e-Health Services

L. SUZANNE SUGGS, NATALIE

RANGELOV, ANDREAS SCHMEIL,
AURORA OCCA, MARCO BARDUS,
OLGA RADCHUK, and SEPIDEH
DIANAT
Universit della Svizzera Italiana, Switzerland

The definition of e-health has evolved over time,

changing from a focus on health care delivered
through electronic means to include a broader
array of health services. The original focus of
e-health was on the delivery of health care, the
transfer of health data, and e-commerce. Many
definitions and reviews of e-health exist, ranging from the business of health care, delivery
of services, collection and transfer of data, and
communication and educational activities for
individuals, health care workers, policymakers,
and administrators. Simply put, e-health includes any transfer of health communication,
services, surveillance or treatment through the
use of digital means (Suggs & Ratzan, 2012,
p. 251).
The idea of e-health is about achieving better
health, better decision-making, better communication, better prices, and better access to health
information and health care. This stems from a
long history of public health services, long before
the World Wide Web was invented or became
commonplace. Health services were typically
local activities aimed at prevention and treatment
of illness and disease. Technological advances
changed the way in which services were designed
and implemented, allowing the traditional house
call by a doctor, or visit to the doctors office, to
be offered from a distance using the telephone.
Early technology based e-services included radio
technology to disseminate information about
health and illness. As early as the 1940s, public
service announcements on television informed
consumers about ways to live a healthier lifestyle
and treat illnesses. Technological advances
allowed audio recordings to move from radio

and live performances to audiotapes that helped

people relax, sleep better, and stop smoking.
Later, CD-ROMs and online streaming became
common ways of exchanging health information.
Even small devices that beeped to remind a
patient to take their medication were available in
the 1980s, followed by health programs on floppy
disks and, later, touch screen kiosks.
The introduction of the publicly accessible
World Wide Web and its rapid adoption across
the globe made it possible to develop and disseminate health services on a wider scale, reaching
more people more quickly as well as improving
surveillance activities and collaborations. Indeed,
in the mid-1990s the first e-health surveillance
service was introduced with the launch of the
International Society for Infectious Diseases
Program for Monitoring Emerging Diseases
(ProMED-mail).
However, e-health services are not exclusively
web based. In fact, many current e-health services
rely on old technology, used in new ways. For
example, today, radio is one of the most effective
channels for reaching audiences in some lowand middle-income countries. The telephone has
gone mobile and has high adoption rates in
low-, middle-, and high-income countries. The
TV show can be seen in 6 seconds on YouTube
and e-infographics are todays new poster ad.
New and improved information and communications technology (ICT) allow for interactions and
gaming on radio, combined with mobile phones
and websites. Web 2.0 reintroduced the idea
of community and knowledge sharing among
friends, but eliminated borders and expanded
the proximity of peoples social networks. Web
2.0 made e-sharing possible and social media
are becoming commonplace for engaging in
personal, professional, and health activities. New
ICTs allow for more personalization of services
so that these can be customized to the individual
level, just as the doctor ordered.
The growth in e-health services has exploded
since the 1990s, facilitated by increased access to
the internet, communication technology functionality and adoption, and a need to reach more

The International Encyclopedia of Digital Communication and Society, First Edition.

Edited by Robin Mansell and Peng Hwa Ang.
2015 John Wiley & Sons, Inc. Published 2015 by John Wiley & Sons, Inc.
DOI: 10.1002/9781118290743/wbiedcs080

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people at lower costs. The drivers of increased

