Some scholars have suggested that it is inappropriate to compare
virtual communities either to ôrealö communities or historical
manifestations of the public sphere. According to Wellman et al. (1996) computer-supported social networks are ônot
just pale imitations of æreal life.Æ The Net is the Netö (p. 231). But
what are these social relationships that are developing on the Net?
Wellman and his colleagues suggest that virtual communities are
simultaneously becoming more global and more local as worldwide
connectivity and domestic matters intersect. Virtual communities are
unlike ôrealö ones in that they are often partial and transitory. An
individual will probably not depend on a single virtual community to
provide all the functionality of a traditional public sphere. Instead,
he or she gathers bits and pieces of both personal and public
information in both interpersonal and mass communication environments
found in multiple computer-based communication environments.
This partial and transitory nature of virtual community poses
potential problems. Turkle (1997) suggested that
individuals must learn to adapt to a social environment characterized by
multiplicity and flexibility. She said ôwe are dwellers on the
threshold between the real and the virtual; we are unsure of how to
cycle between our online and off-line livesö (p. 80). Cerulo (1997, p. 55) suggested this type of uncertainty
should be embraced not feared: ôWhen we blur the boundaries that
distinguish private thought from shared experience, when we adjust the
lines that separate past, present, and future, or fact from fiction, we
extend the confines of what we call reality.ö
Health-related sites on the World Wide Web are an important
starting place for conceptualizing how public spaces and virtual
communities might form in computer-based communication systems. Health
and health-related subjects have played a central role in the early
development of other communication systems. For example, McMillan (1999) noted that patent medicines were among the
first products to advertise in newspapers and that makers of
health-related products were among the first sponsors of radio programs
with a mass audience. Health-related content is also playing an
important role in the development of computer-mediated communication.
It is one of the fastest growing topic areas in cyberspace (Fisher, 1996). Researchers have also found that
health sites are frequently visited and have potential for building
communities (Pingree et al., 1996).>
Fotsch (1996) reported that
computer-mediated communication has been used in health care for about
20 years as a research, educational, and informational tool. Most
health care professionals trained after 1980 have investigated medical-
or health-related topics via online services such as Medline, Grateful
Med, and similar electronic databases. Werner (1996) reported that 90 percent of academic doctors
use the Internet and that academic medical centers were among the first
health care institutions to establish a presence on the
Web. Health-related uses of the Web have expanded beyond academe.
Medical manufacturing companies, health-care institutions and
pharmaceutical companies are leaders in developing commercial uses of
the Internet. Meyer (1996) suggested the primary
purposes of most health sites on the Web are consumer education and
marketing.
Larkin (1996) reported a growing interest
in obtaining health information online. This is viewed by many as a
supplement to, or substitute for, traditional medical counsel. Vaz (1999) reported that an estimated 22 million adults used
the Internet in 1998 to seek medical information. However, Larkin (1996) warned, ômany con artists have penetrated the
Webö (p. 21).Business Week recently reported that superb e-mail forums
for medical professionals exist side-by-side with ôabject quackeryö (Gross, 1999).
Villalon (1999) reported that the
Internet is changing the way managed care companies market their health
plans, stay competitive, and communicate with their members. In 1999,
health-related e-commerce blossomed. Parks (1999)
reported that Seattle-based Soma.com became the first full-service
virtual pharmacy in January of 1999 but was soon followed by other
full-service e-pharmacies.
Health-related Web sites offer a challenge to traditional
relationships between the private and the public.Certainly health is a
personal and private issue, but public health concerns can impact the
lives of thousands. Furthermore, medical professionals have long staked
their reputation and income on their private store of expert knowledge
that needs to be carefully guarded from an uninformed public who might
make poor health choices without the advice of experts. The Web, with
its ready access to virtually unlimited information sources, threatens
this traditional ôexpertö status of medical professionals.
The medical profession has expressed both optimism and concern
about online communication as a supplement or substitute for traditional
medical counsel. Kassirer (1995) provided an
optimistic perspective on ways that interactive computer systems are
being developed to assist with diagnosis and treatment.
But Forderaro (1995)
observed that many health-care professionals charge that the Internet
can be a repository of misleading information.
Orvell (1995) also took a pessimistic view. He
suggested the combination of managed care, which is already focused on
cost saving, and ôcybermedicine,ö which can further increase automation
and reduce costs, might lead to an unfortunate situation in which
patients are reduced to consumers and medical care becomes simply a
product. Interactive computer systems may then become a delivery system
by which diagnosis and treatment are provided. Orvell expressed concern
that such a market-driven system would deliver information that may not
benefit the patient.
Some Web sites benefit both patients and health professionals.
McNeil (1996) reported the National Alliance of
Breast Cancer Organizations and the National Cancer Institute, created
an Internet site that provides women with information about clinical
trials in which they can participate.A goal for the site is to encourage
high-risk women to participate in such trials. Another positive example
of use of the Web for establishing communication between health-care
providers and patients is found in computer-based support systems
developed to address HIV infection and AIDS (Pingree
et al., 1996).
Not all health-related Web sites are equally likely to foster
virtual community. Virnoche and
Marx (1997) suggested that volunteerism is at
the heart of virtual community. McMillan
(1998) found that sites created by non-profit
organizations and/or volunteers were more likely than other sites to
utilize two-way communication tools and that creators of those sites
were more likely than others to believe information is a community
resource rather than a private commodity. By contrast, those least likely
to use interactive techniques and most likely to seek financial gain
from online information were for-profit corporations that created Web
sites to support their corporate goals. Thus sites that invite
individuals to voluntarily participate in an interactive dialogue at or
through the sites seem most likely to foster virtual
community.
