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Health Promotion International, Vol. 15, No. 4, 349-353,
December 2000
© Oxford University Press 2000
The Internet as a research and dissemination resource
Health Education Board for Scotland, The Priory, Canaan Lane, Edinburgh EH10 4SG, UK
Address for correspondence: Mary Duffy Health Education Board for Scotland The Priory Canaan Lane Edinburgh EH10 4SG UK mary.duffy{at}hebs.scot.nhs.uk
SUMMARY
The rapid growth of the Internet and the advantages of the medium over traditional communication formats in terms of flexibility, speed and reach make it an obvious route for research dissemination. Given the emphasis on evidence-based decision-making as a way of improving the allocation of scarce resources to improve health, and given the focus on dissemination therein, the potential of the web to get digestible information to the right people at the right time is even more apparent. While the Internet is no panacea and issues around equity of public access are still to be resolved, its possibilities as a resource for professionals should not be underestimated and its longer term impact on the way we carry out and communicate research are likely to be far reaching. However, before its full potential can be realised, problems relating to underdeveloped skills and lack of support for users need to be addressed, as do issues around the Internet's credibility as a publishing route for professional researchers. Similarly, new types of expertise and creativity need to be nurtured in those charged with developing the unique features of the medium. This will ensure that health researchers, practitioners and policy makers are at the forefront rather than bringing up the rear of the increasing number of professionals finding the Internet a key tool in their work.
Key words: dissemination; health promotion; Internet; research; www
INTRODUCTION
Conservative estimates put the number of Internet users worldwide at 150 million at the end of 1998, and at 500 million by the year 2000, with an associated exponential growth in the number of web sites (Treese, 1999
). In Australia, ~19% of the population was using the Internet in 1998, while in Britain 23% had tried it by the beginning of 1999, a figure that had doubled over the previous 2 years and that translated into 10 000 new users every day, including an increasing number with home access. The USA, meanwhile, retains the highest access rate of any country, constituting more than 50% of all web users (NOP, 1998; Treese, 1999).
The last decade has also seen increased recognition of dissemination as an integral part of the health research process (Freemantle and Watt, 1994; Crosswaite and Curtice, 1994; King et al., 1996; Lewando-Hundt, 1998). This has been due mainly to the acceptance of evidence-based working as the standard in these times of increasing pressure for the most efficient and defensible allocation of scarce resources (Nutbeam, 1999). As a result, dissemination, like evaluation before it, is no longer treated simply as a project add-on and now demands dedicated resources and new types of expertise. Thus, recent years have brought a proliferation of specialist dissemination units, research briefing bulletins and expert seminars, in addition to a plethora of information managers, network co-ordinators, liaison officers and all manner of new dissemination posts.
Putting these two trends together, all good health-related R&D strategies and research programmes now carry an explicit commitment to dissemination, and organizations increasingly look to new technologies to service this commitment. By doing this they seek to disseminate research findings in a more interactive and flexible way, through structured electronic databases, through formal and informal e-mail networks, through dynamic new web sites. Not surprisingly, given this concerted effort, Ramsey (Ramsey, 1999) discusses how ‘love it or loathe it, the Internet is becoming the most popular source of medical information for professionals and patients’ and health-related resources on the Internet have now well and truly ‘taken off’ as a multi billion dollar industry (Delamothe and Smith, 1999).
A GIANT STEP BUT NO CURE-ALL
The advantages of the Internet over more traditional media are numerous. In this new electronic environment, flat, paper-based research articles can become multi-layered, cross-referenced, live resources with integral audio and visual material and links. Users can, from a single entry point, explore and capture numerous additional bundles of information from organizations and individuals across the world. Through a growing number of e-mail newsgroups and focused discussion forums, researchers and research users can communicate and collaborate with extensive networks of professionals and public interest groups; here they can keep pace with many developments long before they reach a print outlet (indeed, assuming they ever do). It is this speed and flexibility of information exchange that represents probably the single most important benefit of the Internet.
Ongoing software advances bring new possibilities all the time—user profiling, for example, paves the way for the specific information needs of different users to be anticipated and for personalized channels to be provided through web sites in the search for the required information. The Internet also provides an outlet for a wealth of research material that is typically missed by the mainstream journals and print publications because it does not meet their requirements of evidence, because it is not considered unique or newsworthy enough, or simply because the researchers (frequently non-academic) have too many other priorities and never find the opportunity to produce the findings in a suitable format. The Internet allows this ‘grey literature’ which contains valuable information of use to many health researchers and practitioners, especially about work at a local level, to be provided on a widely accessible platform.
