Citizens, Health and the Changing Media Culture

Research plan for 1999 - 2002

(Original plan, titles and contents may be changed over time)


1. Background to the project

1.1 The increased need and interest of the citizens in health issues

1.2. The variety of health information in modern media and its characteristics

1.3. Quality aspects of information in a global multimedia context

2. The subprojects

2.1 Supply of Health Information (2 subprojects)

2.1.1. Sinikka Torkkola: Ideologies of Health in Finnish Health Journalism

2.1.2. Marianne Wikgren: Health and Illness on the Internet - Ideology and Image

2.2. Use of Health Information (3 subprojects)

2.2.1. Kristina Eriksson: Media, Cognitive Style and Health Knowledge

2.2.2. Stefan Ek: Social Equity, Health and Media Culture

2.2.3. Margit Mustonen: Search Strategies in Searching Health (Medical) Information on the World Wide Web

2.3. Knowledge organisation and structure (one subproject)

2.3.1. Kimmo Tuominen: Constructing RDF-Based Metadata Vocabulary by Discourse Analytic Means: a Case Study of Heart Surgery Patients

3. The time schedule of the project

4. Implications of the research

5. Organization of research

6. Doctoral education

7. References

1. Background to the project

1.1. The increased need and interest of the citizens in health issues

The British Prime Minister Tony Blair has emphasised in the EU that:

The Member States should concentrate on issues that are of the greatest significance for the population, i.e. health, criminality and environment.(Belcher et al., 1997)

Likewise, today's social political strategies present "sustainable development" as one of the global and national goals most worth striving for while a well-being population is presented as a decisive condition in achieving such a goal. Investments in activities increasing the health of the population become understandable considering that unwholesome foodstuffs and unhealthy life style are responsible for app. half of the national health costs. In a society where over 40% of illness and bad health is directly due to factors which are under the individual's own control it is of interest to stress causes and consequences in health matters (McGinnis et al., 1993).

Much research has been carried out on different aspects of national health, but seldom from the perspective of the communication sciences. Most studies have been analyses of the population's state of health, often from an epidemiological point of view and meant to be used as a basis for different official health political programs. Due to the powerful globalisation we are all, whether we want it or not, in an increasing tempo confronted with problems regarding the entire population of the world. In order to master menacing epidemics and other health risks a co-ordinated know-how and planning on many different levels is called for. The programs presented have usually been based on the presupposition that a better-informed population could lead to great savings of public means. In the same time, it has become apparent that these programs have often been rather inefficient (Gibney et al., 1997). Lennernäs et al. (1997) demonstrate that there is a great desire among the European population to eat wholesome food, but that a mere 30-40% of the people, in reality, choose their food primarily on a health basis.

Within the EU there has recently been carried out a large and expensive attitude research regarding health and food. According to the report the relationship between knowledge, attitudes and behaviour in health issues is not at all clear and unambiguous. The project also analyses those information sources that citizens turn to and states that the studies carried out do not explain this relationship since they merely give quantitative results on citizens' consulting of different sources. The authors point out that access to health information does not automatically result in modified health behaviour. They state that many people have difficulties in internalising information in their own behaviour and stress the importance of a research analysing which kind of information and informational behaviour would be most efficient for different population groups (Margetts et al., 1997; de Almeida et al., 1997).

1.2. The variety of health information in modern media and its characteristics

Supply and use: The reading, listening and watching citizen has many possibilities to stay informed in health matters. According to a survey realised by the National Health Council in the United States in 1997 on the American people's (n=2256) ways of finding health information 40% mentioned television as their primary source of information for medical news (Johnson, 1998). Thereby, television was placed ahead of the medical profession (36%), magazines (35%) and newspapers (16%). Television and radio (29%) took the first place also in the extensive EU survey (Gibney et al., 1997. In Europe, too, television and radio are followed by magazines and newspapers (27%) and medical doctors (26%). Next, Europeans mentioned relatives and friends (22%) and packages (22%). In Finland friends and packages were substituted by information from commercials on fourth place (Gibney et al. et al., 1997). Neither the American nor the European survey considered modern web based information systems.

The citizen's information market has radically changed during the last years. Internet's encroachment in our homes, schools and places of work has widely surpassed the speed formerly accepted in the case of information technical solutions. The medical domain has not avoided the web's influence. On the contrary, biomedical information is among the most sought-for in the web. Although only 2% of the American population consider the Internet to be the primary information source in health matters (n=2256) the proportion is rapidly increasing (Johnson, 1998). Efficient medical information systems are being planned for the Internet while web distribution of information becomes more and more accepted and habitual (Kohane et al., 1996).

When the web capacity will be further increased the Internet is predicted to be the main link both between professional medical groups and between them and the citizens. It is predicted that future medical problems will often be dealt with at home and they will be more of a preventive than a crisis solving nature. Preliminary experiences with videoconferences on medical issues via the Internet in homes have succeeded very well (Shortcliffe, 1998). Doctors are also expected to be confronted more and more often with patients who know or think they know a great deal about health and care. The information available on the Internet has made the public very conscious of many rare and earlier unknown diseases (Johnson, 1998; de Groen et al., 1998). Almost half of the local authorities in Los Angeles use the Internet already now for distributing information. When the citizens (n=6000) were asked why the web has become so popular most of them replied that it was valuable to have access to professional help without having to pay for experts like physicians or lawyers. App. a third were completely satisfied with the information they received (Geffert, 1993).

Impact: The information distributed to the citizens via the media seems to be infinitely more efficient than the one distributed via official health political campaigns. In the National Health Council's survey 75% of the 2256 interviewed persons in the US paid either a big (25%) or a medium big (50%) attention to medical and health related news in the media (Johnson, 1998). It is interesting that over half (58%) of the interviewees had changed their behaviour on the basis of the acquired information and 42% said they had become interested in seeking more information on the matter (Johnson, 1998). According to Michael Koenig (1998) the web information's impact power is due to the fact that it possesses both reach and abundance giving it the power to break down old relationships, routines and ideas. Previously, it has not been possible to combine these characteristics. Personal communication has been rich but lacking in reach and a rapidly and widely spread communication has been, due to restrictions in the distribution channels, poorer, less personal and less influential. Web information is flexible. It can be adapted to the situation and anchored to the recipient's patterns of thinking and personal knowledge basis. The question is, are we able to use the web in the best possible way?

Knowledge content: Another interesting question will be: On who's initiative will the citizens be informed and on who's conditions will they build up their health knowledge?

Today many health risks are international, like e.g. transport of foodstuffs, commerce with harmful substances and spread of global epidemics. On global level research groups, health administrators and official organisations like the UN aim at developing co-operation on health matters of global interest among others by establishing efficient information systems. Powerful networks comprising both printed and virtual publications are offered to professional groups, decision-makers and in an increasing extent also to the wide public (Yach, 1998). Each country also disposes of an official health program available to the citizens via among others advisory offices, health stations and libraries. The Finnish Carelia Project is a good example of a successful national campaign.

Nevertheless, it is becoming increasingly evident that globalisation demands renewed national strategies in health matters (Fidler, 1996). There are many indications that the national governments' global responsibility has mainly consisted in developing an increasingly large international apparatus with a not always functioning co-ordination with national systems (Slaughter, 1997). Many speak for the need of long-term programs for global actions in health matters, actions which develop mechanisms for the control and counselling of states and organisations to fulfil and revise their health promoting programmes (Wirth, 1997). The spread of BSE or the "mad cow disease" to many countries in Europe and the following dread and demands for quarantine on entire nations show the need of international co-operation, global strategies and international information level with the national reality (Delbruck, 1993).

