The experiential health information processing model: supporting collaborative web-based patient education
Laura A O'Grady1* , Holly Witteman2* and C Nadine Wathen3*
1 Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Healthcare, Technology and Place, Centre for Global eHealth Innovation, University Health Network, R. Fraser Elliott Building, 4th floor, Toronto General Hospital, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada
2 Interactive Media Lab, Human Factors, Mechanical and Industrial Engineering, Health Care, Technology and Place, University of Toronto, 5 King's College Circle, Toronto, ON M5S 3G8, Canada
3 Faculty of Information & Media Studies, The University of Western Ontario, North Campus Building, Room 254, London, ON N6A 5B7, Canada
author email corresponding author email* Contributed equally
BMC Medical Informatics and Decision Making 2008, 8:58doi:10.1186/1472-6947-8-58
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6947/8/58
Received: 7 July 2008
Accepted: 16 December 2008
Published: 16 December 2008
© 2008 O'Grady et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
First generation Internet technologies such as mailing lists or newsgroups afforded unprecedented levels of information exchange within a variety of interest groups, including those who seek health information. With emergence of the World Wide Web many communication applications were ported to web browsers. One of the driving factors in this phenomenon has been the exchange of experiential or anecdotal knowledge that patients share online, and there is emerging evidence that participation in these forums may be having an impact on people's health decision making. Theoretical frameworks supporting this form of information seeking and learning have yet to be proposed.
Results
In this article, we propose an adaptation of Kolb's experiential learning theory to begin to formulate an experiential health information processing model that may contribute to our understanding of online health information seeking behaviour in this context.
Conclusion
An experiential health information processing model is proposed that can be used as a research framework. Future research directions include investigating the utility of this model in the online health information seeking context, studying the impact of collaborating in these online environments on patient decision making and on health outcomes are provided.
摘要
背景
第一代互聯網技術，如郵件列表或新聞組給予了前所未有的水平之內的信息交流各種利益群體，包括那些誰尋求健康信息。
隨著出現了萬維網許多通信應用被移植到Web瀏覽器。
其中一個推動因素在此現象一直是交流經驗或傳聞知識，患者共享上網，並有新的證據表明，參與這些論壇可能會產生影響人們的健康決策。
支持這一理論框架的形式尋求信息和學習還有待議。
結果
在這篇文章中，我們提出了一個適應的科爾布的經驗學習理論，開始制訂體驗健康信息處理模型，可能有助於我們了解在線健康信息尋求行為在這方面。
結論
體驗健康的信息處理模型，提出，可以用來作為研究框架。
未來的研究方向包括調查的效用這種模式在網上尋找健康信息的背景下，研究影響合作，在這些網上環境決策和對病人的健康狀況提供。
Background
A core element of the Internet has always been its capacity to facilitate communication.
Designed to support the 'many to many' exchange mode, mailing lists served a similar function as that of newsgroups by providing a forum for asynchronous discussion by people with similar interests.
Like email, these forms of computer-mediated communication (CMC) required use of software applications such as newsreaders or email programs.
These applications became a popular medium to exchange information in the early days of the Internet.
With the advent of the World Wide Web content became, in many cases, authored by 'one' source for 'many' to read ('one to many' mode).
Once the web began to dominate as a preferred means to access content online various CMC tools were ported to web browsers to accommodate this shift.
背景
一個核心要素，互聯網一直是其能力，以方便溝通。
旨在支持“多對多”的交流模式，郵件列表服務類似的功能是通過新聞組提供一個論壇，討論通過異步與志趣相投的人。
如電子郵件，這些形式的電腦中介傳播（CMC）需要使用的軟件應用，如新聞閱讀器或電子郵件程序。
這些應用程序成為廣受歡迎的媒介，交流信息，在早期的互聯網。
隨著到來的萬維網內容成為了，在很多情況下，撰寫了“一個'源'許多'讀（”一對多“模式）。
一旦網站開始佔據主導地位作為首選手段，獲取在線內容的各種 CMC工具，移植到Web瀏覽器，以適應這種轉變。
Many organizations such as non-profits and hospitals, and in some cases individuals, utilized these technologies to support or enhance patient education.
Some early online communities such as the Breast-Cancer List, now in its thirteenth year, are still in operation.
Usenet health-related newsgroups are still available through the web interface Google Groups [1] with many active in both the alt.health and alt.support hierarchies.
Consumer-driven web-based health bulletin boards and lists also exist; for example, WebMD forums [2], HealthBoards [3] and health-specific Yahoo Groups [4], although many of these may be considered relatively recent endeavours in comparison to their older cousins.
許多組織，如非營利組織和醫院，並在某些情況下個人，利用這些技術來支持或加強病人教育。
一些早期的網上社區，如乳腺癌名單，目前已進入第十三年，仍繼續運作。
新聞組與健康有關的新聞組仍然可以通過網絡界面谷歌組 [1]與許多活躍在兩個 alt.health和alt.support層次。
消費者驅動的Web為基礎的健康宣傳欄，並列出還存在，例如，中央社論壇 [2]，HealthBoards[3]和健康的具體雅虎組 [4]，雖然很多這些可被視為較近期的努力相比，他們的年齡較大的表兄弟。
There are numerous and varied factors motivating use of the Internet as a means to access health care information.
For some, the web has been used as a mechanism to both find and share information [5], to determine alternative or complementary treatments and for insights about rare conditions and new treatments [6].
For others, physical remoteness has led to Internet use to mitigate geographic boundaries [7].
For those seeking privacy, the ability to participate anonymously is a strong motivator [8].
In some cases clarification or further understanding of medical content is the goal [9].
One of the common elements found in these types of applications is the sharing of a personal story.
Many health-related online forums have been used to provide anecdotal or experiential knowledge by individuals regarding various treatments or medications [5,10,11].