service offerings have varied country by country.
Indeed, in some countries, the drivers have been
high-speed web, smartphone, and tablet access,
whereas in others, they have been economics,
access to services, human resources, and high
mobile phone adoption rates. Globally, e-health
has been viewed as a way to reduce costs of
services, increase access to these services, and
improve health outcomes.
The development and implementation of ehealth services have experienced successes as
well as failures and challenges. Problems with
compatibility, privacy, affordability, policy, and
access were examined and reported in early
e-health service research. Compatibility across
systems, such as electronic medical records not
being transferable between health clinics, has
resulted in a loss of time, resources, and reduced
willingness to invest in some services. Research
questions explored whether e-services could be
as efficient and effective as human powered services. Many examined interface issues and how
web platforms could automate data collection
and give feedback, in lieu of a human provider.
Early e-health service research papers focused
attention on the digital divide, highlighting the
haves and the have nots, and were concerned
about the possible increase in health inequities by
going e. Other research focused on innovation
and the potential of e-health as a cost savings
tool that could provide better and more efficient
health care.
Today, the digital divide has decreased dramatically across the globe, cloud computing
has minimized issues of compatibility, and
e-health policies addressing data privacy and
human protection issues now exist in many
countries. Now, research on e-health services is
more often focused on the best ways in which
to use technology to communicate with and
between health consumers, providers, and policymakers, rather than on the question is it a good
idea? Questions about the type of communication, frequency of communication, personalized
communication and care, user interface and experience including more subjective and hedonic
measures like emotional impact, aesthetics, and
value, as well as effective channels, messengers,
and messages are the focus of much e-health
research. Current research is also exploring the

use of e-health services combined with services

and care delivered by humans, rather than an
either/or approach.
Many types of e-health services exist, but given
the increased attention and development of services for individuals and the growing reliance on
e-means to educate health consumers, this entry
focuses on several types of e-health services,
where communication plays a fundamental role
in the service: for example, health education,
behavior change, self-management and monitoring, adherence, and surveillance. For each type of
e-health service, the aims and purposes, examples
of services emphasizing communication channels, and strategies used and outcomes associated
with them are provided.

e-Health Education Services

Health education is any combination of learning
experiences designed to help individuals and
communities improve their health, by increasing
their knowledge or influencing their attitudes
(WHO, 2013). Health education is associated
with improving health literacy, better treatment
adherence, and patient empowerment. In the
early days of e-health education, many were
concerned about individuals having access to
expert information that they typically obtained
from professionals, and about inaccurate online
advice and misleading health claims. While
these issues were and continue to be salient for
any communication source (online or offline),
many concerns have been expressed about the
misinformed health consumer, the transfer of
power, as well as the digital divide (Andreassen
et al., 2007). Although people have been able
to obtain both accurate and inaccurate health
information online, early research found that
e-health education transformed the typically
paternalistic patientprovider relationship into
one that benefits from a more mutual model of
communication and decision-making between
health care professionals and patients.
Health education can become a particularly
powerful learning experience when new technologies are utilized because e-health applications
improve both providers and consumers access
to health-related information. The advance of
e-technologies has sparked a revolution in the

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way people search for information online and
interact with each other by providing collaboration, participation, and apomediation, a
term that refers to an alternative way to identify
credible and trustworthy sources of information
(Eysenbach, 2008).
Several advantages can result from the use of ehealth education services. Users can self-navigate
through a program, deciding to spend more
time on topics that are relevant or of interest
to them. The information can also be tailored:
expert systems guide the user experience, providing information that is most relevant to
the individual user. Technologies also allow
health education programs and online content
to be more interactive, and this is particularly
important considering that active and interactive features, rather than passive and isolating
approaches, characterize effective education.
Communication strategies involving e-health
services for health education are of two types:
a didactic communication approach, focused
on transmitting specific learning content, and
a narrative approach, more adapted to engaging people and to integrating technical medical
knowledge into specific and peculiar cultural
contexts. Using a mix of didactic text, statistics,
graphics, audio, video, chats, and forums, ehealth education can be informative, educational,
and even entertaining.
Many types of channels can be used to provide
e-health education. The most utilized technologies include websites, SMS, emails, videos, and
video games. In addition to information, patients
can receive social support through participation in social networks, thematic blogs, and
forums. Social media and, especially, social networking sites (e.g., Facebook and Twitter) have
made information seeking more satisfying and
convenient (Park, Rodgers, & Stemmle, 2011).
The use of e-health education in the form
of blogs shown to be effective at improving
learning outcomes in health education, public
health, and nursing courses. Interactive teaching strategies performed online have changed
the role of the learners, from passive to active
and self-directed. Although it is necessary to
have some level of computer literacy in order
to interact with computer programs and the
internet, it has been reported that even those with

little computer experience can effectively receive

health information online (Chien, 2007).
Although e-health education has been shown
to be valuable in disseminating health knowledge, the effects of more modern channels and
materials (such as games, video, and infographics) used for e-education have not yet been
thoroughly explored. Current research does
and should aim to examine the optimal use of
such communication technologies and channels in e-education. Further research explores
questions related to engagement for example,
levels of engagement and how much or what
kind of engagement is associated with better
outcomes.