Method
Two research questions guided this study of health-related Web
sites. First: Are there boundaries between mass and interpersonal
communication at these sites? And second:How do public and private
spheres interact and overlap at these sites?
Sample/Procedure
The
Web sites analyzed in this study are drawn from a subset of an earlier
study of health-related Web sites (McMillan 1998).That
study drew a random sample of sites from the Yahoo! directory of health-related
topics. Yahoo! is a topically arranged
electronic directory of Internet content.
A
total of 1,050 sites was selected randomly from the nearly 15,000 health-related
sites listed by Yahoo! in early 1997.After
removal of duplicates, non-functioning Web addresses, and bad e-mail addresses,
the valid sample size was 834 Web sites.Surveys
were sent via e-mail to electronic addresses found at Web sites.A
reminder e-mail message was sent one week after the initial message.A
total of 395 completed surveys were returned via e-mail resulting in a
response rate of 47.5 percent.
A central question in that earlier study was the source of
funding for content.Of the 395 respondents analyzed, 202 reported that
the content of their Web site was supported by volunteer efforts and/or
funding from non-profit organizations. The majority of these sites (76
percent) spent less than $10,000 per year (in dollars and/or volunteer
time) in creating and maintaining the content of their
sites. Furthermore, these sites were more likely than others in the
sample to exhibit high levels of interactivity and creators of these
sites were more likely than their counterparts at other sites to
indicate that information should be freely available on the
Internet. Thus, these 202 sites seemed to be a good starting point for
examining virtual community on the Internet.
Approximately one year after the initial study, the researcher
returned to each of the 202 sites identified above.Most of the sites
were still operating and many appeared to be very similar in concept,
purpose, and content a year later.However, 31 of the sites were no
longer operating. Within this category
there seems to be about a 15 percent attrition rate annually. The 171
sites that remained after one year formed the sample for the current
study.
Analysis
Analysis of these sites is reported below.The researcher used two
procedures. First, survey responses provided by site creators were
reviewed with primary attention on the statement of purpose for each
site. Second, each of the 171 Web sites was examined. The primary
focus of this examination was on the ôhome pageö (first screen) of the
Web site. These home pages were printed for each site. The goal in
using these two procedures was to gain a preliminary understanding of
how virtual community might be implemented in health-related Web
sites. Because of the exploratory nature of this study and the relative
paucity of literature that defines and explains virtual community, the
researcher believed it was more important to qualify virtual community
rather than to quantify it.
After immersion in the statements of purpose and the basic
content of each Web site, the researcher identified four ôtypesö that
provide a system for categorizing these sites. These types represent
multiple approaches to the blending of mass and interpersonal
communication. Table 1 summarizes distribution of the sites in these
four types.
Table
1. Four Types of Health-Related Web
Sites
|
Site Types
|
Sites in Sample
|
|
Packaged
Content
|
77 (44%)
|
|
Rich
Content
|
39 (23 %)
|
|
Virtual
Transaction
|
37 (22%)
|
|
Virtual
Community
|
18 (11%)
|
These four types represent different forms of interactive
communication.Two key dimensions help to define the types. The first is
direction of communication. As noted earlier, two-way communication is
an important aspect of virtual community, but not all Web sites fully
utilize the two-way communication capabilities of the medium.
The second key dimension is control over the communication
process.Virtual communities should allow all participants to both send
and receive messages.Centralized control should be low and all
participants should be able to exert some control over their
communication experience. Again, however, not all Web sites allow this
level of participant control. Figure 1 graphically illustrates the way
in which direction of communication and control of the communication
experience define these four types.
All
of the 171 sites analyzed in this study were examined in terms of both
of the key dimensions illustrated in Figure 1 (direction of communication
and receiver control).Four other
dimensions were also considered in the analysis:time
sensitivity, sense of place, activity, perceived communication goals.
Sites
that facilitate virtual community should allow visitors multiple ways to
communicate at times that are convenient for them. They should also
create a sense of place so that visitors have a virtual public sphere in
which to interact.Virtual communities
should allow communicators to be active rather than passive.They
should also be based more on goals of exchange of information and ideas
rather than on persuasive or transactional communication goals.
The
four types described above are used to organize the 171 sites analyzed
for this study.As noted in the method
section, both the content of the sites and the site managersÆ responses
to survey questions were used to help organize these sites.While
all of the sites were characterized by funding from volunteer and/or non-profit
funding sources, not all were characterized by the Virtual Community type.
Packaged Content
The
largest group of sites (44 percent) may be best categorized as Packaged
Content.These Web sites seem to
be little more than a translation of marketing messages to a new medium.Some
are like brochures, others are like newsletters, but all seem characterized
by one-way communication that is ôpushedö from the organization to its
target markets.They have limited
sensitivity to the time needs of site visitors, a limited sense of ôplace,ö
limited user activity, and persuasive goals.These
sites do not facilitate conversation; they carry marketing oriented messages,
but they donÆt actually sell.Brief
profiles of three characteristic sites are provided below.Because
respondents were promised anonymity, site names and addresses are not provided.Instead,
pseudonyms are used for each site.
Science
Center. The Science Center is a research division of a medical program
at a major state university.The stated purpose of this specific site is four-fold:
ô(1) To provide colleagues, the public and prospective students and post-docs
information about our department, its faculty, and our research.(2) To provide our staff and colleagues up-to-date information
concerning seminars and conferences at our site. (3) To provide starting
points for our staffÆs Internet research needs (primarily bibliographic
and molecular biology sources). (4) To provide a source for information
about the surrounding rural communities.ö
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