有許多不同因素的激勵和利用互聯網為手段，以獲得醫療保健信息。
一些人認為，網絡已經被用來作為一種機制，既查找和共享信息[5]，以確定替代或補充治療和觀點關於罕見的條件和新的治療方法[6]。
對於其他人，物理偏遠，導致互聯網的使用，以減輕地理界限[7]。
對於那些尋求隱私，有能力參與匿名是一個強大的動力[8]。
在某些情況下，澄清或進一步了解醫療內容是目標[9]。
其中一個共同的元素存在於這些類型的應用是分享個人的故事。
許多與健康有關的網上論壇已被用於提供傳聞或個人經驗知識有關的各種治療方法或藥物[5,10,11]。
Early efforts to communicate online often fell victim to disruptive behaviour such as flaming, baiting or spamming.
In other cases communities failed due to issues with the usability [12] or accessibility [13] of the interface, or with the sociability of the community [9].
For some health communities, a fading need may have been a mitigating factor.
For example, the Crix List, a forum to exchange information related to the HIV protease inhibitor Crixivan, is no longer active.
One of the main purposes of this list was to discuss the side effects of this new medication, and its demise may well have been due to growing understanding of interventions to reduce the impact of HIV/AIDS treatment side effects.
These kinds of issues – alone or in combination – have likely contributed towards many online communities, including those on health-related topics, ceasing operation.
早期的努力，在線溝通往往犧牲品破壞性行為，如熾盛，引誘或垃圾郵件。
在其他情況下社區失敗，因為問題的可用性[12]或輔助[13]的接口，或與群性社會[9]。
對於一些健康的社區，一個衰落的需要可能是一個減輕的因素。
例如，Crix名單，座談會，交流信息與艾滋病毒蛋白酶抑製劑 Crixivan，不再有效。
其中一個主要目的是討論這份名單的副作用這一新的藥物，其滅亡可能是由於人們越來越認識的干預措施，以減少影響艾滋病毒/艾滋病治療的副作用。
這些類型的問題 - 單獨或組合 - 有可能導致對許多網上社區，包括那些與健康有關的話題，停止運作。
Recent advances and cultural shifts in online participation have coincided with technologies such as wikis and blogs that support this type of community sharing [14].
This shift, referred to as Web 2.0, includes the use of new tools that are designed to support collective knowledge sharing with interfaces that promote ease of editing and real-time changes unlike their web site predecessors [15].
Fewer technical barriers mean that those using these applications in order to learn about health are changing their roles from passively receiving information from a site (where content was often generated solely by the owner of the site), to collaboratively building knowledge [16].
This concept, where knowledge is generated amongst a group of individuals, has been described as the "wisdom of crowds," a notion that postulates the more people participating together to create knowledge, the better the information generated will be [17].
However, this idea raises concerns that learners with dissenting ideas and views may find such learning environments unfriendly.
A collaborative filtering model in which popularity breeds popularity can lead to subject "icebergs," where less popular topics and ideas are submerged [18].
However, despite its potential pitfalls, the application of this concept in the domain of health remains a promising approach to the challenges of accessing useful information and support in a timely manner, and, many would argue, is an improvement on the pre-Internet days, when the capacity for group peer support was limited to the numbers of patients who could get together in person at any given time.
Web 2.0 provides an environment that easily supports this type of behaviour, transcending to a significant degree space and time constraints.
However, little research has examined the notion of collaborative behaviour in relation to health information seeking and knowledge creation on the Internet.
最近的進步和文化的變化都在網上參與恰逢技術，例如wiki和博客，支持這種類型的社會共享[14]。
這一轉變，被稱為 Web 2.0，包括使用新的工具，旨在支持集體知識共享的接口，易於推廣的編輯和實時變化不像他們的前輩的網站 [15]。
較少的技術壁壘意味著那些使用這些應用程序，以了解健康正在改變自己的角色從被動地接收信息從一個站點（其中的內容往往產生完全由該網站的所有者），以協作建設知識 [16]。
這個概念，在知識之間產生一組個人，被形容為“智慧人群”的概念，即假設更多的人參與，共同創造知識，更好的信息將產生 [17]。
然而，這一想法引起了關注，學習者與反對的想法和看法可能會發現這樣的學習環境不友好。
一個協同過濾模型，其中人氣品種的普及可能導致主體“冰山”，其中較冷門的主題和思想被淹沒 [18]。
然而，儘管其潛在的隱患，應用這一概念在域中的健康仍然是一個有前途的方法來挑戰的訪問有用的信息和支持，及時，而且，很多人會說，是一種進步的前互聯網天當同行的支持能力組的人數是有限的，以誰的病人可能扎堆在人在任何特定時間。
網絡 2.0提供了一個環境，可以輕鬆地支持這種類型的行為，在很大程度上超越空間和時間的限制。
然而，很少有研究探討了概念的協作行為有關健康的信息和知識創造尋求在互聯網上。
Collaborative web-based patient education is intended to encompass the use of web technologies that support information seeking in this context.
This includes forums to exchange information, blogs that chronicle people's illness journeys, and wikis where a group of participants builds a repository of knowledge on a condition.
Social networking web sites such as FaceBook and MySpace are also playing a role in these interactions.
As the Internet has matured and made strides towards its original democratic ideals, collective knowledge-building using these applications has evolved.
Implications for collaborative web-based patient education arise partly because this "social software" [19] helps participants to communicate and share knowledge directly with each other in increasing and novel ways.
Online health information users can more easily bypass traditional information intermediaries such as medical professionals and instead use other community members as "apomediaries" [20] or health info(r)mediators [21], to learn about health topics, share and obtain recommendations about health providers and services at web sites such as Rate MDs [22] and Health Care Reviews [23], or even to collaborate in grassroots research by contributing and organizing personal health data at a site like PatientsLikeMe [24] or sharing personal genetic information at a site such as 23andme [25].