e-Behavior Change Services

Many health issues derive from unhealthy behaviors, which can be prevented and modified
through appropriate interventions. Behavior
change initiatives are activities that focus on
the individual, community, and environmental
influencers of behavior to provoke a change.
Technologies available in e-behavior change
services can be used to improve the function
of supporting behavior change and sustaining
healthy behaviors.
These services can be designed to foster the
adoption of a new, healthy behavior (e.g., dieting,
physical activity, breast cancer screening, etc.),
the cessation of an unhealthy behavior (e.g.,
smoking, drinking, speeding), or to promote
and encourage the maintenance of a healthy
behavior (e.g., diabetes management, physical
activity, nutrition). In addition, e-health services can serve as persuasive tools for health
behavior change, providing possibilities for customization, personalization, and tailoring of
information to users characteristics, as well as
self-monitoring and reinforcement of the desired
behavior. They are important means to expand
the scope of an intervention, reaching more
people wherever they are, providing information,
prompts, modeling, skill building, and social
support.
Since the early 2000s, an increasing number of health interventions have employed
e-technologies as an integral part of their communication and implementation strategies,

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showing good potential in achieving behavioral

objectives. Examples of e-health applications for
behavior change include computer and web based
health information interventions, online support
groups and collaborative communities, interactive television applications, computer controlled
in-home telephone counseling, biometric assessment and monitoring, patientprovider email
contact, email and text messaging reminders,
and mobile phone/smartphone applications and
programs. Mobile applications for behavioral
change have become a common approach to
changing lifestyle behaviors, including physical
activity, weight loss, alcohol consumption, HIV
testing, smoking cessation, as well as clinical
behavior such as medication and appointment
adherence.
Some hypothesize that these technologies exert
particularly positive effects on human behavior
because they possess specific persuasive features which make the content more personally
relevant and interesting (Fogg, 2002; Lehto,
2012). These features include the capability to
customize, personalize, and tailor information
to the users characteristics, and the possibility to self-monitor and reinforce the desired
behavior.
Research has shown that the use of e-health services is associated with some positive, significant
effects in prompting behavior change in a variety
of settings and behaviors, including smoking
cessation, health care delivery, weight loss and
weight management, and physical activity and
dietary behavior change. From the perspective of
individuals who utilize them, e-health services
have become instruments that offer direct behavioral support, thereby having direct effects on
individuals behavior.
But while there is some evidence to show that
e-health behavior change services are effective,
the effects tend to be small and short-lived,
suggesting that longer-running programs are
needed. The effects of e-health interventions
on behavior also vary with regard to the types
of service utilized and their combination. The
issue now is to examine what components of
e-health interventions are associated with larger
effects. Current research is examining contents,
techniques, and delivery modes in an attempt to
understand which aspects of the interventions
work and which do not.

Self-Monitoring and Disease Management

Services
Monitoring describes the act of listening and
watching: keeping track systematically with
a view to collecting information (http://www.
thefreedictionary.com/monitoring). Health monitoring can be conducted by an external observer
(e.g., a nurse) to discern different aspects of the
health status of a patient, or by patients themselves, which is referred to as self-monitoring.
Monitoring, by definition, seeks to have little to
no effect upon the operation or condition that is
currently being monitored or observed. Disease
management aims to improve the effectiveness
of the management of (mainly) chronic conditions, where patient self-care efforts are critical.
This also includes preventing complications and
improving clinical outcomes, both of which are
enhanced through self-monitoring.
Technology plays a central role in all types of
monitoring and management, not least because of
the growing possibilities of automatic data collection (with the increasing availability of ever more
powerful sensors) and storage (with the decreasing physical size of electronic storage media and
increasing connectivity to online databases).
Furthermore, e-services allow for enhanced coordination and information sharing among health
care providers and patients. These systems for
monitoring have the potential to improve health
across borders and socioeconomic groups.
With an ever-increasing pervasiveness worldwide, smartphones currently comprise the most
widespread group of devices that allow for selfmonitoring and disease management. A second
group of devices, including the so-called smart
coaching gadgets, is portable and wearable:
small-scale bracelets, necklaces, and ribbons to
be carried or worn during workouts or throughout the day. Some devices come with a dongle that
connects to a smartphone or computer via USB;
others connect via Bluetooth. So-called tracking
applications for smartphones are easily available
at very low prices, if not for free. Today, some are
even prescribed by health care professionals for
their patients.
Monitoring and disease management services
are employed for various purposes, such as
diabetes self-monitoring and the tracking of
nutrition and physical activities, like running,