Globalisation, thus, leads to a greater internationalisation. The decision-making is moved from national to international professionals, half-professional and private actors on the web. Jessica Matthews describes the flow away from the State ¾ up, sideways and down ¾ to a supra-governmental, sub-governmental and super-governmental space outside the public establishments. The new international information clusters strengthen individuals and collectives while weakening traditional authorities. The structures change from hierarchies to networks and the centre of gravity is moved from centralised coercion to voluntary co-operation and global mastering. These clusters are held together both by shared insecurity and shared knowledge. The question, then, is: Is all information equal even if it isn't with certainty equally truthful?

1.3. Quality aspects of information in a global multimedia context

Knowledge, belief and disbelief in the citizens' health knowledge

The choice of an information source influences the knowledge to be used as a basis for the citizens' health behaviour. The behaviour profile generated in the individual by his knowledge may lead to a healthier life and a way of life, which is favourable for his health, but it may also lead to a less healthy behaviour. Environments built on knowledge and actions are easily exposed to dynamic forces such as power, control, submission to dominance, and resistance (Wikgren, 1998; Watkins, 1994). At the same time it becomes increasingly obvious, that the future actors on the global market will be nations, organisations and individuals who control the global knowledge flow and are able to use it for their own objectives.

Since the 1980's the interaction between the health care sector and the media has become extremely intense. Dramatic changes have led to a violent competition for the citizens' attention. Both researchers and media owners consider investments in health and medical information to be profitable. User surveys continuously place these programs among the most sought-for by the public (Johnson, 1998). This seems to influence the so-called inviolable ethics within both professions. While research refers to collective knowledge rather than anecdotes and to the value of constancy rather than speediness the public interest is tempting researchers to publish premature knowledge to the public. Likewise the media lets established medical researchers make use of column space without controlling the information. The result is a variety of news, advertisements, feature stories, discussion clubs and "puffs" in the exploding range of media and networks (Johnson, 1998).

While the official authorities continue officially to stress the importance of objective knowledge the net-based clusters devote themselves to joint problem solving with a varying and unpredictable pattern of participants both on professional and grass-root level. They create global debates, but also international epidemic problems like fear for real or imagined epidemics, dangerous foodstuffs and alternative therapy forms. Many net-based interest groups negotiate, act and lob where and when they believe to achieve the best impact. "Net expertise" becomes an influential, sophisticated and shrewd tool in producing a highly visible knowledge that uses international practice as an efficient striking weapon. Traditional values are easily softened and substituted by culture and group specific attitudes and ideologies.

With the Internet these ideas and values spread to all corners of the world creating a limitless world without responsibility. The power of regulating national forces is being ironed out as the actors can easily escape national norms and national laws. The flow of information and capitals is so quick and so great that it appears to be impossible to control (Johnson, 1998; Yach, 1998). The situation is alarming. A basic condition for actions is a mapping survey of the information available on the Internet. The need for such a mapping becomes even more urgent considering that parallel to the enormous flow of information with private, commercial and political objectives there is a strong tendency to privatise and to put a charge on scientific information based on serious research and development in the health care sector. The new proposals for copyright laws put forward widely in the world provide the owner of intellectual property in electronic form with great possibilities to restrict access to it and free use of it. Likewise, publishers put maximum charges on the use of serious net-based electronic journals. The question rises: What happens if it becomes difficult and expensive to get objective scientific information on the global networks while, at the same time, the world is glutted with free, subjective and actively persuasive information that legitimises a different health behaviour, free from present day social rules and norms?

As a synthesis, we could say that globalisation and information technology seem to offer both possibilities and menaces, which influence nations, organisations and economics as well as individual life situations. The profile adopted by the citizens in this game is highly dependent on the information forming the basis of his or her outlook on life, attitudes and behaviour. We will bring answers to the project's questions by the compound result from six subprojects.

The basic research questions in all the included subprojects deals with the connection between: The Citizen - the Media Content - the Communication Capabilities or Knowledge Organisation and Structure. The emphasis of these connections varies however in the different subprojects. In project 1 and 2 the main emphasis is on the communication capabilities of the media and their health ideologies. In projects 3, 4, 5 and 6 these connections are analysed from the point of view of the abilities and performance of the citizen in respect to media messages and health.

2. The subprojects

2.1 Supply of Health Information (2 subprojects)

2.1.1. Sinikka Torkkola: Ideologies of Health in Finnish Health Journalism

University of Tampere


There has been an increase in topics related to health and illness in the media (Atkin and Arkin 1990, 14, 20-21). In Finland, approximately 10 magazines about health are published and almost all media have a column or programme dealing with health. The growth of Finnish health journalism can be explained by several reasons. The public feels an increasing need for knowledge about health; and a topic that the audience is interested in is a good topic from the point of view of the media. Even readership surveys have found medicine to be one of the most interesting topics (Ruuskanen & Jalanko 1997). In addition, the public health service is increasingly interested in cooperating with the media. The changing practices of health care, such as shorter periods of hospitalization and the law on the patient's right to self-determination, call for improved communication from the public health service. (Stuyck 1997. For changing practices in Finland see Leino-Kilpi and Suominen 1997, 23-25; Pahlman 1996.) The media have also been involved in various publicity campaigns. Furthermore, medicine and the public health service want to use the media to explain their financing needs (Aarva 1991, 27-30; Ruuskanen & Jalanko 1997).

Despite the increase in the quantity of health communication and health journalism, and despite the growing demand for it, research in health communication, especially in health journalism, has been meagre in Finland. Naturally, there have been studies on the topic in other countries (e.g., Atkin and Wallack 1990; Karpf 1988; Klaidman 1991). In Finland, studies related to health journalism (e.g., Kauhanen 1997; Kärki 1998) have dealt with scientific journalism and publicity of medicine, but health journalism proper has been little touched upon. Health journalism has not been studied on a doctoral thesis level in Finland.


Health and Illness as Social Constructions

Health and illness are constructed in individual experiences, in medical diagnoses and in socio-cultural definitions. Health and illness are defined and redefined in socio-cultural processes, in which the media also participate. On the one hand, the manner in which health is defined and discussed in health journalism and other media relate how health is understood socio-culturally. On the other hand, the discourses of health in the media influence the construction of that understanding. (Nettleton 1995, 14-35; on contructionism see Berger and Luckman 1967.)

Irwing Zola brought out the concept of medicalization, which is at least indirectly connected to social constructionism. Medicalization means that interest in medicine has extended to new areas, and more and more aspects of normal life are seen as medical problems. (Zola 1972; Nettleton 1995, 26-27.) In consequence of medicalization, many of the phenomena of human life, such as birth control and giving birth, are now seen as biomedical questions. People have become more dependent on health professionals (Illich 1977; Oakley 1984).

The Pressures on Health Journalism

The relation between journalism and its sources has been described as a complex competition, where the media compete for sources and the sources compete for publicity (Luostarinen 1994, 64-90). The sources and the journalists have different interests, which creates conflicts in health journalism as well.

There is tension between medicine and the media. Medical scientists and journalists have different views on what should be written about medicine, and how it should be done. (Nelkin 1996) Finnish writings dealing with medical communication have noted that the level of writing varies. In addition to factual articles, sensational and pseudo-scientific stories are published. From the viewpoint of medicine, the task of the media is to convey factual and relevant information about health. (See e.g., "Arvoista valintoihin [From Values to Choices]" 1994, 20-21; Ruuskanen & Jalanko 1997) Medical journalists also seem to emphasize facts. According to a Swedish study (Finer et al. 1997), medical journalists consider the conveying of facts their primary task, whereas most other journalists consider their most important role to be the watchdogs of power.