協作網絡為基礎的耐心教育是一套涵蓋了利用信息網絡技術，支持尋求在這方面。
這包括論壇，交流信息，博客，記載人的病情行程，其中一組和wiki的參與者建立一個信息庫的知識條件。
社交網站如Facebook和MySpace也發揮了作用，這些相互作用。
隨著互聯網已經成熟，並取得進展對原來的民主理想，集體知識建設使用這些應用程序已演變。
啟示協作網絡為基礎的耐心教育產生的部分原因是因為這個“社會軟件”[19]幫助學員進行交流和分享彼此的知識直接增加和新穎的方式。
網上健康信息使用者可以更容易地繞過傳統的信息中介機構，如醫療專業人士，而使用其他社區成員的“apomediaries”[20]或健康信息（R）的介質[21]，以了解有關健康的話題，分享和獲取有關建議醫療服務提供者和服務網站，如MD的速率[22]及健康護理評論 [23]，甚至在合作研究的貢獻和基層組織在個人健康資料的網站像PatientsLikeMe[24]或分享個人遺傳信息的23andMe公司的網站，如[25]。
One example of knowledge building through collaboration is the DCA forum, a group of cancer patients taking the experimental drug DCA (dichloroacetate) off-label (i.e., not for its originally intended purpose) who share experiential or anecdotal information about using this drug [26], including exchanging dosage information and self-treatment protocols.
Those new to off-label use of DCA are mentored by others more experienced in this application.
Sharing this type of information by using the online technology allows others with cancer to learn about their illnesses [27].
一個例子是通過協作知識建構是DCA論壇，一組癌症患者在服用實驗藥物 DCA（二氯）關閉標籤（即不是其原定用途）誰分享經驗或傳聞有關使用這種藥物[26]，包括信息交換量和自我治療方案。
這些新來關閉標籤使用輔導的DCA是由有經驗的人在此應用程序。
這種類型的信息共享利用網上技術允許其他人患癌症，了解自己的病情[27]。
However, as with all knowledge/information generated outside of specific standards or without the benefit of at least some expert review or guidance (even at the peer level), the issue of potential harms of misinformation must be considered.
Processes of "misinfo(r)mediation" [28] highlight the fact that even well-intentioned provision of poor quality information can have significant negative consequences, and the Internet must continue to be seen as another "buyer beware" environment within the landscape of health information – one where the significant gains in access to, and transmission speed of, information can cut both ways – i.e., for high and low quality information.
Concerns about misunderstanding and misuse of information are especially important in light of the expanding body of research in the areas of health literacy [29] and numeracy [30].
Skills for interpreting various forms of health information and integrating them into one's health decisions vary widely across populations [31].
Those with low health literacy and numeracy may be especially susceptible to misleading information and framing effects [32], whether these are intentional, as in malicious behaviour in an online community, or whether they simply reflect a poor fit between information content, its presentation, and the learner.
然而，與所有的知識 /信息產生的具體標準之外或沒有好處至少有一些專家審查或指導意見（甚至在同行的水平），這個問題的潛在危害，必須考慮的誤傳。
進程的“misinfo（R）調解”[28]強調的是，即使出於好意提供質量低劣的信息可以有很大的負面後果，而互聯網必須繼續被視為另一種“買方提防”內環境景觀衛生信息 - 一個地方的重大成果中獲取和傳輸速度，同時可以減少信息的方式 - 即，高，低質量的信息。
令人關注的誤解和誤用的信息是特別重要的輕體的擴大研究領域的健康素養[29]和計算[30]。
技能解釋各種形式的健康信息和整合他們成為一個健康的決定有很大的不同人群之間[31]。
這些低健康素養和算術可能特別容易受到誤導信息和框架效應[32]，不管是有意的，因為在惡意行為在網上社區，還是僅僅反映一個貧窮的配合之間的信息內容，其表示，和學習者。
These issues provide a useful lens through which to examine health education and decision-making as complex issues for patients and physicians alike.
For someone recently diagnosed with an illness, prognosis and treatment information are likely to be foreign and even daunting, requiring learning in the context of stress and perhaps fear.
Making decisions in this context is a complex process that may involve a wide variety of interpersonal interactions, as well as information requirements.
這些問題提供了有益的鏡頭，通過它來檢查健康教育和決策的複雜問題的病人和醫生的一致好評。
對於最近有人診斷為一種疾病，預後和治療的信息有可能被國外甚至艱鉅，需要學習的環境壓力和可能的恐懼。
在這方面做決策是一個複雜的過程，可能涉及到各種各樣的人際交往，以及信息的要求。
Research to date indicates that there are a variety of roles in the patient/physician decision-making dyad.
Physician-directed decision-making (stemming from the Parsonian model), while authoritarian in nature, was the primary means in health care delivery for many years.
Various social movements, including feminism/women's health and other advocacy-based approaches, led to an emphasis on individual autonomy, and in the health realm, actively including the voice of the patient in a process of 'shared decision making' [33,34].
However, not all patients wish to be fully autonomous. Some may wish to be informed [35] and/or participate in certain kinds of decisions, but not others [36].
Charles et al. [33] proposed three primary models of decision making: the 'paternalistic' model where the physician makes the decisions, the 'informed or autonomous' model where the physician imparts knowledge to the patient and the patient makes the decision, and the 'shared decision making' model where the process is collaborative.
The role assumed by a patient may have an impact on how information sources are weighted.
For example, one study found that those who desired the most control in their decision-making stated that their physician was their main information source and many were guided by the doctor's preferences [37].
迄今為止的研究表明，有各種角色在患者/醫生決策矢。
醫師指導決策（產生從帕森斯模型），而專制性的，主要手段是在衛生保健服務多年。
各種社會運動，包括女權主義/女性的健康和其他宣傳為基礎的方法，導致了強調個人的自主權，並在衛生領域，積極包括語音的病人在一個進程中的“共同決策”[33,34 。
然而，並非所有的患者希望得到充分的自治。有些人可能希望了解[35]和/或參加某些種類的決定，但沒有人[36]。
查爾斯等人。 [33]提出了三種主要模式的決策的：“家長式”的模式，使得醫生的決定，“通知或自治”的模式在傳授知識的醫生對病人和病人作出的決定，和“共同決策使得“模式，這個過程就是合作。
角色承擔病人可能產生影響的信息來源是如何加權。
例如，一項研究發現，那些誰想要的大多數控制在他們的決策表示，他們的醫生是他們的主要信息來源，許多人遵循醫生的喜好[37]。
In addition to the patient-physician decision-making dyad there are also other possible collaborations that can affect this process.
