Online Health Communities and Health Literacy: Applying a Framework for Understanding Domains of Health Literacy

Introduction

The Internet has become a valued part of managing consumers’ health. For physicians and health care professionals, the Internet offers cost-effective communication for patients, including the potential for health education (Cline & Hayes, 2001; Stout, Ball, & Villegas, 2004). For consumers, the Internet offers virtually limitless information on health, multiple health perspectives, and the ability to communicate with others regarding health issues. Online health communities, or OHCs, are a popular source of health information online. Consumers join OHCs in search of specialized health information, social support, and psychosocial benefits (Cline & Hayes, 2001; Rodgers & Chen, 2005; Wright, 2000). It has been estimated that one in four consumers actively participates in an OHC (Raines, 2005). Initial studies suggest that basic health literacy skills and knowledge are needed to effectively communicate about a health problem and technology places greater demands on consumers’ health literacy as well ability to effectively use technology, suggesting the need to examine e-health literacy in conjunction with health literacy in OHCs. However, compared with the growing popularity of OHCs among everyday health consumers, research has lagged regarding the examination of health and e-health literacy in OHCs. Additionally, while OHCs remain an untapped resource in which to examine health literacy, it is unclear as to the extent to which consumers use health literacy – the development of which can improve health behaviors - in online communication. Recent health literacy research shows a need to streamline the definition of health literacy and e-health literacy; multiple definitions of health literacy abound, necessitating consideration of both the context (setting) in which health literacy demands are made and the skills that people bring to the setting (Rudd, Moeykens, & Colton, 1999). The purpose of this chapter is to explore consumers’ health literacy in OHCs using domains of health literacy, defined below. To develop a more robust view of health literacy and e-health literacy, it is important to look at the domains of health literacy in the capacity of OHCs; in addition to active exchange of information (Korp, 2006; White & Dorman, 2001) consumers provide emotional and psychological support to each other in OHCs (Rodgers & Chen, 2005; Wright, 2000; 2002). With consumer benefits such as psychological support, personal connection, and anonymity, health information provided in online discussions can influence consumers’ health-related attitudes, decisions, and behaviors - more so than health information found on general health-related Websites (Wang, Walther, Pingree, et al., 2008). It is, therefore, crucial to examine domains of health literacy within an e-health literacy context to better understand the types of domains of health literacy being used, as well as extent of health literacy use, in OHCs. To orient the reader, the remainder of this chapter is outlined as follows. First, features of OHCs are discussed; second, health literacy and e-health literacy are defined. Multiple domains of health literacy are adopted in order to provide a multi-dimensional perspective of health literacy within OHCs. Last, the results of a case study are presented to demonstrate the use of domains of health literacy in OHCs, followed by a discussion to further explore the implication of OHCs in relation to health literacy and e-health literacy.