Hypothesis and Research questions

The hypothesis of the present study is that doctors and other health professionals carry authority in Finnish health journalism. This is no surprise. Several studies have shown that journalism tends to trust official sources and sources of power (e.g., McQuail 1994, 212-232; Tuchman 1973). Because of the authority of health professionals, the discourses of health professionals are the main discourses of health journalism, whereas the discourses of the clients of health care tend to be marginal. This may be a consequence of the manner in which journalism acquires its sources, but the reason may also lie in the biomedical ideologies of health which guide health journalism. At this stage of the study, ideologies of health are understood to be comprised of the presuppositions and propositions connected to health, which produce the discourses of health in the media. (See Fairclough 1995b.)

The central objective of the study is to examine the nature of Finnish health journalism and its discourses of health. What texts say about health, illness, the public health service and medicine, and how it is said, are indications of the character of ideologies of health existing in the media and in the culture as a whole. The figure below shows the hypothesis and connected problems in a condensed form:

Health journalism and ideologies of health


The research problems can be summed up in two groups of questions:

1) Questions about the nature of texts:

- What kinds of similarities and differences do articles of health journalism have?

- How do medicine and the public health service appear in the media?

- How are health and illness defined?

- Who makes the definitions, and what kind of actors are involved in health


2) Questions about (health) journalistic practices:

- What is the relationship between journalists and their sources, and what kind of

sources do journalists use?

- Where do the ideas for articles come from?

- How do journalists define health journalism?

- What is good health journalism from the viewpoint of journalists?

- How do journalists define health and illness?

Research Data and Methods

The research data includes both journalistic texts and thematic interviews describing journalistic processes. The journalistic text data have been acquired from health journalistic articles from Helsingin Sanomat (a quality paper), Iltalehti (a tabloid paper), and television news by Yleisradio (public service television). The data describing the journalistic process have been collected in thematic interviews with journalists. For the study, 10-15 journalists have been interviewed, including both journalists specializing in medicine and public health service, and ordinary news editors. The thematic interview method used combines a questionnaire interview and open questions. The themes and topics of the interviews are predefined, but the form and sequence of the questions vary according to the situation.

The health journalistic texts are analysed both quantitatively and qualitatively. At the first stage, an outline of the topics of health journalism is drawn. At the second stage, the ideologies of health in the data are examined. Methods of critical discourse analysis are used to analyse how texts are constructed and what kind of linguistic and visual means are used to create meaning. The discourses of health in the texts are analysed; one objective of this study is to examine what kinds of discourses are used in health journalism. The data from the thematic interviews are also scrutinized using the methods of discourse analysis. In critical discourse analysis both the actors in the texts and the speech acts of health are examined. The central issue when analysing the actors is their positions in the texts. What position do doctors, nurses, patients and other possible actors take: are they active speakers or are they objects of speech? In analysing health speech acts, special emphasis is laid on the definitions of health and illness. (See Fairclough 1995b, 201-205.)

2.1.2. Marianne Wikgren: Health and Illness on the Internet - Ideology and Image

Åbo Akademi University


The Internet is seen as a natural source of information about health, disease and illness, used by physicians and the lay public alike. How is the medical information represented and discussed in different types of Internet sources, and how can the quality of health information be assessed? What are the images of health and disease in these new media? How is the knowledge communicated between scientific discourses and lay public discourses?

The aim of the project is to analyse how the changing media culture of today, represented by the Internet, has influenced the communication of health and medical knowledge, and to analyse the discursive practices that shape and reconstruct that knowledge in different social contexts and in different cultures. Of special interest is the study of how the health discourse practices mediated by this globally accessible medium affect and are affected by local health discourses, which reflect the everyday life of the citizens on a national level.


The form and content of health information on the Internet are defined by the registers, ideologies and discursive practices of the health institutions on the one hand and those of the health information consumers on the other hand. From a health professional aspect the communication of medical information is a question of information being transmitted (e.g. in the form of medical consultation or health education), whereas from a cultural aspect communication is about shared meaning (Carey 1994; Dervin 1992).

Changing discursive practices are parts of wider processes of social and cultural change (Fairclough 1995a); they actually participate in generating these changes. Discourses are social practices that shape the social reality, and at the same time are defined by "external" forces, such as institutions and social processes (Väliverronen 1993). The medical research field is by its very nature located at the borderline between science and society (Kauhanen 1997), while the social health policy is of outmost importance for every government and its citizens. Questions of authority versus democratisation of discourse, and the connections between global and local discourse practices, are thus of particular interest and importance.

The communication of health and medical information on the Internet takes many different forms, some of which are unique for this medium. The information is communicated in scientific articles of electronic journals, on the web sites of official institutions, through serious health clinics, and as information disseminated by organisations with a commercial or ideological interest. Some of the more interesting dimensions of the new media culture are private web sites with accounts of personal experiences of illness, as well as e-mail lists, bulletin boards or chat rooms dedicated to specific diseases and conditions. These support groups are used by a large number of members, and reflect the elemental need to communicate what is deeply felt on a personal level (McLellan 1998). All these various sources of health and medical information are characterised by specific discourse practices and specific knowledge structures. The public understanding of "science" represents an interactive process between lay people and technical experts, rather than a narrowly didactic or one-way transmission of information practices (Wynne 1991). Sociologists have talked about a process of "informalisation" (Featherstone 1991), which can be understood as a form of colonisation of public orders of discourse by the discursive practices of the private sphere - the "conversationalisation" of public discourse (Fairclough 1995a).

The Internet presents many challenges, both to users and suppliers of the information. Through the Internet, the public has access to a growing supply of information on health and disease, often of variable quality and relevance. The information is accessible from most parts of the globe, and access and dissemination is largely uncontrolled and uncontrollable. As a consequence, the quality of information varies widely, from the most up to date practice guidelines produced by leading clinical bodies to out of date or inaccurate recommendations. Misinformation could literally be a matter of life or death. There is now a growing concern within the medical profession - reflected in prestigious medical journals - about how the quality of health information sources on the Internet could be assessed (Eysenbach and Diepgen 1998), and already tools have been developed to monitor the quality of healthcare information (Kim et al. 1999).

The Internet has profoundly changed the ways in which citizens communicate about medical information. As patients acquire more information (especially of the type that used to be only in the hands of the professionals) from many different kinds of sources, and informal exchanges of information increase, the relationship between physicians and patients is affected. A particular set of discourse conventions (e.g. for conducting medical consultation) implicitly embodies certain ideologies - particular knowledge and beliefs, particular "positions" for the types of social subject that participate in that practice (doctors, patients) and particular relationships between categories of participants (Fairclough 1995a, p. 94). Change in knowledge leads to change in power, and power changes relationships (McLellan 1998). The Internet is thus creating "a profound levelling effect" in a relationship historically marked by an imbalance of power (Podolsky 1998). On the other hand, widespread use of the Internet is likely to aggravate existing conflicts between patients' expectations and the provision of health care.

The interaction of cognitive and social fields in the knowledge process can best be studied in the dynamic zone where knowledge meets society (Nolin 1993). The Internet offers a splendid forum for investigating this encounter, and for formulating a model of how different forms of knowledge are made equal with reference to the influence of the local context on the production and interpretation of both scientific and everyday knowledge (Kasperowski 1997).

Research questions

1. How can the content and the discursive practices of medical and health knowledge in different Internet sources be described (context; producer, end user, mediated; authority; quality)?

2. Which are the knowledge structures, power structures and ideologies in a) "objective" medical (scientific) information based on research, b) adapted (popularised) health knowledge directed to a mass public, and c) everyday knowledge of health and medical matters discussed between citizens?

3. Which are the images, metaphors, and repertoires by which the medical knowledge is represented and mediated in different professional and lay public sources, including image of science itself, image of health and disease, image of the relationship between physicians and patients. How do these images or representations differ from those observed in traditional media, and how is the medical knowledge represented in discourses shaped by different social and cultural contexts?

4. Which are the connections between the global and the local discursive practices in the communication of health information on the Internet, and the social and cultural changes in the society as a whole?