Physicians often consult each other to help with the decisions they make about care.
In this provider-provider dyad, consultative practices start in medical school, continue during training, and are a method of information seeking and decision-making among practicing clinicians.
Although not seemingly directly related to care, such interactions can be an important part of what treatment options are provided to patients, and in fact this practice has been cited as a barrier to evidence-based clinical care [38].
Information for all of those involved in care is an important element to the decision making process within this context.
除了醫患決策矢也有其他可能的合作，可以影響這一進程。
醫生往往相互協商，以幫助他們做出的決定照顧。
在此提供者提供二分體，協商的做法開始在醫學院，繼續進行訓練，並尋求方法的信息和決策中執業醫師。
雖然看似不直接相關的服務，這種相互作用可以是一個重要組成部分，什麼治療方案提供給患者，而事實上這種做法已被引為屏障，以證據為基礎的臨床護理 [38]。
所有這些信息涉及護理是一個重要的元素，決策過程在這一背景下。
People's information seeking behaviour (ISB) is complex and often iterative.
Research in this area has produced consistent findings that comprise what has been called the "principles of information seeking" [39]; these include that people seek information
1) in familiar and comfortable patterns;
2) often following an informal to formal continuum; and
3) in an opportunistic and situated/contextualized way.
Thus information seeking is often multi-faceted and complex and is comprised of interactions between individual, environmental and social factors.
All of these variables and their interplay result in the observation that ISB is often seemingly "irrational" to the outside observer.
Certainly these patterns are replicated in studies that have examined health information seeking in a variety of contexts [40,41].
人們的信息尋求行為（ISB）是複雜的，經常反复。
這方面的研究產生了一致的結果，即構成了所謂的“原則尋求信息”[39]，這些包括人們尋求信息
1）在熟悉和舒適的模式;
2）經常下一個非正式的正式連續;和
3）在投機取巧，位於/語境的方式。
因此，尋求信息往往是多方面的，複雜的，是由個體之間的相互作用，環境和社會因素。
所有這些變量及其相互作用的結果，在觀察到ISB往往是看似“非理性”的旁觀者。
當然，這些模式被複製的研究，已經研究衛生信息謀求在各種環境中[40,41]。
Individual characteristics play a role in people's decisions regarding whether and how to seek information for a health condition.
Some may be more likely than others to seek information as a coping strategy.
For example, Miller's Behavioural Style Scale is predicated on the idea that people tend to cope with stressful situations by blunting and/or monitoring.
Broadly speaking, blunters avoid information and prefer not to think about their stressful situations, while monitors actively seek information to reduce anxiety and help themselves cope [42,43].
Williams-Piehota et al. [44] demonstrated that for women at risk of breast cancer, adapting messages about the importance of mammography to receivers' behavioural style increased blunters' likelihood of obtaining a mammogram.
In a study of metastatic cancer patients, Steptoe et al. [45] showed that while monitors had more factual knowledge about their health condition, they were less satisfied with the communication of their medical care.
Although high levels of information seeking have been shown to be associated with effective coping strategies in cancer patients [46], other research has supported the idea that those who actively seek information may have poorer coping skills [43], a finding that should temper assumptions about the unvaryingly positive impacts of CMC in the context of health.
In addition, individuals may themselves vary in their information seeking and coping styles, in some cases acting as blunters, while in others as monitors, and this may be due to contextual factors such as the person's understanding of the threat posed to them by the situation [47], and the type of stressor encountered [48].
個人特點發揮作用，人的決定就是否以及如何尋求信息的健康狀況。
有些人可能比其他人更有可能尋求信息作為應對策略。
例如，米勒的行為方式量表的前提是，人們的思想傾向，以應付有壓力的情況下被鈍化和/或監控。
從廣義上講，blunters避免信息和不喜歡思考他們緊張的情況下，同時積極尋求信息監控，以減少焦慮和幫助自己應付 [42,43]。
威廉姆斯Piehota等。 [44]表明，婦女患乳腺癌的風險，適應信息有關的乳房X光檢查的重要性，以接收“行為風格增加blunters”的可能性獲得乳房X光檢查。
在一項研究中轉移性腫瘤患者，世強等。 [45]表明，雖然有更多的事實性知識監控自己的健康狀況，他們不太滿意通信的醫療服務。
雖然高層次的信息要求已經被證明是有效的應對策略與癌症患者[46]，其他研究支持這個想法，那些誰積極尋求信息可能有較差的應對技巧[43]，這一發現應脾氣假設關於 unvaryingly積極影響的背景下的CMC的健康。
此外，個人本身可能各不相同的信息，尋求和應對方式，在某些情況下充當 blunters，而在其他的顯示器，這可能是由於環境因素，如人的認識造成的威脅到他們的情況[47]，以及遇到的類型的應激 [48]。
Other information seeking theories examine motivation as a key aspect of information seeking and behaviour change.
The Extended Parallel Process model has been proposed to explain how people rationalize decisions they make in relation to messages that evoke threat and fear, and how efficacy influences the ability to change [49].
For example, health promotion messages about the dangers of smoking (threat) are ubiquitous, and invoke concerns about cancer (fear), but individuals may continue to smoke because they do not think they are able to quit (lack of efficacy).
Similarly, the Theory of Reasoned Action has been used to explain the ways in which individuals and groups engage in information seeking.
For example, African American men have specific behavioural and normative beliefs in relation to seeking information related to prostate cancer that may differ from those of Caucasian American men [50].
Another theory, the Health Belief Model, attempts to explain motivation regarding behaviour in relation to goals and values.