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cycling, swimming, hiking, walking, and other
outdoor and indoor activities. For example,
applications exist that allow users to select, from
an extensive list of foods, exactly what they have
consumed, and in what quantities; the system
then instantly adds up and displays the calorie
intake. Exercises can also be entered, using the
same method (e.g., 45 minutes of swimming, 30
minutes of baseball). Applications display calculations of calorie intake and calorie burn, and the
trend of the users weight. Sometimes, guidance
from a health or fitness professional is included
in the service. Other examples include rating
food on a fitness scale instead of calculating its
calories, whereby users take pictures of foods and
rate their own and other users pictures so as to
reach a consensus on the fitness value.
For glucose level monitoring, a number of
phone applications exist. Interestingly, web applications rarely include glucose level monitoring
in their set of trackable elements. While most
are kept simple, some applications offer such
features as extended graphs, detailed options for
tracking (in the case of nutrition, for example),
or an online backup database so that tracking
data is not lost, visual feedback, goal setting, and
the possibility of sharing the results via social
networking sites.
As a key behavior change mechanism, selfmonitoring is associated with sustained health
behavior change, weight loss, and long-term
maintenance of weight loss. A necessary condition for these positive effects is the adherence to
(i.e., the sustained use of) self-monitoring regimens. Self-monitoring can offer effective ways to
encourage and sustain behaviors and share data
with a persons health care provider in a secure
manner. To motivate (and educate) users, health
scores, goal setting, rewards, bonuses, and other
incentives can be used, as part of more comprehensive strategies. Tracking data, accomplishments, challenges, and self-management strategies can be shared with other people through
applications, social networks, and online worlds.
There are many websites about diets and
healthy nutrition and lifestyles, some of which
offer communities and contacts to nutrition or
healthy-living professionals; but there are only a
few websites or web applications that implement
a full nutrition or diet tracking system. Current
research is exploring these systems further,

focusing on analyzing the degree of acceptability and on exploring participants ability and
willingness to actively interact with new devices
and applications. Although a device might seem
appropriate, cultural, economic, demographic,
psychosocial, and contextual factors play an
important role in influencing peoples acceptance
of such devices.
Research issues in e-self-monitoring and
disease management include the accuracy of
objectively measured data, and the utilization
of data (privacy and confidentiality) collected
through mobile and smartphone applications. A
current stream of research addresses the design
process of e-health services and health care
devices; conventional methods of user centered
design are not fit for the main target groups (i.e.,
elderly and unhealthy people).

e-Treatment Adherence Services

Although not perfect synonyms, terms such
as compliance and adherence have been
employed interchangeably to refer to the patients
act of following a health care providers instructions regarding medication intake (dosage,
timing, frequency). However, differences in
meaning exist. Compliance (a term first introduced in 1976) suggests a hierarchy between
patient and prescriber (the patient obeys the
prescriber), whereas with adherence (a term
introduced in 1993) this hierarchy disappears,
leaving room for collaboration between the two,
and thus a more mutual relationship regarding
treatment decisions.
Nonadherence to treatment and medication
is associated with poorer health outcomes,
higher resistance to drugs, poorer quality of life,
increased mortality, and increased health care
costs. The effectiveness of a treatment/therapy,
particularly for chronic diseases, can be improved
through medication adherence. There are different forms of nonadherence with medication:
intentional and unintentional. Patients can willingly decide not to adhere to a treatment or to
stop a treatment altogether, but they can also
simply forget to take the relevant medication,
for example because of a difficulty in following
the necessary schedule or because the amount
of medication prescribed is too high. A patients