Research data and methods

The content, the knowledge structure in relation to the context, and the ideology and imagology in representative samples of health-related texts from different Internet sources are analysed and described:

1) Electronic versions of medical journals, directed either to professionals or to the public. Because of its prominence in disseminating information about the state of art in medicine, the general medical journal may in the future find itself at an intersection between the health-care professionals and the lay public. Both groups have pressing needs for information, but the public is not the journals' primary audience. The public's increasing demand for information suggests that the journals' responsibilities may be expanding, as the need for quality resources becomes even more critical (McLellan 1998). The electronic journal is affected by the new media culture - is the scientific (professional) discourse in these journals also affected?

2) Web sites for patient education and support (official web sites, health clinics). The medical information is mediated and "popularised". The study of communication of medical knowledge to lay publics involves assumptions about the scientific knowledge, how audiences are constituted, and how the organisation of knowledge production is connected to its dissemination to nonspecialist audiences (Whitley 1985). In these samples it should be possible to study the relationship between global and local discursive practices, and their connections to social and cultural practices. (Fairclough 1995a).

3) Private stories of illness and patient support groups (private web sites, newsgroups, e-mail lists and chat rooms), as well as different forms of direct communication between doctors and patients. In the discourses, the consumer's approach versus the medical approach can be studied (Karpf 1988)

Methods: In the texts, the form and content of the messages in their specific context are analysed using various qualitative methods, including register analysis, analysis of rhetorical features, knowledge structures, and authority relationships (Atkinson and Coffey 1997). To describe and analyse the power structures, ideologies, images and metaphors of the messages, discourse analytical methods are applied. Discourse is here understood as the use of language seen as a form of social practice, and discourse analysis is analysis of how texts work within the sociocultural practice (Fairclough 1995a). Critical discourse analysis looks to establish connections between properties of texts, features of discourse practices (text production, consumption and distribution), and wider sociocultural practice (Fairclough 1995a, p. 87). The method of discourse analysis thus includes linguistic description of the language text, interpretation of the relationships between the (productive and interpretative) discursive processes and the text, and explanation of the relationship between the discursive processes and the social processes (Fairclough 1995a, p. 97).

2.2. Use of Health Information (3 subprojects)

2.2.1. Kristina Eriksson: Media, Cognitive Style and Health Knowledge

Åbo Akademi University


The rapid evolution of modern media makes it possible for every citizen to access an immense volume of information. It is, however, unclear which role this information plays in people's lives. The objective of this project is to examine the citizens' existing knowledge level in health matters (health schema) and how it is affected by the information from traditional and interactive media. The analysis concentrates on the influence of cognitive styles on the citizens' process of developing their own health schemata. The goal is to illustrate the relationships between knowledge structures, the personal information behaviour in the modern media culture and the citizens' acting in health matters.


Relations between people's knowledge base and information intake

The fact that there is a relationship between the person's knowledge base and his/her information behaviour has been pointed out by, e.g. Kirschenbaum, 1992; Patel & Groen, 1992; Latta & Swigger, 1992. In cognitive research the logical structure within the problem to be solved has been related to various operative schemata. According to schema theories, all knowledge is packed into units. These units are the schemata. Embedded in these packages of knowledge there is, in addition to the knowledge itself, information about how this knowledge is to be used. A schema, then, is a data structure for representing the generic concepts stored in memory. Fiske & Taylor (1991) define a social schema as a cognitive structure that represents organised knowledge about a given concept or type of stimulus (Huston et al., 1997). Schemata are acquired by observation and inference from one's everyday experience, including the media (ibid.). There is a direct connection between the thinking phenomenon behind the problem solving and the problem's schema or mental structure and the operations the problem solver uses. Thus, the schemata reflect the structure of the person's conception of the world, which is based on learning, observation and everyday experiences. Schemata grow and develop constantly and they possess a hierarchical structure (ibid.)

It is possible to draw parallels between the schema theory research and the analysis of the research by communication science on cognitive structures in relation to people's information behaviour. According to Dervin (1976) people try to "make sense of the world" by a continuing problem identification and solving. In the first of the model's three phases people are placed in a situation where they experience a gap between what they understand and what they should understand in order to master the current situation. This gap produces questions and information seeking in order to fill the gap and to gain control over the situation. Belkin (1980) constructed a similar model for information seeking emphasising the "information seeker's anomalous state of knowledge (ASK)". The model presents a situation in which the information seeker doesn't quite understand neither the problem itself nor the information required for its solving but these become clearer bit for bit as he or she acquires more information increasing his/her understanding of the phenomenon. This model has a clear connection to the learning process and among others to Kuhlthau's (1988) theories describing the relationship between information seeking and learning. Kuhlthau demonstrates that the information behaviour is associated not only with cognitive but also with affective factors. These theories will form the base for the analysis on what people know and what they learn on the basis of the information they get from the media.

What can the citizen learn from the modern media culture?

The general expectation is that the new media culture has a favourable affect on people's capacity to assimilate information for a life-long learning process. Findings reveal that i.e. hypermedia has the potential to individualise instructions to meet the specific needs of the learners. Interactive systems allow the information seeker to use non-linear styles of access and take in information at his/her own pace. Non-linear access offers the information seeker the choice of speed and navigation and browsing route through the subject content according to the seeker's particular needs and cognitive abilities. It has been suggested that non-linear knowledge access within interactive, hypermedia-based media can enhance learning in comparison to relatively linear access within more traditional media (Chen & Ford, 1998). Hypermedia as an information presentation and representation system possesses, in addition to non-linearity, three other distinctive characteristics: associativity, flexibility and efficiency (Liu, 1992).

The extent to which the individual can benefit from these characteristics offered by different media is related to his/her cognitive abilities. Riding and Rayner (1998) describe the term cognitive style as an individual's preferred and habitual approach to organising and representing information. Riding (1991) found two principal learning styles associated with learning: The Wholist-Analytic and the Verbaliser-Imager. In this research we will focus on the wholist-analytic style, since it reflects one's mode of perceiving, remembering and thinking. Wholist individuals tend to perceive objects as a whole, whereas the Analytic person tends to analyse the object into its component parts (Chen & Ford, 1998) The strength of the wholist is that he/she sees the whole picture. The negative aspect is that he/she finds it difficult to separate out parts. As to the analytic, his/her positive ability is to be able to analyse information in its components, but he/she may not be able to get a balanced view of the whole (Riding, 1991). Wholist individuals seem to have a more passive approach to learning and to require more structure and guidance. They also consider the volume and level of detail of the information difficult to deal with. They tend to stay at relatively superficial levels and to have a global and less analytic approach to learning. Analytic individuals are better able to engage in learning requiring independent analytical thought. The research results of Chen & Ford and others suggest that analytic persons learn more efficiently than wholist persons in an interactive hypermedia-based information environment.

Which kind of information influences the citizens' health related schemata?

It has long been known that people tend to see and hear mainly things that they know and believe in from earlier experience. One and the same person may have schemas both for a real world and an imaginary one, e.g. a virtual world. The phenomenon is based on "pre-understanding", on feedback mechanisms and on the adaptation of the abstraction level and the language to the recipient's level (both the content and language schemata). This phenomenon can explain why expertise leads to seeking behaviours and filtering mechanisms, which differ from those of the inexperienced, and the uninitiated. Camacho and Good (1989) studied experts' and novices' problem solving when they were involved in solving difficult chemistry problems and noticed that those who did not succeed had many knowledge gaps and misunderstandings about the phenomenon they were dealing with which led to fuzzy problem logic. Allen (1994) stated, however, that the behaviour is influenced as much by "self-understood" knowledge (metaknowledge) as by real knowledge. Other control instruments in this connection are the "tacit knowledge" based on the information seeker's implicit valuations and convictions and the "common sense" phenomenon which constructs a system of rules that likewise control to a large extent our comprehension about what is important "to know and to do" (Fiske, 1990). Both the common sense phenomenon and our system of rules strongly relate to the social environment and to group dynamics examined in subproject 5.