If someone places high value on their health, it is believed they will engage in behaviour to maintain it [51].
Other more comprehensive information seeking frameworks take into consideration other variables such as the source of information, mechanism, individual differences and external environmental variables such as cultural and socio-economic status [52].
These theories tend to explain motivation for seeking information but do not account for the desire to do so collaboratively or to find others in a similar circumstance in order to obtain anecdotal or experiential information.
其他資訊尋求理論研究的一個重要動機方面的信息要求和行為的改變。
擴展並行處理模式已經被提出來解釋人們如何做出合理的決策，他們在有關消息，引起威脅和恐懼，以及如何影響療效的能力，改變 [49]。
例如，健康促進信息有關吸煙的危害（威脅）是普遍存在的，並調用關注癌症（恐懼），但個人可繼續吸煙，因為他們不認為他們能夠戒菸（缺乏療效）。
同樣，理性行動理論已被用來解釋的方法，使個人和團體從事信息尋找。
例如，非洲裔男性有具體的行為規範的信念與追求信息與前列腺癌可能與那些美國白人男性[50]。
另一種理論，健康信念模式，試圖解釋動機有關的行為有關的目標和價值觀。如果有人的地方對他們的健康價值高，相信他們會從事的行為，以維護它[51]。
其他尋求更全面的信息框架，考慮到其他因素，如信息來源，機制，個體差異和外部環境因素，如文化和社會經濟地位[52]。
這些理論來解釋動機往往尋求信息，但不佔渴望這樣做，或找其他人協作在類似情況下，才能獲得傳聞或經驗的信息。
Given these individual and situational influences on health information seeking, it is perhaps not surprising that people will use new media to explore their health conditions and their needs for both information and social support.
The Internet can be seen as but one more way – and for some a particularly convenient and useful one – to meet these needs.
Indeed it has been suggested that "sharing ideas and experiences with others through online health support groups may have health benefits." [53], and online communities have been described as the "...single most important aspect of the web with the biggest impact on health outcomes." [54].
鑑於這些個人和情境因素對健康信息的要求，這也許並不奇怪，人們將使用新媒體，探索他們的健康狀況和他們的需要為信息和社會支持。
互聯網可以被看作但多一個方式 - 和一些特別方便和有用的 - 滿足這些需求。
事實上，有人認為“交流思想和經驗，通過網上與他人的健康支持團體可能有健康的好處。” [53]，網上社區被描述為“... ...最重要的方面是網絡的最大影響健康結果。” [54]。
We are now beginning to understand that these collaborations are an important element in supporting those learning about health conditions [55].
In particular, some patients may be seeking anecdotal information about their conditions from others who have the same condition but are not relying on online environments [56].
We believe that as Web applications such as wikis, blogs, and social networking sites continue to proliferate, more and more patients will be sharing and learning from each other in online environments.
Increased participation in online communities strengthens the potential for patients to influence each other's decision making, emphasizing a third decision making dyad: patient-patient.
It must be noted however, that, as described above, many of the information seeking patterns we now see on the Web are not in fact new – they merely replicate, in a new environment, the patterns and preferences for information seeking seen in non-online environments.
What is new is the increased ability for some people to access "more people like me" in very fast and highly convenient ways.
Therefore we must move towards a model that explains collaboration with other patients in health information seeking.
We now shift our focus to consider ways in which these online environments can improve the capacity to support collaboration in relation to web-based patient education, in particular that which acknowledges experiential learning.
We explore one theory of experiential learning as a way to understand the benefits, and potential harms, of online patient collaborations.
我們現在開始明白，這些合作是一個重要的因素在支持那些學習有關健康狀況 [55]。
特別是一些病人可能會尋求傳聞有關他們的情況，從別人誰擁有相同的條件，但不依賴於網絡環境 [56]。
我們相信，隨著網絡應用，如維基，博客和社交網站不斷增加，越來越多的患者將被分享和相互學習的在線環境。
更多地參與在線社區加強對病人的潛在影響對方的決策，強調決策的第三個二分體：患者住院。
但是必須指出，即，如上所述，許多的資訊尋求模式，我們現在看到在網絡上其實不是新的 - 他們只是複製，在新的環境，模式和偏好信息尋求見於非在線環境。
什麼是新增加的能力是對某些人訪問“更多的人喜歡我”的非常快，非常方便的方法。
因此，我們必須朝著一個模型，解釋了合作與其他病人的健康信息尋找。
我們現在我們的重點轉移到考慮如何使這些在線環境可以提高能力，以支持與合作，基於 Web的耐心教育，特別是其中承認經驗學習。
我們探討一個理論學習的經驗，以此來了解其好處和潛在危害，網上病人的合作。
Experiential learning is defined as learning by doing or learning based on experience.
It is often associated with informal adult learning such as life experiences occurring outside formal classroom instruction.
Kolb [57] proposed a four stage cyclical process that includes concrete experience, observation and reflection, forming abstract concepts, and testing in new situations.
Table 1 adapts this process to the patient education experience in a web-based environment. We refer to this framework as the experiential health information processing model.
體驗式學習是指在實踐中學習或學習的經驗。
它往往是與非正規成人學習生活經驗，如發生境外正規的課堂教學。
科爾布[57]提出了一個四階段的循環過程，包括具體經驗，觀察和思考，形成抽象的概念，在新的形勢和測試。
表1適應這個過程中給患者教育的經驗在一個基於 Web的環境。我們把這個框架作為體驗式健康信息處理模型。
Table 1
The experiential health information processing model
Kolb model for experiential learning
Steps in patient experience
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1. Concrete experience: an event
The diagnosis of an illness, presentation of treatment options or other decisions related to care creates a need for information.
2. Observations and reflections: thinking about the event and its impact
By entering an online community an individual observes by reading the messages and reflects about their own experience in relation to the information shared.
3. Formation of abstract concepts and generalizations: what was learned
Inquiry through posted messages is made regarding a patient's next steps or treatment decisions related to their care from other community members.