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misunderstanding of a medical prescription

(because of its complexity or because of language
barriers) can represent an unintentional reason
for nonadherence. Wei, Hollin, and Kachnowski
(2011) highlight the multidimensional character
of nonadherence, calling for a complex solution
that includes monitoring, reminding, consulting,
supporting, and educating (p. 47).
Both health care providers and patients can
benefit, and have benefited, from the use of digital technologies to improve treatment adherence.
The benefits of e-adherence services include
cost-effectiveness (affordable for low-income
countries), and the ubiquity/portability of digital
devices, which can be used even when the user
is not at home (helpful when nonadherence
is caused by forgetfulness, for example). Also,
reminders can be sent in different moments and to
different devices, allowing those who do not often
consult their emails or mobile phones to receive
reminders when and where it is best for them.
Tailored, personalized, and generic messages,
such as simple general reminders, are used to
improve treatment adherence. Messages can be
one-way (push) or two-way (pull). The latter
are more interactive (i.e., the patient receives
a reminder versus the patient needs to reply,
send a picture, or complete a chart), providing
a more effective exchange of information and
personalized communication.
Text and multimedia messaging (SMS and
MMS), emails, computerized telephone calls,
telephone linked computer systems, and other
electronic devices and applications (apps) have
been used as reminders to improve treatment
adherence (e.g., reminders about appointments,
and reminders about types of medication and the
timing and/or dose of the medication), but also
as a means to monitor treatment adherence and
prepare electronic prescriptions.
Technologies for treatment adherence have
been employed in various health areas, such as
HIV, malaria, tuberculosis, hypertension, obesity,
asthma, childhood vaccination, breast cancer,
multiple sclerosis, and others. For example,
devices allow for electronic auto injection in
the subcutaneous administration of multiple
sclerosis treatment. Mobile apps remind patients
to take the scheduled dose, and also provide a
photograph of the pill they need to take. SMS
reminders have widely been used as a way of

improving treatment adherence. On the whole,

both old and young have been willing to accept
such methods and e-devices for adherence, which
have been shown to be effective in many areas of
health management.
Barriers against the use of electronic devices
in treatment adherence interventions are often
linked to the difficulty of monitoring treatment
adherence: the actual adherence is only assumed,
but not confirmed, through the use of the device.
Furthermore, the timing of reminders can be a
problem. For example, if the person cannot select
the timing, the reminder prompt might arrive
at an inappropriate moment. Current research is
examining questions related to timing and repetitiveness of reminders, push versus pull reminders,
and ways to confirm treatment adherence.

e-Surveillance Services
Surveillance activities are used to identify and
characterize health related problems, design
interventions to tackle them, and evaluate the
efficiency and outcomes of such interventions;
e-health surveillance is defined as a systematic
and ongoing health assessment that includes data
collection, analysis, interpretation, and dissemination of findings, using electronic health records.
The use of electronic systems facilitates the
approach of traditional surveillance, and makes
possible more accurate and near real-time data
collection and interpretation. In addition, esurveillance facilitates timely dissemination
of the results of such analysis, which enables
health care facilities to apply early control and
prevention measures.
The traditional health surveillance system heavily relies on printed or broadcasted
announcements from government agencies. With
the introduction of e-health surveillance, such
announcements are being posted online and
through social media, which facilitates the spread
of information and increased speed of raising
awareness about an outbreak. The application of
internet technologies allows agencies to employ
such informal channels as blogs and chat rooms
in order to reach the public. The aim of e-health
surveillance does not differ from the aim of the
conventional approach to surveillance, but rather
emphasizes the advantages brought in by new