As information affects our knowledge structures, these structures are extended, reinforced and altered. This process not only broadens our understanding of the world but also bolsters our biases and misunderstandings and affects our subsequent expectations. This implies that organisation of our information resources is critical to affective future actions and that we must not only control the amount of information but also create evaluative filters to minimise inaccurate or low-quality information (Marchionini, 1997, pp 27-28). In other words, there are not necessarily any objective filter mechanisms for the information that influences our health schemata.

How does the received information affect the individual?

Even though there are level differences in our learning capacities we are all, on some level, affected by the messages we receive. The "cultivation theory" has shown that both adults' and children's conceptual apparatus is strongly affected by the messages to which they are repeatedly and consistently exposed from the mass media (Fitch et al., 1997; Hawkins et al. 1982; Potter, 1986; Signorelli & Morgan, 1990). It has also been stated that what people learn e.g. by watching television relates to how they process the received information. For instance, an exclusively active and involved information reception leads to critical evaluation of the received information. Information behaviour and seeking is directly related to learning motivation. Better-motivated persons use more information and put more effort into the seeking process. The degree of experienced uncertainty also has a direct repercussion in the intensity of the information seeking (Allen, 1996, p. 95). Through a passive information intake the difference between reality and fairytale is less distinct (Huston et al., 1997). This means that the difference between what a person learns from a true world versus an imaginary world is less sharp if the information intake is less involving and less emotionally charged. This is often true for the information intake we are exposed to in a daily confrontation with a rich media culture. The public's interest in health information is generally not dependent on the person's present health situation but more related to the person's general information profile and his/her attitude to health care (Allen, 1996, p. 92). Fitch et al. claim that a more general, not too emotional interest in the received information implies that the person's liaison between source and information becomes looser and thereby tends to disappear in time resulting in a more diffuse comprehension of what conforms with reality.

Research questions

On the basis of the theories and research results presented above this project will try to answer the following questions:

1.Is there a connection between the cognitive style of a citizen and his/her health knowledge?

2. Is there a connection between the cognitive style of a citizen and the preferred type of information in the media or media use?

3.Is there a difference between individuals with different cognitive styles in learning health schemata from the media?

4. Do citizens learn health schemas both from factual and fictional media information on nutrition?

5. Do citizens learn health schemas from interactive and traditional media in a greater extent than from professional health information sources?

6. Does low emotional involvement in the received information reduce the likelihood of distinguishing between fictional and factual sources of health schemas?

Research data and methods

A research material as representative as possible will be chosen from among citizens in the stratified groups in the extensive questionnaire survey in subproject 5. This study brings together individual and social views on the use of information provided to the persons in a dynamic media culture for the purpose of managing their health. Another advantage is that the project will be able to profit from the information on the population's health situation, health behaviour and nutrition habits and on the basic use of different media surveyed in connection with the socio-economic research.

Three different tests will be conducted during the study

The cognitive style test

Riding's (1991) Cognitive Styles Analysis (CSA) will be used to identify citizens' cognitive styles in the same way as Chen & Ford (1998) successfully did. The CSA measures Wholist/Analytic dimensions of cognitive style. The CSA includes two sub-tests giving scores to individuals participating in the test. Riding's recommendations are that the scores below 1.03 denote Wholist individuals and scores of 1.36 and above denote Analytic individuals. Participants scoring between 1.03 and 1.35 are classified as Intermediate. These recommendations were followed by Ford in several studies (ibid., Ford et al. 1996). These recommendations will also be followed in this study.

The existing and changed knowledge test

The citizens' existing knowledge structures about health, healthy living and nutrition will be elicited and mapped, as will the knowledge structures after the exposures to different media-information on health and nutrition. A combination of free-generated discourse and a semi-structured interview will be chosen to elicit the knowledge of the citizens. The combination of these two approaches has proved to be very informative in exploring the content of a particular knowledge base (Greaser & Clark, 1985).

The type of impact of different media and information

The testees will be confronted with information coming from different media and dealing with the connection between health and food. The information shall represent different degrees of 1) objective, clinically tested knowledge, 2) common sense, 3) stereotypes, and 4) completely misleading information. The choice of information to be presented to the testees will be conducted in co-operation with subproject 2 (health image in the media) and subproject 3 (health image in virtual, net-based media). The testees will be divided into two parallel groups according to their interest in and attitude towards health care "to test the different levels of involvement during media use in schema acquisition".

The conformity with reality of the received knowledge will be measured by means of three concepts (Potter, 1988): 1) Factuality - how does the acquired image correspond to the real life outside the virtual world, 2) Social realism - how reliable and true are the phenomena, people, and events in reality, and 3) Utility - are the acquired guidelines applicable to one's own behaviour.

2.2.2. Stefan Ek: Social Equity, Health and Media Culture

Åbo Akademi University


The present day society has a pronounced desire, strategies and potential for a development where global information networks and interactive media constitute positive tools in view of a healthier and more active life for every citizen. It is, however, unclear whether the media and the citizens are prepared to take advantage of the offered challenges. The objective of this sub-project is to study the possibilities and the barriers in connection with the desired development, and the connection between this development and the individual's socio-economic position and education. The aim is to determine the contribution of modern media on life styles and citizens' health in different socio-demographic groups.


Relationship between socio-economic factors and health:

People's health and well-being is affected by not only genetic disposition but also by the social reality both in adulthood and childhood (Bosma et al. 1999; Davey, Smith et al., 1997; 1998; Kaplan & Salonen,1990). People are influenced and moulded by their positions within family, profession, the social environment, linguistic group membership and other demographic circumstances. Émile Durkheim pointed out already in 1897 (1960, 209) that this influence could be both dramatic and extensive. After he had carried out an extensive and innovative empirical survey, "Le suicide. Étude de sociologie", he stated his famous thesis about the inclination to suicide (i.e. an ultimate expression of ill-being): "Suicide varies inversely with the degree of integration of the social groups of which the individual forms a part".

The underlying mechanism

The reasons of the differences in the health situation among the different groups are not yet completely clarified. Bad health and ill-being seem to be in covariation with plain medical reasons (e.g. high blood pressure and cholesterol) and also with minor social pathologies which are difficult to measure, such as bulimia, anorexia, gambling addiction, smoking, abuse of alcohol, narcotics and medicine (Stepukonis, 1997; Bosma et al. 1999).

The degree of social affinity and social relations, on the other hand, correlates negatively with mortality in general (Rogers, 1996; House & Landis & Umberson, 1988; Berkman & Syme, 1979). Group membership provides the individual well-being with such positive attributes as self-respect and group-oriented attitudes and behaviour patterns (Smith & Tyler, 1997). Suominen (1993, 121), who has studied Finnish circumstances, concludes his thesis by:

"Based on the present results, it seems possible to defend the view that by supporting the rise of voluntary social contacts and possibilities for activities during time of leisure, it is possible to exert advantageous effects on the population's health and life control. Health problems that could be dealt with by applying these kinds of strategies are for example mental disorders, addiction problems, psycho-somatic diseases and health-endangering risk behaviour".

In the Finnish society identity, social integration, social communion and group membership have been developed and sustained to a large extent also in the sphere of the working life. In the post-industrial society, on the other hand, life-long employments are rather exceptions than a rule and project-based time-bound employments become increasingly common. The loyalty bonds and the authorities, which were earlier so natural, don't exist anymore. This creates insecurity and, in continuation, discomfort and bad health.

The importance of life style.