4. Testing implications of concepts in new situations: active experimentation
By using knowledge acquired from the group the patient proceeds to a treatment decision.
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O'Grady et al. BMC Medical Informatics and Decision Making 2008 8:58 doi:10.1186/1472-6947-8-58
將英文翻譯為中文(繁體)
表1
體驗健康的信息處理模式
科爾布的經驗學習模式
患者體驗的步驟
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1。具體的經驗：一個事件
一個疾病的診斷，治療方案介紹或其他決定建立一個相關的護理需要的信息。
2。觀察與思考：思考事件及其影響
通過輸入一個在線社區，個人閱讀的消息指出，反映他們自己的經驗與信息共享。
3。形成抽象的概念和概括：學到了什麼
通過查詢發布消息的是提出的關於病人的下一個步驟或治療的決定與他們的照顧，其他社區成員。
4。測試意義的概念在新的形勢：積極試驗
利用學到的知識，從該組中的病人所得的治療決定。
By framing collaborative web-based patient education in the context of experiential learning we may find that those who participate in the forums are seeking specific forms of support from the community, particularly at stages 2 and 3 where requests for and presentations of new information play a key role in the learning experience.
Participants who post their questions and concerns in an online forum may in part seek to have these issues addressed by other more experienced members [58].
Facilitators or seasoned participants may play a key role in ensuring that this occurs.
通過制定協作網絡為基礎的耐心教育的背景下體驗式學習我們可能會發現，那些誰參加論壇的具體形式尋求社會的支持，特別是在2和第3階段在請求和介紹新的信息發揮關鍵作用，在學習的經驗。
與會者誰後的問題和關注在一個網上論壇，可能有部分尋求解決這些問題，由其他有經驗的成員 [58]。
調解人或經驗豐富的參與者可以發揮關鍵作用，確保發生這種情況。
In many online forums participants focus on sharing their experiences, which in turn becomes filtered and distilled within the community such that the experience becomes de facto "information" or "fact".
For example, someone may post a positive experience about taking a medication and be quite persuasive (intentionally or not) in suggesting that others will have the same successful outcome regardless of whether this is medically indicated or even possible.
Indicators of trustworthy or believable content found online have included credentials of the author (e.g., a medical degree) [59], among others [60].
However, as more information is shared amongst laypeople online, the accredited status of 'MD' (or other traditional source credentials) may become less important.
Individuals with a disease or condition are beginning to emerge as authoritative sources [61].
As more participants collaborate online, distinctions between a web site, its content, and other users becomes less defined.
With this blurring, credibility indicators will likely shift as well.
Those who are reading online content need to both determine the credibility of the message and its applicability to their own circumstances.
Some may be unduly influenced or give credence to experiences shared anecdotally over more scientifically acceptable forms of information, due in part to the perceived credibility of the person posting the message.
As the patient-patient dyad in an online context becomes more popular, credibility may become an important issue in relation to decision making in the offline world (e.g., between patient and physician).
在許多網上論壇的參與者專注於分享他們的經驗，從而成為過濾和蒸餾等社區內的經驗變成事實上的“信息”或“事實”。
例如，有人可能會發表了積極的經驗和有關服用藥物是非常有說服力的（有意或無意）的建議，其他人也會有同樣成功的結果無論是醫學上表示，甚至有可能。
值得信賴的指標或可信的內容包括在網上找到了作者的憑據（例如，一個醫學學位）[59]等人[60]。
然而，隨著越來越多的教友之間信息共享上網，認可地位的“MD”（或其他傳統的來源憑證）可能變得不那麼重要。
個人與疾病或情況已開始出現的權威來源 [61]。
隨著越來越多的參與者協作網絡，網站之間的區別，它的內容，和其他用戶變得不那麼確定。
有了這個模糊，信譽指標將有可能轉變為好。
誰是網上閱讀這些內容需要雙方確定的信譽信息，其適用於自己的情況。
有些可能是不必要的影響或輕信經驗共享閒談形式接受了更加科學的信息，部分原因是感知信譽的人發布的消息。
由於患者住院矢在網上環境越來越流行，信譽可能成為一個重要問題，關係到決策在離線世界（例如，病人和醫生之間）。
A key step will be to test this model empirically.
A number of research designs lend themselves to this task.
For example, in depth qualitative interviews would be an important first step to understand whether the model, and it's proposed stages, can be applied to the context and experiences of these users – i.e., does the Kolb model map onto this learning context, and if not, where are the divergences?
For example, did a diagnosis create an information need (Stage 1)?
If so, did the patient explore an online community or other sources of information?
If an online environment was used to meet these needs (Stages 2 and 3) then in what ways and to what extent?
Similarly, focus groups with assorted types of participants in these communities (new, experienced, etc.) could elucidate group processes.
Various participant-observation and/or ethnographic approaches, including analysis of postings, could provide a clear sense of these processes in situ.
Finally, to understand the actual impact of these processes on important health (and other) outcomes, studies employing longitudinal methods would be an important second step in a proposed research agenda.
For example, participants would be asked to what extent and how the information obtained from others online was useful or influential, and, conversely, whether decisions made using these processes were later regretted (Stage 4).
The findings of these types of research could have important implications for those who design and support such environments, and also for our understanding of processes of learning in new media environments more generally.
一個關鍵的步驟將是檢驗這一模型的實證。
一個數字的研究設計提供參與這一任務。
例如，在深入定性訪談將是一個重要的第一步，了解有無模型，它提出的階段，可以應用到的背景和經驗，這些用戶 - 即，是否科爾布模型映射到這個學習環境，如果不，這裡是分歧？
例如，做了診斷需要建立一個信息（第一階段）？如果是這樣，做了耐心探索網上社區或其他來源的信息？
如果一個網絡環境是用來滿足這些需要（階段 2和3），那麼什麼樣的方式和到什麼程度？
同樣，焦點小組與各類類型的參與者在這些社區（新，經驗豐富，等等）可以闡明組進程。
各參與觀察和/或人種學的方法，包括分析的帖子，可以提供一個清晰的感覺到這些過程的原位。
最後，要了解實際影響這些過程的重要健康（和其他）的結果，採用縱向研究方法將是一個重要的第二步中提出的研究議程。
例如，參與者將被要求到什麼程度，如何從別人獲得的信息網絡是有益的或有影響的，相反，作出的決定是否使用這些方法後來後悔（階段 4）。
這一發現對這些類型的研究可能有重要影響的那些誰設計和支持這樣的環境，也為我們理解學習過程中的新媒體環境更普遍。
Understanding at what stages an individual requires information could provide important insight into both individual outcomes, as well as sustaining the community.