And not least, the Internet represents a powerful democratizing force in research. The accessibility of many ‘professional’ sites by lay members of the public and the increasing attention being paid by organizations to the rights of ‘consumers’ to have access to research information, especially when it is publicly funded, are making researchers more accountable. This will increase the expectation on researchers and research translators to present findings in different formats, with different audiences in mind, in plain language and in summary rather than only in the often overlong and overblown academic style. This in turn is likely to lead to more diversity and improved design in the web sites of large national bodies catering to many different user needs (the excellent and extensive Health Canada site is a good example here).
In many respects, the potential of the Internet as a research dissemination resource is to an extent bounded only by the imagination and skills of those who build and use it. But it is no panacea. At the 1999 launch of two web sites from the Health Education Board for Scotland, the keynote speaker, Nicky-Sinéad Gardner, Professor of Academic Innovation at the University of Stirling, reminded the audience that 80% of the world's population had yet to make their first telephone call. From the point of view of lay users, limited access is an ongoing concern because it maps onto existing patterns of exclusion, the growth of Internet use being predictably in the homes and in the workplaces of those who are economically better off.
However, the Internet is increasingly appearing in public spaces, community centres, libraries and other places where wider access is encouraged. Schools now bring it to those who might otherwise miss out, helping to make children more computer literate and less afraid of the new medium, and accounting in part for why the highest level of use is among the young. Moreover, the ubiquity of free subscriptions to Internet Service Providers (ISPs) is already reducing the cost burden that was formerly the single biggest identified barrier to use. As technology advances, more user-friendly modes of access will open up, entry-level prices for hardware and software will be driven down, and usage figures will inevitably increase further and faster over the next few years.
PROFESSIONAL BARRIERS
With respect to research information specifically, it is the professional user who is the key to unlocking many of the potential public health benefits of the Internet and, in the short term at least, to ameliorating some of the inequalities in access by acting as a channel for knowledge. For many health professionals, the increased availability of the required technology—in the UK for example through the growth of the ‘National Health Service Net’—means that Internet access in the workplace is now occurring rapidly. However, survey research from Scotland, and anecdotal evidence more generally, indicate that there is still some way to go before all staff who could benefit professionally from using the Internet at work are able to take full advantage of it (Reece and Eadie, 2000).
An obvious barrier is cost, especially in providing facilities to individual staff on well-equipped PCs; this is a problem in particular for voluntary organizations and others with often very restricted funding. However, as in the case of public usage, cost should become less of an issue over time.
Another barrier arises when employers and managers discourage Internet use, either explicitly though blocking wide access across the organization or, more often, by not fostering a supportive environment in which people feel they can use the medium freely. Such blocking can occur because of the belief that Internet access encourages time wasting and generates information that is not useful and often erroneous. Notwithstanding the fact that time can be wasted in many ways not associated with the Internet, this myopia overlooks the wealth of excellent up-to-date information for professionals, at the very least counterbalancing the amount of dubious material. Clearly users need to be able to employ the same critical appraisal skills to identify quality resources on the Internet as they would for any other format—i.e. this is not a problem of the medium but an issue in general. Moreover, to assist users in making these critical judgements there are an increasing number of professionally vetted web sites sifting quality and signposting routes through what can be an overwhelming quantity of information (Silberg et al., 1997; Welsh, 1998). There is also a growing trend for web site reviews to take their place among the book reviews in health journals and this too helps to guide users to the material they require [e.g. (Eachus, 1999)]. Such developments may help to reassure employers about quality control and have the added advantage of helping users to avoid the information overload (of even good quality material) that is always a risk given the vastness of the Internet. Equally, as in the case of those groups examining how to disseminate health information most effectively on the Internet to professionals and to the public, these developments offer much needed guidance on pitfalls and possibilities (Eng et al., 1999).
But what of the risk-averse employer who sees other dangers in the Internet? It is no coincidence that such employers may also be least convinced of the potential of the medium and least familiar (if at all) with using it. Some concerns are understandable given the occasional scare story about breached securities and administrative carelessness resulting in inappropriate material appearing in public sites, and it is not hard to see why this is particularly problematic in relation to health information. However, while not dismissing the fact that things can and do go wrong, it is important to keep a sense of scale, in much the same way as the public is encouraged to put infinitesimal risks into perspective when faced with the latest media health scare. Certainly, the Internet carries with it risks but these can be managed and should be balanced against the benefits that it can generate, leading to fact- rather than fear-based decisions about whether to open up access.