In this context the psychological reasons stand out as particularly interesting factors. Bosma et al. (1999) claim that unhappy socio-economic factors during childhood and in adulthood can affect the health situation. He found that persons coming from lower social groups demonstrate in a significantly higher degree characteristics such as "external locus of control", parochialism (a narrow, local and non-scientific attitude) and lack of future orientation. They were also characterised by a depressive reaction model, a less active search for social support, an evasive behaviour, and a lesser capacity in showing sensibility and in solving problems. The behaviour patterns also coincided with a poorer health.

Which is the importance of the citizen's information and communication profile?

As seen from the perspective of the science of communication these results are highly interesting due to their close relationship to phenomena, which depend on successful information management strategies and a good communicative capacity for a successful realisation.

Could it possibly be that the psychological factors, which correlate with poorer health in the lower social classes have their roots in a less developed information and communication behaviour?

Phenomena such as low level of control and the lack of problem oriented actions which Bosma et al. (1999) showed to be particularly significant for citizens issued from lower social classes, have been quite frequently studied from a communication scientific point of view. The analyses have included the citizen's ability to make use of information in order to make his or her world more meaningful and the strategies he/she develops in an effort towards a better life quality. The Office of Technology Assessment at the US Congress (1990) has stated that "The opportunity for people to participate in economic, political, and cultural life depends on their ability to access and use information services. Individuals need skills and tools to locate the communication pathways, information, and audiences in a timely fashion and in an appropriate form. Unequal access to communication resources leads to unequal advantages, and ultimately to inequalities in social and economic opportunities".

Is media culture thereby in a long perspective a social culture?

The social importance of communication has been strongly stressed e.g. by Brenda Dervin who sees the communicative process mainly as a social process, strongly connected to the life situation of the communicating parties. Affective needs reveal cognitive gaps that make people seek information in order to find relevant and meaningful information. The result is comprehension, changed attitudes, problem solving and interpretations, which bind together friends and fellow-workers. It is a life-long process that becomes a part of our social behaviour. The social environment facilitates, moulds or impedes information seeking. A strong factor is the fact that the members in a social group or a collective share ideas (Morgan & Schwalbe, 1990; Ginman, 1983, 1987). Groups develop a collectively shared knowledge and a group control based on social intercourse, norms and communication. Several studies have shown how social relations have been able to decrease unhealthy eating habits, smoking and abuse of intoxicant and to promote desirable activities, such as physical exercise, interest for an adequate diet and regular rest (Rogers, 1996; Antonucci, 1990; House, Landis & Umberson 1988).

In other words, there are strong reasons to believe that people within groups that on the average suffer of poorer health lack the communicative skills needed to efficiently consult and interpret the information offered in the media. This hypothesis is backed in Chatman's (1987, see also Agada, 1999) study showing that lowly paid employees turn to their opinion leaders with their information needs, e.g. in connection with health and life style problems although they have access to the same information (newspapers and books) that the opinion leaders. The phenomenon is related to the low educational level in those social classes. Better educated citizens seek information, read more, use professional sources to a larger extent and experience information evaluation as less troublesome (see e.g. Dervin, 1976; Ginman, 1983). Childers & Post have studied "culture of information poverty" and found that the information poor groups coincided with the more or less dropout groups. Apart from purely communicative skills the variety of the media culture may also have a certain importance in this connection. A Finnish 'special characteristic' is that, according to several comparative studies, the Swedish speaking minority has proved to feel better, be in better health and stay longer active in working life than the Finnish speaking population (Hyyppä & Mäki, 1997a, 1997b; Ohinmaa et al., 1996). This leads to an interesting question: Could a contributing reason to this be that the culture and information supply is enriched by three media cultures; the Swedish (from Sweden), the Finnish, and their own? The Finnish speaking population, however, lives more often in a monoculture from the mass media point of view. Could the media culture have such a radical influence on our well-being?

Is the new media culture strong enough to change life style?

The optimists in the post-modern society claim that the relationship between the information rich and the information poor will change as the new media culture keeps spreading. Optimistic decision-makers consider this as a new opportunity to create security, meaning and healthier life styles across all social classes. The vision of a global information society is taking form in the political circles in the EU.

The Rexrodt & Bangemann report (1997) from the ministerial meeting of the European Union in Bonn states that global information networks will change the world and bring people closer to each other with the help of better global communication. This enables thorough economic and social changes, which expand to all areas of human activities. New advanced multimedia techniques in communication will co-operate and be integrated with new products and services for everyday life. The global networks will convey a variety of information for a wide public or for a little group of experts and enthusiasts. The target groups can be either global or purely local. In order to bolster such a development a number of important international agreements have been signed. The emphasis is now being moved from the infrastructure to the creation and spreading of content and trust and to the development of value-added services on the global networks. By encouraging the spread of knowledge over the entire world and by offering access to resources without national boundaries the global information networks and the new global media culture will play the leading part in the development of a new digital general knowledge and offer possibilities for a healthier, more active and more participating life for every citizen. At this point it is uncertain in which extent the media have the strength to fulfil these visions. Will they aid the citizens in establishing and actively participating in the new social networks, independently of time and space?

For such a development at least the following conditions should be fulfilled:

1) The modern media culture must reach all groups on the same terms

2) These groups must be "media literate", in other words, they must be able to receive and make use of the communication and the messages that the media convey

3) The received information must be strong enough to co-operate in discarding the factors that lead to weaker health prerequisites, among others the above mentioned psychological factors and life styles

This challenge is enormous, but the potential in the interactive, net-based communication, its strength and its impact power are deemed to be good. "In contrast to mass-mediated channels, interpersonal channels provide rapid and continuous feedback and are therefore more capable of providing transactional response-dependent communication, ... (Cassell & Jackson & Cheuvront, 1998). And in the area of pure health promoting the Internet's merits have been considered to be obvious. Through an examination of the conceptual bases of persuasion, it is posited that the World Wide Web and other Internet-based resources have many of the characteristics necessary for persuasive communication and may, in fact, constitute a hybrid channel that combines the positive attributes of interpersonal and mass communication. The notion that the Internet features many of the persuasive qualities of interpersonal communication makes it a prime candidate for the application of key behavioural science theories and principles to promote healthier behaviours" (ibid.).

The use of Internet is growing very fast. In 1995, 43.5 % of the Europeans did not know what Internet was. Already in 1997 the number of "unconscious" Europeans as to the Internet was reduced to 3%. Net-based information is, however, used today mainly by young men, by people with higher education and higher income.

(28.8.1999 http://www.ispo.cec.be/infosoc/promo/pubs/poll97/eurobaroen.htm)

The potential of the modern media culture in becoming a means towards better health and quality of life among the social groups with less resources remains an unanswered question.

The research questions

1. What are the most used media and what is the level of trust associated with these

sources among citizens with different socio-economic and educational background

2. Which are the life styles and problem solving strategies of the surveyed social groups

3. Is there a connection between citizens' life styles, communication profiles and health

within the surveyed groups

4. Is there a difference in the way information from different media affect the health

behaviour within different social groups

5 Does the use of interactive media help the citizens to establish and actively participate

in new social networks, independently from time and space

6. Do the modern media help the citizens to take better advantage of the messages in view

of a healthier behaviour

Research data and methods

The respondents will be stratified according to socio-economic and demographic factors and quota controlled in order to get representative samples of Finnish adults from the chosen groups and geographical areas. In the choice of groups the group division in the big EU survey will be taken into consideration.

The questionnaire will be divided into three major sections.(Monneuse et al, 1997, Bosma et al, 1999):

In the first section, five major classes of health-related behaviours will be assessed, namely1) substance use, 2). diet and eating habits 3) positive health practices 4)preventing health care and 5 )perceived health.

