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Over the last few decades, advances in information and communication technologies (ICT) have been changing many aspects of modern society, including the health sector. New ICT applications, mostly subsumed under the term ‘e-health’, have facilitated access to and exchange of health-related information. The diffusion of ICT into the health sector has led to, for example, changing operation processes, new forms of patient information-seeking behaviors, and changes in physician-patient relationships (Andreassen, Trondsen, Kummervold, Gammon, & Hjortdahl, 2006; Kivits, 2006; Richardson, 2003; Tautz, 2002). Moreover, these changes have attracted growing scientific interest; since the turn of the millennium, the number of publications related to e-health has increased markedly (Ahern, 2007; Curry, 2007).
However, most of this research has concentrated on current ICT applications mainly based on the Internet. Only rarely has attention been paid to present and prospective technological changes, as well as to the social impacts that might accompany these changes. The enhanced power of microchips and storage devices allow ICT components to be smaller and cheaper (Mattern, 2005), and to be integrated into so-called ‘smart’ everyday objects. Such ‘smart objects’ can be identified, localized and linked to associated data records and broader sensor networks. Thereby, they are enabled to interactively explore their environment (e.g., collect and deliver environmental data such as temperature, location and speed) and to respond to other smart things or human beings. This vision of invisible, smart computers assisting individuals’ everyday tasks almost anywhere and at any time, has been called ‘ubiquitous computing’ (Weiser, 1991).
Ubiquitous ICT offer both the in- and outpatient health sector a new application spectrum. In the outpatient health sector, i.e., in non-clinical and non-institutional care, this application spectrum ranges from smart consumer-goods packaging that might allow for diet monitoring, to clothes that might attend to physical training by recording bodily indicators such as duration and intensity, to portable devices that register bodily indicators, such as blood pressure, glucose level and substance use. Sensor networks may allow for these registered indicators to be automatically transmitted to a patient’s electronic health record, with the option to generate warning signals to the patient (or directly to the corresponding medical service) if there is significant deviation from normal values. As a feature of ‘smart homes’, such ubiquitous ICT applications may compensate for handicaps and support convalescence or aging (Brown, Hine, Sixsmith, & Garner, 2004; Dengler, Awad, & Dessler, 2007; IAF, 2006; The Royal Society, 2006).
Expected benefits from ubiquitous ICT applications in the outpatient health sector may be threefold. First, convenience and autonomy for those in need of care may increase, e.g., by enabling them to stay longer or come back earlier to their own home (Brown et al., 2004). Second, ubiquitous ICT may enhance efficiency in health administration and health care and thus help to reduce health costs (Hillestad et al., 2005; Tan, 2005). And third, ubiquitous ICT applications are assumed to include several features which may enhance individual preventive health behavior; they are accessible independently of time and location, and allow for a widespread dissemination of general information as well as for tailored and personalized information, feedback and interactivity (Curry, 2007; Evers, Prochaska, Driskell, Cummins, & Velicer, 2003; Fogg, 2003; Neuhauser & Kreps, 2003). Since modifiable risk factors such as smoking, alcohol or substance use, lack of physical activity, or inappropriate nutrition, are important causes of premature mortality (Mokdad, Marks, Stroup, & Gerberding, 2004), there is a growing interest in this third, preventive application of ubiquitous ICT to support and monitor health-related behavioral changes.