The article reviewed here is ‘Health 2.0 and Medicine 2.0: Tensions and Controversies in the Field’ by Potts et al and freely available here.
This is a qualitative study (although there are some quantitative aspects to it). The authors set out to define the term Medicine 2.0, to determine ‘tensions’ in the field and to explore the relationship between popular understanding of these term and the meaning as used in the academic literature.
The authors use a Grounded Theory approach. Essentially they identify online definitions of Web 2.0 using the Google page rank. Their argument for using the Google search engine to retrieve relevant articles is that the field is relatively new and so there hasn’t been sufficient time for a stable base of academic literature on the subject to arise. Google’s search engine however uses non-transparent algorithms which change with time. Thus they do not necessarily correlate with the ‘popularity’ of a site nor to the number of links but also incorporate ‘authority’ on the subject. Thus we cannot draw too many conclusions about the sampled pages other than to say that they have been optimised for the terms in the relevant search engine – passively or actively. Indeed if the same search was to be performed 3 months or a year later, a different set of results might be obtained.
The authors use a grounded theory approach which involves looking analysing the text for themes according to a specified process which is outlined in the article. They repeat the process with subsequent articles until they have saturated the themes. In effect this means that they keep assessing definitions until they have covered all of the attributes of the web 2.0 definition in the sampled material. We could create attributes for Web 2.0, generate an article with reference to these attributes, optimise it for Google and then it would have been included in an analysis had the methodology been used in a replication study. I’ve mentioned this because it illustrates something about the Grounded Theory methodology. That is, the methodology is dependent upon the sample. As we are using words, which have context-dependent meaning with the usage evolving through time, the Grounded Theory approach generates socially-contextualised meaning or themes. In this sense, the Google search engine has determined the social context of the themes. Thus we can say that the definition derived in this analysis is one that is collectively understood by authors who’s work is highly ranked in the Google search engine. This most likely means that it is a shared understanding by people who have a good working knowledge of search engines or search engine optimisation. This would represent a relatively small (but increasing) segment of the population and may not therefore represent the wider meaning. An example of other groups that might use Web 2.0 in their discussions would be people accessing the web for health information but not publishing themselves. Perhaps they might use different attributes dependent on their experiences and so it would be interesting to explore the definition derived from this study using a survey for example.
Having used this approach to derive a definition, the authors then examine the research literature and by applying this defintion are able to exclude a number of papers of potential relevance that they had identified from a previous search. Essentially they had used a number of databases and search engines to identify papers of potential relevance to Web 2.0 health. They now analysed the included papers to identify ‘tensions’ in the literature. They found a number of areas of controversy: The existence of Medicine 2.0, ‘doctors’ concerns with patients’ use of Medicine 2.0′, innaccuracy and associated risks and privacy/ownership.
The authors determine from the definition and their reading of the literature that Medicine 2.0 and e-Health are quite different from each other and speculate also that the two areas may continue to diverge. The authors have used a number of methods in order to create an accurate definition of Medicine 2.0 and have used this to examine the literature and identify areas of discussion and have thereby produced a potentially quite useful paper in the field.
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