In the second section, the psychological attributes will be assessed by questions on personality characteristics and coping styles according to the studies of Bosma et al., (Bosma et al.1999; Rotter, 1966; Eysenck,1985 ). The personality characteristics will be external locus of control (low perceived control), emotional distress, parochialism (a narrow, local and non-scientific attitude) and estimation of future-orientation. The coping styles will comprise: active problem focusing, avoidance behaviour, social support seeking, and palliative reaction pattern (Bosma et al, 1999).

In the third section the use of, the attitudes to and the evaluation of the different media will be assessed. This section will also contain questions on personal patterns of communication both with the media and with the personal network.

Data from the questionnaires will be transformed into machine readable form and analysed by some appropriate technique (using SPSS program) to reveal clusters of behaviour patterns and to give connections between health related behaviour, the psychological and socio-economical attributes and the communication patterns in respect to the emerging media culture .

2.2.3. Margit Mustonen: Search Strategies in Searching Health (Medical) Information on the World Wide Web

University of Oulu


In this subproject information searching and relevance judgement in the new electronic communication culture is considered. The purpose of the study is to analyse search strategies and relevance judgement principles in searching health and medical information on the World Wide Web (web) environment. We will investigate both professionals' and non-professionals' behavior because different competencies may cause different behavior and judgements.


The search strategy can be defined as a plan or approach to a search, and it can consist of several tactics and moves (ideas or actions) taken during a search in order to continue the search or reach a successful conclusion (e.g., Bates, 1979, Bates, 1987). During the search process both positive (to do something) and negative (not to do something) decisions are made. Relevance judgement can be defined as a user's judgement about how well documents satisfy their information needs. Relevance judgements can be made on the basis of document attributes , i.e. the user estimates the relevance of documents on the basis of the formal features of the documents, e.g. the name of the author, title, subject description, source of the publication, or the date of publication. The relevance judgement can also be made on the basis of information attributes, e.g., when the user estimates the accurary, completeness, content, suggestiveness, timeliness and treatment of information. (Bruce, 1994.)

The web is a huge collection of information resources that are available and can be reached almost everywhere by a new communication technology, i.e. computers and information networks. It offers new possibilities for finding and transferring information. Numerous documents about health and medical issues such as diseases and disabilities, health related products, special diet and other programs, health care etc. can be found via the web. For example when the Ebola-virus spreaded in Africa in the beginning of 1990's doctors were able to have valuable information about the virus via the web and to fight against the virus. Health and medical information is one type of information that is widely searched via the web. Spink, Bateman and Jansen (1998) found that 8 % of search topics of web-searches (n=287) were related to health and medical issues.

However, finding relevant information on the web may be problematic because unlike other information resources, the web is diffuse, dynamic, and almost without any quality control of web documents. Web documents also include very little metadata which tells about the content of documents and is data associated with objects which relieves their potential users of having to have full advance knowledge of their existence or characteristics (Dempsey and Heere,1998). Information searching can be very confusing and frustrating. In addition, users may easily become overloaded with information while not knowing how to judge and evaluate webdocuments. In addition it is possible that useful information is not found while misinformation is accepted as a search result. We can assume that selection and filtering strategies play more important role in the web than they did in the printed world (Green, 1996). We can also suppose that users' ideas about the relevance and usefulness of the documents will change and can be different to those they have used to in the printed world.

On the basis of previous studies we already know some characteristics about web users. For example, studies have shown that men use web more than women do and that web-users are either young students or rather well educated professionals, e.g. academics. (See e.g. Covi & Kling, 1996, Kaminer, 1997, Savolainen 1998, Tillotson, Cherry & Clinton 1995, Wang & Tenopir 1998, Wang et al. 1998.) In comparison, there are only a few studies and a weak understanding about search strategies used in searching information on the web. However, two main findings can be mentioned. First, there are some special strategies for searching on the web. Second, users prefer rather simple searches when searching on the web.

Catledge and Pitkow (1995, cited here from Hsieh-Yee, 1998) studied web users' navigation strategies by analysing log files. They found that users used hyperlinks or other heuristics in browsing the WWW. Hsieh-Yee (1998) studied web users' search tactics using a search simulation exercise. She found that searchers preferred to start their web searches by a search engine. She also found that browsing the search result was the most popular tactic when too many items were retrieved. Using another term was the most popular tactic when nothing were retrieved. She also found that some of web users' search tactics were similar to tactics used in searching online catalogs, but many tactics such as changing search engines, selecting items for possible hyperlinks and checking the web site of a parent organization, were unique to web searching. Wang and Tenopir (1998, see also Wang et al., 1998) studied web searches and collected data by using multiple data collection techniques including transaction logs, thinking aloud during the search processes, questionnaires, and tests of cognitive styles and anxiety levels. They found two main web search strategies. The users either preferred to trace links from known and familiar pages or they used search engines and modified search statements. They also noticed that many searchers, who found an incorrect answer, were sure that they found the right information. Spink, Bateman and Jansen (1998) studied web searches by web-survey method. They found that users preferred rather simple search strategies, carried out quick successive searches, and that their ability to specify good search terms and create complex search queries was rather low.

On the basis of previous studies carried out in a traditional online search environment (see e.g. Iivonen, 1995) we know that different searchers use different search strategies, and that the subject knowledge they have impacts their search behavior. Therefore we can assume that health care professionals such as doctors and nurses use different search strategies compared to non-professionals, e.g., citizens ("ordinary people") who are just interested in health and medical information because of personal reasons (e.g., information about some disease or health products). Because the competence area of health care professionals is different from the competence area of citizens, it is important to consider how the differences in competencies effect both the chosen search strategies and also the relevance judgements of web documents.

Research questions

In this subproject the following research questions will be addressed:

1) which kinds of topics are health care professionals and citizens (ordinary people) searching on the web, and how do they differ from each other

2) which kinds of search strategies are used in searching health and medical information on the web by health care professionals

3) which kinds of search strategies are used in searching health and medical information on the web by citizens

4) how do the search strategies used by health care professionals and citizens differ from each other

5) on which basis do health care professionals select relevant documents from among those web documents which were found in a search

6) on which basis do citizens select relevant documents from among those web documents which were found in a search

7) how do the selection criterias used by health care professionals and citizens differ from each other

8) which relevance attributes are important when health care professionals judge (estimate) the relevance of web-documents

9) which relevance attributes are important when citizens judge (estimate) the relevance of web documents, and

10) do relevance judgement principles of health care professionals and citizens differ from each other.

Research data and methods

The data for the study will be collected by interviews and in test situations. In the test situations data about the informants' search behavior and search strategies will be collected. In the test situations search diaries, observation and log files will be used. By interviews before the test situations data about subjects and their knowledge about web and health and medical issues will be collected. By interviews after test situations, data about relevance judgements of web documents will be collected.

The study will be a valuable contribution to our understanding about searching health information in the new electronic communication culture. It will add to our knowledge about various skills used in searching information on the web and various relevance judgement principles when estimated the value of hyperdocuments available on the web. The results of the study can be used when developing web search services and also in teaching people how to take a benefit about the services which can be reached via the web.

2.3. Knowledge organisation and structure (one subproject)

2.3.1. Kimmo Tuominen: Constructing RDF-Based Metadata Vocabulary by Discourse Analytic Means: a Case Study of Heart Surgery Patients

University of Tampere


The aim of the project is to build a controlled vocabulary reflecting the information world of heart patients. The vocabulary is constructed by using discourse analysis as a research method. The main assumption of the project is that it is possible to build better and more user-centered information services on the web by using metadata and controlled vocabularies that are derived directly from the health discourses that patients use.

The empirical data of the project are collected by interviews of twenty heart patients and their spouses.

When using a vocabulary that has user-warrant the patient does not need to learn the resource producer's discourse in order to find relevant information sources and she can search for resources in her own language and on the basis of her own interests and knowledge structures.