The above discussion points to the need for training and support in relation to Internet technology, an issue that is clear from a survey of specialist and non-specialist staff in the health, education and voluntary sectors in Scotland (Reece and Eadie, 2000). By building people's knowledge and confidence through effective training, and by providing them with a supportive environment in which to improve their skills through practice, employers can ensure that their staff get more out of the Internet by developing the shortcut thinking that brings experienced users reliable information from across the world within minutes (about as long as it takes to fill out an inter-library loan form ...). Perhaps this explains why there are now a number of courses aimed at providing employers (and well-placed employees in a position of influence) with the necessary ‘bottom line’ data to encourage them to familiarize themselves with the pros and cons (realistically appraised). This should help them to make informed decisions that ensure that their organization gets the most from the Internet and that perceived risks can be managed and are perhaps worth taking.
Potential risks for professional researchers also exist. For example, work can be cut and pasted unscrupulously by others, as has been seen in some universities where students have taken text directly from the web without proper citation. However, this is, after all, only a more convenient method of plagiarism, an ignoble tradition that has long dogged the print media. Indeed, new electronic technologies and the increasing linkage between international researchers that they facilitate may even offer ways of more effectively identifying plagiarism.
A more serious barrier to maximizing the research dissemination potential of the Internet relates to the system of academic accreditation for publications. The importance of peer review as a quality control mechanism and the sheer volume of research papers in circulation mean that there is inevitably a hiatus between establishing the findings from a given project and communicating these to the outside world. At the same time, the orthodoxy remains that certain published outlets are ‘better’ than others and this pecking order is reflected in the way in which a researcher's academic worth is assessed [the Research Assessment Exercise (RAE) in the UK is a good example]. Because academic journals do not in general publish research that has appeared elsewhere and because most insist on retaining copyright of what they do publish, researchers are often not in a position to provide their findings to Internet outlets that would be able to communicate them more quickly and more extensively.
However, while many researchers still see Internet publication as the poor relation, there are signs that the dominance of print is being challenged and the issues around peer review can be satisfactorily resolved. An obvious step is to provide web sites linked to already respected print publications and to ensure that similar quality standards are applied. Whilst the growing number of full-text web versions of journals is evidence that this is already happening, the most innovative approaches go beyond mere mirroring of content and exploit the unique features of the medium to their full advantage. The British Medical Journal is an excellent example, the web site having recently hosted a user survey to explore satisfaction with the format and possible new directions. Having such a high profile journal in the vanguard of electronic dissemination is positive, but work remains to be done before the Internet in itself is regarded as a respectable publishing arena. The fact that this article was sent first to the print-led Health Promotion International and not, say, to the web-only Internet Journal of Health Promotion is a case in point.
CONCLUSION
In one respect the Internet is simply another medium for transferring information and it is constrained by many of the same factors that impinge upon books, journals, seminars and other formats. Like them, it is only as good as the information it carries: if research is low grade, if shoddy work could not for good reasons get published elsewhere, making it available through the Internet will not make it better. If good research is presented in an inaccessible way, or without the implications for different audiences clearly drawn out, people are as likely to be put off as when faced with an over-technical journal article or a thick, single-spaced, paper report. Many of the common sense lessons we have learned about how to present information in print apply equally to the Internet. However, there are also unique features of this new medium that allow us to do things not possible before and have the potential to really change the way we think about, carry out and communicate research, creating a linked global research community and linking this in turn to research users in all sectors and at all levels of society. The fact that, by the time this paper appears in print most of its facts and figures will be out of date, testifies to the growing importance of the Internet in public and professional life.
A final sobering thought amid the enthusiasm for new technology is that, even if all key research findings and their implications were available on the Internet in an appropriate format and at the right time, and even if all health practitioners and policy makers were online and adequately skilled to access and absorb them, decision making would remain a complex process, rarely based only on a rational appraisal of evidence (Radaelli, 1995; Nutbeam, 1996; Smith, 1998). My argument is simply that building, refining and extending the reach of research through the Internet, while in itself not a sufficient step towards an evidence-based nirvana, is without doubt a necessary one and we in the health research community should strive to be at the forefront, helping to shape this brave new world.
NOTES
HEBS Research Centre is at www.hebs.scot.nhs. uk/research; HEBS Learning Centre is at www. hebs.scot.nhs.uk/learningcentre
The British Medical Journal is at www.bmj.com
Health Canada is at www.hc-sc.gc.ca
Regarding tips and guidelines for communicating health research and health information, two useful sites are: The Canadian Health Services Research Foundation at www.chsrf.ca/english/document-library/index.html and The Science Panel on Interactive Communication and Health at www.scipich.org
The Internet Journal of Health Promotion is at http://elecpress.monash.edu.au/IJHP/index.htm
ACKNOWLEDGEMENTS
The author would like to thank her colleagues at the Health Education Board for Scotland (HEBS) for helping to stimulate some of the ideas in this article, in particular Wilma Reid. She would also like to thank the two anonymous referees whose comments were very useful. The opinions expressed in the article reflect those of the author and not necessarily the position of HEBS.
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