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technologies: timely identification of outbreaks
and vulnerable populations, timely implementation of control measures, and real-time
monitoring of the effectiveness of interventions.
Notably, the sources of incoming and outgoing
information are no longer separated. Information
about new epidemiologic events can be gathered
as well as disseminated using the same information channels. One approach, for example, is
based on an analysis of logs of keywords used for
web searches and location information of users
computers.
The Global Public Health Intelligence Network (GPHIN) was created in 1997, following
the ProMED-mail initiative. It was developed
in collaboration with the Public Health Agency
of Canada and the World Health Organization
(WHO), with the aim of retrieving relevant information from news aggregators every 15 minutes.
It disseminates outbreak related information
through emails and posting reports, provided by
both readers and governmental authorities, and is
one of the largest publicly available reporting systems in the world. Examples of other worldwide
e-surveillance services, both general and disease
specific, include: HealthMap, NBIS (Network Biosurveillance Integration System), FERN (Food
Emergency Response Network), ICLN (Integrated Consortium of Laboratory Networks),
BioWatch, BioSense, ESSENCE (Electronic
Surveillance System for the Early Notification
of Community based Epidemics), EuroFlu, and
GAINS (Global Animal Information Systems).
Further advancement of e-surveillance and
collaboration between different organizations
has led to the development of interdisciplinary
projects, such as the GeoSentinel project (an enetwork of travel related illnesses), the Emerging
Infections Network (a network of unusual clinical
events and new cases during the outbreaks),
and the DiSTRIBuTE project (the Distributed
Surveillance Taskforce for Real-Time Influenza
Burden Tracking and Evaluation).
There are several ways in which e-health
surveillance provides more benefits than the conventional approach. First, it provides timely data
acquisition: e-surveillance enables data collection
and analysis in near real time, which facilitates
data entry and, consequently, syndromic surveillance. This makes the data obtained from the
first source available for immediate analysis and

quick development of preventive measures in

case of an outbreak. Open source software, provided to the health care services by governmental
agencies, enables unification of the processes
related to data collection and analysis. It facilitates the data exchange between regions and
organizations that otherwise might have different
reporting systems. In addition, e-surveillance
systems provide an opportunity for online training of surveillance and health care professionals,
and for the incorporation of such training into
medical curricula, reducing training costs. Web
based surveillance networks and portals enable
social networking for health care professionals,
patients, the general public, and media representatives in order to mobilize resources and
facilitate communication and dissemination of
information. Mobile technologies further facilitate such connections through global positioning
systems, enabling microblogging or sending
of text messages, especially in resource limited
settings. Surveillance professionals in countries
of different economic conditions benefit from
the development of international relationships,
sharing experience and information, and communicating with mass media, governmental
agencies, and the general public. Surveillance
networking also enables coordination of efforts
during an outbreak within a country (between
the health care and other sectors, such as police
or transportation), as well as between different countries. However, challenges related to
e-surveillance remain for example, privacy
issues, compatibility of systems and databases,
policies to adopt surveillance, and restrictions in
data access and data sharing.

Where Do We Go From Here?

In health education, communication, behavior change, self-management, adherence, and
surveillance, e-health services have a long history,
but innovation has modified the way in which
they are offered and how technology is used.
The proliferation of new technologies creates
an exciting opportunity for health communication scholars, practitioners, and policymakers, in
terms of reach, cost savings, and health outcomes.
However, keeping in mind the idea of e-health,
future innovation in e-health services should be

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about achieving better health, better decisionmaking, better communication, better prices, and
better access to health information and health
care, and not about the technology itself. Technology provides a vehicle to reach, motivate, and help
people make good choices. Putting the e in services alone is not sufficient. Good communication
practice is fundamental to any health services
success, and should complement the utilization of
technologies. But communication is not the only
aspect to consider, and the utilization of techniques and strategies should be planned carefully,
considering policy, privacy, and economic factors,
Current e-health service research needs to
examine how to improve the functions of existing
devices and programs, and how to extend or
integrate them in order to improve the e-health
services on offer. However, in this process of
innovation, it is important to consider feedback
from potential users, by opening and keeping
up an ongoing discussion with both users and
providers. The established approach of putting
the potential user in the center of the design process needs to be reinvented in the realm of health
care. Integration and interoperability of e-health
services with human based services should be
further investigated. Research should focus on
developing appropriate, relevant, and appealing communication channels, so as to attract
and maintain peoples interest, curiosity, and
active engagement in their own health. Future
e-services should be designed to be user centered,
but a balance between preferences, needs, policy,
and evidence about what works must be achieved.
This may not be as simple as it sounds, but the
future is promising.

