Abstract
In this article, we make a case for research which examines the cultural inclusiveness and salience of health portals. We make our case from the standpoint of African-American women. While healthcare should be a ubiquitous social good, health disparities exist among various demographic groups. In fact, health disparities have been placed on the U.S. disease prevention and health promotion agenda. Healthy People 2010 is an initiative sponsored by policy makers, researchers, medical centers, managed care organizations, and advocacy groups across the country. Although there is no consensus regarding what a health disparity is, sponsors agree that “racial and ethnic minorities experience multiple barriers to accessing healthcare, including not having health insurance, not having a usual source of care, location of providers, lack of transportation, lack of child care, and other factors. A growing body of evidence shows that racial and ethnic disparities in health outcomes, healthcare access, and quality of care exist even when insurance, income, and other access-related factors are controlled.”1 In addition to healthcare, African American women have less access to the internet. Even at equivalent income levels, African Americans are less likely than either whites or English speaking Hispanics to go online. Demographically, the composition of populations not online has not changed dramatically since 2000. Overall, 60% of the total U.S. population is online with African Americans making up 11% of the total U.S. population, 8% of the online population, and 14% of the offline population. However, when looking at those who are offline, African Americans are more likely than offline whites or Hispanics to believe that they will eventually go online (Lenhart, 2003). Although online health information is available from multiple sources, we focus solely on those health portals sponsored by the U.S. government. We made this choice based upon some early interviews with physicians and managers at a healthcare facility which serves predominantly African American clients. We learned that most clients exhibited a low degree of trust in information provided by pharmaceutical companies and other sources which seemed too commercial. Instead, clients searched for information from recognizable sources, and tended to use portals and search pages like Yahoo and Google. We found that portals sponsored by U.S. government agencies were received positively by clients. Also, portals like healthfinder.gov and cdc.gov are highly regarded by the Medical Library Association2. Moreover, the government is entrusted to uphold values of democracy and social justice therefore the health information that they provide should be accessible to a demographically diverse audience. To gain insights into the cultural inclusiveness and salience of health portals, we use Nakumura’s notion of menu-driven identities. For Nakumara (2002), the internet is a discursive place in which identity is enacted. She uses the term “menu-driven identities” to signify the ways in which content providers represent identities through the design of the interface and the personalization of content, and users perform their identity as they engage with the content. In what follows, we discuss health disparities and the promise of the internet in redressing inequities. Next, we further explain the ways in which users perform identity and health portals represent identities. We do this by theorizing about the health portals as mediating two-way communication between users and information providers. We conclude with directions for future research.