The vocabulary will be built in XML based metadata syntax called Resource Description Framework (RDF). Metadata in this context means structured resource descriptions embedded into documents and/or databases. The syntax transforms metadata in a machine-understandable form and thus it can be processed by different web based applications. The vocabulary can also be embedded into resource descriptions made with metadata formats like Dublin Core. It is possible to use the vocabulary, for example, in information services and in metadata based site maps of Internet resources. A comparison between the vocabulary and the information architecture of current web services directed to heart patients will also be made in the study.


Discourse analysis (DA) is a language philosophical point of view on data. As a research strategy DA captures and portraits the variability in discourses that approach or conceptualise certain object (Potter & Wetherell 1994). Discourse could be defined as a way of producing sentences and structuring reality on the basis of them (Tuominen 1997). Discourse makes it possible to "see" the object in a certain way, while limiting other ways of knowing or understanding it. Thus, discourse as a relatively coherent system of meaning both enables and constraints our speaking and sense making. Every discourse allow reality to be approached from a certain angle, and from that angle only (Foucault, 1972).

The aim of the project is to capture the different discourses that characterise the information world (cf. Chatman 1992) of the people waiting for heart surgery. On the basis of the discourses found from the interview data a controlled vocabulary will be built that can be used to organise information resources of, for example, Internet services directed to heart surgery patients. Talja et al. (1997) have shown, how discourse analysis can be used to construct vocabularies that constitute the basis of information organisation in a regional information service. On the present project it is important to analyse according to which dimensions the respondents' information world is organised and what kind of words and phrases they use when talking about their illness and the coming medical operation. On building a search interface, the vocabularies constructed by using DA can function as links to the terms with which the producers (for example, medical experts) describe their resources (ibid.). Thus, the user does not need to learn the resource producer's vocabulary in order to find relevant information resources and she can search for information in her own language and on the basis of her own interests and knowledge structures. These are not necessarily similar to that of information providers.

The project's purpose is not to construct a user interface to a particular information system. The vocabulary that will be built in the project can be used as information organisation tool in many kinds of environments, for example, in information services and in metadata based site maps of Internet resources. Metadata means structured resource descriptions either embedded into documents themselves or located externally to them (for example, in different databases). It has been characterised as the best mean to solve the serious problems associated with information search robots like Alta Vista (Hakala et al. 1998). Metadata is also often used in constructing organised collections of information resources like, for example, digital libraries. Furthermore, metadata is a mean of representing information about web resources in a way that is easy for machines to deal with. Metadata will facilitate searching, helping authors to describe their documents in ways that search engines, browsers and Web crawlers can understand. As a result of a wide adoption of metadata, users will have better information services available to them.

There are many holistic metadata formats, like, for example, Dublin Core, that tries to capture many significant aspects of web resources. The controlled vocabulary constructed in the project can, for example, be embedded in descriptions of web resources based on Dublin Core. This is made possible by using Resource Description Framework (RDF), XML-based metadata syntax that World Wide Web Consortium (W3C) has standardised in February 1999 (Lassila and Swick 1999). XML is a subset of the text processing standard SGML specifically intended for use on the Web.

RDF provides the foundation for metadata interoperability across different resource description communities (Tuominen 1999). It increases interoperability between applications that exchange metadata and is targeted for many application areas including resource description, site-maps, content rating, electronic commerce, collaborative services, and privacy preferences. RDF additionally provides a means for publishing both human-readable and machine-processable metadata formats and vocabularies. Formats and vocabularies are the set of properties, or metadata elements, defined by resource description communities. The ability to standardise the declaration of formats and vocabularies is anticipated to encourage the reuse and extension of semantics among disparate information communities. Thus, RDF is becoming a standard mechanism for the global exchange of metadata and their schemas. (Miller 1998)

In the project, the controlled vocabulary will be built as RDF schema that defines the meaning, characteristics, and relationships of a set of properties that are found by using DA. RDF provides the ability for the researcher to define metadata elements as needed and it also gives application developers the possibility to use the metadata schema constructed by the researcher.

The vocabulary schema constructed by using DA will also be compared to different www based information services directed to heart patients. Is the information architecture (Rosenfeld & Morville 1998) of these services similar to the aspects of the controlled vocabulary constructed in the study or by what ways do they differ from it? Talja & al. (1997) argue that web services are almost always formulated using the language of its provider, and the real interest to produce the information from the users' perspective is overlooked, or the knowledge to do so is lacking. Thus, it might be presumed that there could be significant aspects in which the user warrant vocabulary (cf. Soergel 1985) constructed in the study differ from the organisation of services provided by, for example, medical experts.

The preliminary analysis of the interview data has shown that the respondents construct two realities in their discourse. Eliot Mishler (1984) calls these realities lay and medical voice that are present, for example, in medical interviews. Differences and tensions between lay experience and medical knowledge are, in fact, found in many qualitative studies made by medical anthropologists and sociologists (cf. Baruch 1981, Kleinman 1988, Radley 1993). The researcher intends to build the organisation of the controlled vocabulary to reflect this major trait of the respondents' information world.

Research Questions

1) How is the information world of heart patients organised? What kind of discourses do they use to make sense of the illness and the upcoming surgery?

2) How to construct RDF-based controlled vocabulary of the information world of the respondents?

3) Does the organisation of the vocabulary differ from the information architecture of www services directed to heart patients?

Research data and methods

The empirical data of the study consists of interviews of twenty heart patients and their spouses. These interviews have been already carried out. Eleven of the interviewees were going to a coronary bypass surgery, five to surgery for aortic valve disease, and four were going to have both operations at the same time. The interviews were relatively informal, and their length varied from one and a half to two and a half hours. The themes in the interviews were: present life situation of the interviewees, events leading to heart surgery, attitudes towards the operation, plans for the future and information seeking. These interviews are transcribed by the researcher (559 single-spaced pages in typescript) and a preliminary analysis of the data is already going on. The method of analysis is discourse analysis.

3. The time schedule of the project

All project will be performed during 1 August 1999 - 31 July 2002

4. Implications of the research

The new media culture, where important medical information is transmitted to the individual from many different sources and authorities, is thoroughly affecting the everyday life of the citizens. There is a need to encourage more awareness and debate about the institutional and private forms in which medical knowledge is created and presented. The patients' use of the Internet is a phenomenon that should not be ignored, but rather evaluated for what is most useful and relevant to medical journalism and clinical practice. An understanding of this phenomenon could contribute to a more holistic view of health and illness.

The changing media culture is affecting the individual's information competencies as well as changing traditional power balances in the society as a whole. It is also changing the individual's image of medical knowledge and medical authority. The new media culture may actually change the way in which we regard the scientific knowledge itself. It is thus connected with integrating science more deeply within the cultural sphere.

So far research in health communication, especially in health journalism, has been meagre in Finland. Even if the topic has been studied in other countries it has not before been studied on a doctoral thesis level in Finland.

5. Organization of research

The researchers involved in the project will be working at their respective departments, which will provide them with facilities as is required for projects financed by the Academy of Finland. The project leader has the overall responsibility for the progress of the project. The task includes the co-ordination of the sub-projects and keeping-up a high level of communication and cooperation between all members of the group by arranging both informal meetings and more formal seminars and workshops

The findings obtained trough the project will be reported in Finnish and international research forums, including scientific journals and conferences. The objective is to publish as great part of the research findings as possible in international referee journals. The research group will also establish a homepage of its own, where progress of the research done will be reported continuously.

6. Doctoral education

Doctoral students in the project will be mentored by their current supervisors. The project works in a close co-operation with the National Graduate School in Information and Communication (VIVA), which has members from all the departments included in our project. The five doctoral students participating in our project are expected to receive their PhD:s during the project duration at the end of 2002 at the latest.

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