SEE ALSO: Commercial Applications in Digital

Communication; Digital Divide(s); e-Commerce
and Online Security; e-Commerce and Online
Trust; e-Government; Internet Telephony; Mobile
Commerce Applications; Mobile Games; Privacy
Law and Policy; Privacy and Social Media
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topics/health_education/en/

Further Reading
Bean, N. H., & Martin, S. M. (2001). Implementing a network for electronic surveillance reporting
from public health reference laboratories: An international perspective. Emerging Infectious Diseases,
7(5), 773779.
Brownstein, J. S., Freifeld, C. C., & Madoff, L. C. (2009).
Digital disease detection: Harnessing the web for
public health surveillance. New England Journal of
Medicine, 360, 21532157.
Castillo-Salgado, C. (2010). Trends and directions
of global public health surveillance. Epidemiologic
Reviews, 32(1): 93109. doi: 10.1093/epirev/mxq008

e- H E A L T H S E R V I C E S
Free, C., Phillips, G., Watson, L., Galli, L., Felix, L.,
Edwards, P., Patel, V., & Haines, A. (2013). The effectiveness of mobile-health technologies to improve
health care service delivery processes: A systematic review and meta-analysis. PLOS Medicine, 10(1),
e1001363. doi:10.1371/journal.pmed.1001363
Ryhnen, A. M., Siekkinen, M., Rankinen, S., Korvenranta, H., & Leino-Kilpi, H. (2010). The effects
of internet or interactive computer-based patient
education in the field of breast cancer: A systematic literature review. Patient Education & Counseling, 79(1), 513. doi:10.1016/j.pec.2009.08.005
Webb, T. L., Joseph, J., Yardley, L., & Michie, S.
(2010). Using the internet to promote health behavior change: A systematic review and meta-analysis
of the impact of theoretical basis, use of behavior
change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research, 12(1), e4.
doi:10.2196/jmir.1376

L. Suzanne Suggs is an Assistant Professor of

Social Marketing and is head of the BeCHANGE
Research Group, Institute for Public Communication (ICP), Faculty of Communication Sciences
at the Universit della Svizzera Italiana. Her
research focuses on behavior change communication through information and communication
technologies.
Natalie Rangelov is a doctoral student and
research assistant in the BeCHANGE Research
Group, Institute for Public Communication,
Universit della Svizzera Italiana. Her research
focuses on public communication and innovative approaches to health behavior change and
support.
Andreas Schmeil is a postdoctoral research
fellow in the BeCHANGE research group, Institute for Public Communication, Universit della
Svizzera Italiana. Holding a PhD in Communication Sciences and an MSc in Informatics, his

research focuses on visual communication, avatar

based collaboration, and innovative approaches
to health behavior change and support. Past
roles include positions at the Palo Alto Research
Center (formerly Xerox PARC, US), Simon
Fraser University (Canada), the HIT Lab (New
Zealand), Fraunhofer FIT, and Fraunhofer IAO
(Germany).
Aurora Occa is a research assistant in the
BeCHANGE Research Group at the Universit
della Svizzera Italiana (USI). She holds an MA
in Business Administration from Virginia Tech,
and an MA in Communication, Management,
and Health from USI. She is interested in the
application of marketing and communication
strategies to prevent disease and improve the
quality of life.
Marco Bardus is a postdoctoral researcher at the
Universit della Svizzera Italiana (USI) and is
currently working for the European Journalism
Observatory and for the BeCHANGE Research
Group at the USI. His research combines the
domains of e-health communication and health
promotion, research dissemination, and science
communication through new media.
Olga Radchuk is a postdoctoral researcher at
Biofaction (Austria). She holds degrees in Biology from Taras Shevchenko National University
(Ukraine) and Communication from Universit
della Svizzera Italiana. Her research interests
include scientific communication and science
visualization.
Sepideh Dianat holds an MA in Communication, Management, and Health. She has worked
on multiple health projects at the Universit della
Svizzera Italiana, and at the University of Alberta,
investigating the role of technology in nutrition
and health promotion.