For example, if it is understood that most new learners require a period of time in which they prefer to only read messages online before actively participating, this could be outlined in the instructions for participation.
Of equal importance will be examining disruptive behaviour within the model.
Disruptive behaviours in traditional collaborative web-based environments such as forums and lists include spam (unsolicited messages), flaming (messages that attack others), baiting (an inside joke in which participants are solicited to post responses that are humorous to others) and trolling (messages that contain false responses to an inquiry, generally to provoke an argument) [9].
Blogs can also be subjected to these types of behaviours through the comment section, while in applications such as wikis, malicious altering of content is also a concern [16].
Research directions in this area include investigations about how disruptive behaviour in online communities might affect an individual's search for health information and what mitigation and management techniques for dealing with this are most effective and appropriate in collaborative web-based patient education communities.
了解一個人處於什麼階段需要的信息可以提供重要的洞察既有個人的成果，以及維持社會。
例如，如果據了解，大多數的新學員需要一段時間中，他們更喜歡網上只能讀取郵件之前積極參與，這可能是概述說明參加。
同樣重要的將是破壞性行為研究模型中。
破壞性行為在傳統的協作網絡為基礎的環境，如論壇，並列出包括垃圾郵件（不請自來的郵件），燃燒（消息攻擊他人），引誘（一個內部笑話，其中參與者徵求張貼回應是幽默給他人）和曳（含有虛假消息的反應進行調查，一般要挑起爭論）[9]。
博客也受到這些類型的行為，通過註釋部分，而在應用，如維基，惡意修改的內容也值得關注[16]。
在這方面的研究方向包括調查有關如何在網絡社區破壞性行為可能會影響個人的健康信息和尋找什麼緩解和管理技術，為處理這是最有效和最適當的協作網絡為基礎的社區患者教育。
Another avenue of future research is to explore potential clinical applications of experiential patient engagement and learning in online environments.
Individual stories that are propagated using collaborative applications through popularity ratings may promote learning but may also effectively submerge information that has in fact been verified by formal research.
By tracing the online spread of such ideas via network analysis, models of online information flow in collaborative Web applications could be developed.
今後研究的另一個途徑是探討潛在的臨床應用經驗的病人接觸和學習網絡環境。
個人故事，傳播使用協作應用程序通過民望可能促進學習，但也可能有效地淹沒的信息實際上已經驗證了正式研究。
通過跟踪網上傳播這樣的想法通過網絡分析，模型的網上信息流的協作 Web應用程序能夠得到發展。
Sharing experiential information through blogs and other mechanisms as compared to other methods of conveying information online may change the way information is acquired, perceived, and internalized.
In addition, investigations that compare these approaches to other forms of information exchange, including in-person support groups, and more self-directed, non-social approaches to information-seeking and learning are required.
This is a rich area for research that has yet to be well-explored.
經驗共享信息，通過博客和其他機制，相對於其他方法傳遞信息網上可能會改變信息的方式獲取，感知和內化。
此外，調查的比較這些方法的其他形式的信息交流，包括在人的支持團體，更自主，非社會的方法來尋找信息和學習是必需的。
這是一個富人區的研究，還有待精心探索。
Also of interest is the evolving nature of credibility and the way it is depicted, understood and accepted as more laypeople become recognized as experts and opinion leaders in online environments.
More research will need to be conducted in order to understand this evolving concept.
In this area, quantitative and visual methods such as social network analysis offer tools for analyzing the social nature of learning.
Such analyses may be strengthened through the use of now-ubiquitous Web features in which users rate or comment on each other's content.
Feedback to commonly seen questions such as, "Was this review helpful to you?" can provide proxy measures for assessing the impact of individuals within a collaborative learning environment.
另外的興趣是不斷變化的性質和方式的可信性是描述，理解和接受更多的教友成為公認的專家和意見領袖在網絡環境中。
更多的研究需要進行，以了解這個不斷發展的概念。
在這方面，定量和視覺的方法，如社會網絡分析提供工具分析社會性的學習。
這種分析可能得到加強，通過利用現在已經無處不在的網絡功能，讓使用者率或評論彼此的內容。
意見反饋常見問題，如“該點評有幫助嗎？”可以提供代理措施的影響評估個人在協作學習環境。
The face of health care on the Internet is changing.
Just as we begin to research how new technologies are being used by health-interested web users, they change and impact the frame of reference.
Recently, large scale web-based personal health record repositories have been implemented by Google (Google Health) and Microsoft (Vault).
It remains to be seen whether or not these initiatives will eventually supersede many of the smaller, community or hospital-based projects that currently support peer to peer exchange of information.
However, it is important to understand user needs and behaviour when implementing any technology, including that which supports collaboration in web-based patient education.
而面對保健互聯網上正在發生變化。
正如我們開始研究如何利用新技術正在使用的健康感興趣的網絡用戶，他們的變化和影響的參照系。
近日，大型網絡為基礎的個人健康記錄資料庫已實施谷歌（Google衛生）和微軟（庫）。
這還有待觀察是否這些舉措最終將取代許多較小的，社區或醫院為基礎的項目，目前支持點對點的信息交流。
然而，重要的是要了解用戶的需求和行為時實施的任何技術，包括支持協作網絡為基礎的耐心教育。
Many theories exist that attempt to explain information seeking, and some have been applied to health-related scenarios.
