G., Kukafka, R., Jimison, H., & Stavri, Z. (Eds.). (2005). Consumer health informatics. New York: Springer.Murero, M., & Rice, R. E. (Eds.). (2013). The Internet and health care: Theory, research, and practice. Hoboken, NJ: Taylor and Francis.Noar, S. M., & Grant Harrington, N. G. (Eds.). (2012). eHealth applications: Promising strategies for behavior change. New York: Routledge.Science Panel on Interactive Communication and Health. (1999). Wired for health and well-being: The emergence of interactive health communication. Washington, DC: U.S. Department of Health and Human Services.Tan, J. (2005). E-health care information systems: An introduction for students and professionals. New York: John Wiley.Wetter, T. (2016). Consumer health informatics. New York: Springer.Whitten, P., Kreps, G. L., & Eastin, M. S. (Eds.). (2011). E-health: The advent of online cancer information systems. Creskill, NJ: Hampton.

Major primary texts concerning ehealth communication include:

Primary Sources

There are several major collections of publications that provide a variety of important primary sources that are directly relevant to ehealth. These include:

Kreps, G. L. (Ed.). (2010). Health communication and new information technologies (eHealth). Health communication, Vol. 4 (Sage Benchmarks in Communication Series). London: SAGE.Find this resource:

This reference volume provides full-text reprints and reviews of major scholarly articles concerning ehealth communication.

The U.S. Office of Disease Prevention and Health Promotion (part of the Department of Health and Human Services) provides a website on consumer and patient ehealth, which provides access to resources concerning ehealth tools and services, as well as primary reference works. It also provides a website concerning health communication and health information technology, which provides general information about how ehealth programs are being used to improve population health outcomes, health care quality, and to achieve health equity. In addition, the site provides links to evidence-based resources for consumer health information.

The U.S. Centers for Medicare and Medicaid Services (part of the Department of Health and Human Services) provides an eHealth website, which describes ehealth, identifies ehealth programs, and lists ehealth resources, vendors, and events. It also provides access to information and materials on ehealth through its eHealth University link.

The U.S. Office of the National Coordinator for Health Information Technology (part of the Department of Health and Human Services) provides an ehealth page as part of its HealthIT.gov website. The page describes EHRs and how to use them effectively, as well as ehealth devices, applications, and sources of health information to promote wellness, such as personal activity/fitness trackers, smart scales, multimeasure wellness-tracking tools, diet, weight loss, and fitness tools, and general health information sites.

The Australian government’s Department of Health provides an ehealth webpage that provides information about a range of ehealth resources, including forms, brochures, fact sheets, and scenarios for consumers, and health care providers.

The Royal College of Nursing (United Kingdom) provides a webpage of links to ehealth resources concerning electronic record-keeping, using technology to complement clinical practice, resources from the Royal College of Nursing, and external ehealth resources.

Nontext Resources

The U.S. Department of Veterans Affairs provides an Ehealth Media Gallery webpage, which links to a number of video presentations concerning ehealth tools and programs.

The Community Pain Center web portal provides access to digital ehealth resources for pain management on its eHealth Media webpage. The digital media provided include a research and science channel, an interactive health channel, a lifestyle and treatments channel, and a community sharing channel.

The National Cancer Institute, part of the U.S. National Institutes of Health, provides access to a number of evidence-based digital cancer control programs and services on its Cancer Control Planet website. Programs are designed to address the following cancer issues: breast cancer, cervical cancer, colorectal cancer, diet/nutrition, human papillomavirus (HPV) vaccination, informed decision making, obesity, physical activity, public health genomics, sun safety, cancer survivorship, and tobacco control.

The Australian National E-health Transition Authority, which is charged with supporting the use of ehealth services in that country, provides a Getting Started with eHealth webpage that provides access to software products on ehealth from the government and public and private hospitals.

Further Readings

There are several important books and articles that are essential sources for learning more about ehealth:

Ahern, D. K., Kreslake, J. M., & Phalen, J. P. (2006). What is ehealth? Perspectives on the evolution of ehealth research. Journal of Medical Internet Research, 8(1), e4.Find this resource:

Eysenbach, G. (2001). What is e-health?Journal of Medical Internet Research, 3(2), e20.Find this resource:

Gustafson, D. H., Brennan, P. F., & Hawkins, R. P. (Eds.). (2007). Investing in e-health: What it takes to sustain consumer health informatics. New York: Springer.Find this resource:

Hesse, B. W., Ahern, D. K., & Beckjord, E. (Eds.). (2015). Oncology informatics: Using health information technology to improve processes and outcomes in cancer care. Paris: Elsevier.Find this resource:

Kreps, G. L. (2014). Achieving the promise of digital health information systems. Journal of Public Health Research3(3), 471.Find this resource:

Kreps, G. L., & Neuhauser, L. (2010). New directions in ehealth communication: Opportunities and challenges. Patient Education and Counseling, 78, 329–336.Find this resource:

Kreps, G. L., & Neuhauser, L. (2010). E-Health and health promotion. Journal of Computer-Mediated Communication, 15(4), 527–529. (4.346 5 year impact factor)Find this resource:

Lewis, D., Eysenbach, G., Kukafka, R., Jimison, H., & Stavri, Z. (Eds.). (2005). Consumer health informatics. New York: Springer.Find this resource:

Neuhauser, L., & Kreps, G. L. (2010). Ehealth communication and behavior change: Promise and performance. Social Semiotics, 20(1), 7–24.Find this resource:

Noar, S. M., & Grant Harrington, N. G. (Eds.), (2012). eHealth applications: Promising strategies for behavior change. New York: Routledge.Find this resource:

Science Panel on Interactive Communication and Health. (1999). Wired for health and well-being: The emergence of interactive health communication. Washington, DC: U.S. Department of Health and Human Services.Find this resource:

Whitten, P., Kreps, G. L., & Eastin, M. S. (Eds.). (2011). E-health: The advent of online cancer information systems. Creskill, NJ: Hampton.Find this resource:

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