However, few address this behaviour in relation to others that seek information or those who are specifically looking for peer experiences, guidance and support.
Since most (if not all) individuals searching for information about their health care condition are already motivated (as defined by actively seeking help) we propose, in contrast to models based on motivation, an online health information seeking model based on learning theory.
A key to understanding and supporting collaborative web-based patient education will involve examining environments that aid such information exchange using tools, technologies and approaches that assist these processes.
Knowledge about an individual's health condition that is constructed collaboratively through collective sharing of experiences can provide not only "information" but also support, and, a key for many health information seekers, care [62,63].
Given that these forms of collaboration may well influence the decision making process for patients, we need to consider ways to better enable and support the exchange of experiential and anecdotal information, and help patients differentiate the different kinds of information to which they may be exposed in these environments.
This is particularly important in a rapidly evolving technical environment, where we need to find ways to test whether new technologies actually help people, and if so, in which populations and in what ways.
We also need to be cautious and critical about the as yet untested benefits of these emerging technologies.
We must be mindful that contribution rates in these online environments remain low, with lurkers (those who read messages but do not contribute) continuing to significantly outnumber more active participants.
許多理論存在，試圖尋求解釋的信息，有些已應用於健康有關的情況。
然而，很少有解決這種行為與他人尋求信息或誰是專找同行的經驗，指導和支持。
由於大部分（如果不是全部）的個人搜索信息對他們的醫療條件已經動機（定義，積極尋求幫助）我們建議，在對比車型的基礎上的動機，尋求一個網上健康信息模型的基礎上學習理論。
一個關鍵的理解和支持協作網絡為基礎的耐心教育研究會涉及環境，援助等信息交換用的工具，技術和方法，協助這些進程。
知識有關個人的健康狀況是通過集體協作構建共享經驗，不僅可以提供“信息”，但也支持，而且，許多健康的一個重要的信息搜索者，護理 [62,63]。
鑑於這些形式的合作很可能影響到決策過程中的病人，我們需要考慮如何更好地啟用和支持交流經驗和傳聞的信息，幫助患者區分不同種類的信息，他們可能被暴露在這些環境。
這是特別重要的一個迅速發展的技術環境，在這裡我們需要找到方法來測試新技術是否真正幫助人們，如果是這樣，其中的人口以及以何種方式。
我們還需要謹慎和關鍵對尚未未經檢驗的利益，這些新興技術。
我們必須銘記的貢獻率在這些在線環境仍然很低，與潛伏者（那些誰讀消息，但沒有貢獻）繼續顯著多於更積極的參與者。
If collaboration is indeed an important element to patients' online health education experiences a key next step will be finding ways to understand and, ultimately, support experiential learning, and reinforce the capacity for individuals to learn in these environments by enabling their exposure to others with similar needs and experiences.
It is important to note that despite rhetoric about the democratization of information via the Internet, online interactions may simply reproduce existing power structures and may not, in fact, truly empower patients [64,65].
We propose that understanding each step of our proposed experiential health information processing model will help elucidate the interactions between users and other users, mediated by the technologies.
Delineation of the steps outlined in Table 1 can assist organizations and individuals working in the field of patient education. Additional research – perhaps following approaches taken to other complex and multi-faceted socio-technical (so-called "wicked") problems [66] – is urgently required.
如果合作的確是一個重要的因素對病人的在線健康教育經驗的關鍵下一步將是設法理解，並最終支持經驗學習，並加強能力為個人學習，這些環境以使他們能夠接觸到別人的類似的需求和經驗。
重要的是要注意的是，儘管言辭關於民主化的信息通過互聯網，在線互動可能只是複製現有的權力結構，可能沒有，其實，真正使患者[64,65]。
我們建議，了解每一步我們建議的體驗健康信息處理模型將有助於闡明用戶之間的相互作用和其他用戶，介導的技術。
劃定的步驟列於表1可以幫助組織和個人在外地打工的患者教育。進一步的研究 - 可能採取以下方法對其他複雜的和多方位的社會技術（即所謂的“惡人”）的問題[66] - 是迫切需要。
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
LOG conceptualized and wrote the first draft of the paper.
HW added content throughout the paper, contributing most substantially to the sections on determinants of health information seeking behaviour, the role of new technologies in information seeking behaviour, the future directions and conclusions. NW wrote sections related to collaboration in web-based patient education component as well as the future directions and conclusion sections and contributed substantially to the content of the remaining sections.
All authors read and approved the final manuscript.
Acknowledgements
* Funding was provided by The Canadian Institutes of Health Research (CIHR), Health Care, Technology, and Place Research Training Program (HCTP), Knowledge Translation Branch, Institution of Health Services and Policy Research, and Institute of Gender and Health.
+ L. O'Grady was supported by a Post Doctoral Fellowship sponsored by the Ontario Women's Health Council (OWHC), The Canadian Institutes of Health Research (CIHR), and the Institute of Gender and Health (IHC).
± C.N. Wathen holds a CIHR-OWHC New Investigator Award.
競爭利益
作者聲明他們沒有利益衝突。
作者的貢獻
LOG概念化和寫了第一稿的紙張。
硬件添加整個文件的內容，最顯著貢獻的部分就決定尋求健康信息的行為，作用的新技術，尋求信息的行為，今後的方向和結論。 NW寫部分相關協作網絡為基礎的耐心教育組成部分，以及未來的方向和結論，並作出了重大貢獻的部分內容，其餘部分。
所有作者讀通過了最後的手稿。
致謝
*經費是由加拿大衛生研究院的研究（CIHR），醫療保健，科技，並將其放在研究培訓計劃（HCTP），知識翻譯科，衛生服務機構和政策研究，研究所性別與健康。
+ L奧格雷迪是由一名博士後聯誼會主辦的安大略省婦女健康局（OWHC），加拿大衛生研究院的研究（CIHR），以及性別與健康研究所（IHC）。
± C.N. Wathen持有CIHR- OWHC新研究者獎。
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