e-Health(電子化健康)透過資訊與通訊科技的使用，得以用較低的成本，將不同的健康照護服務加以整合，減少使用者接受服務時的障礙，並協助服務的遞送、改變服務的面貌。現今，由於消費者意識的抬頭以及網路資訊的普及，e-Health的使用者逐漸由醫療人員轉變為一般大眾，並由病人擴大到一般的健康者，其功能也由生病後的醫療照護延伸至生病前的健康促進，內容則包括了有形與無形的健康資訊服務，並以主動參與及知識分享為運作核心。透過這些的新觀念的引入，e-Health已產生本質上的改變，未來的科技將以更積極有效的方式，幫助民眾及早取得可信賴的健康資訊，提升健康資訊素養，進而對健康價值的觀念產生轉變，強化自我健康照護能力，本研究中將這個現象或過程稱之為e-Health 2.0。e-Health 2.0與過去的e-Health(或稱為e-Health 1.0)最大的不同，在於e-Health是以病人為主，並強調資訊科技可以運用在生病的過程中，提供診斷、治療與照護上的幫助，而e-Health 2.0則是藉由資訊科技，特別是Web 2.0，協助健康的民眾透過社會網絡(Social Network)及虛擬社群，主動參與其個人的健康管理，並透過個人健康資訊素養的提升，進而促使社群、服務提供者、產業以及政府機構改變健康照護思維的現象或過程。 醫療新科技的不斷進展以及人口老化、民眾對健康日益重視等社會環境多重影響下，世界各國在醫療上的支出均不斷地成長。透過資訊與通訊科技的快速發展，健康照護服務已產生重大的變革，因此，多數國家開始發展與建立國家e-Health政策，並期望透過政策的規劃及制定，因應未來環境與民眾的需求，提供前瞻、低成本高品質的服務，達到提升國家整體健康照顧系統能力的目標。然而，e-Health 2.0現象方興未艾，其影響與範圍雖大但卻缺乏有系統的評估，故本研究透過文獻回顧、次級資料分析及專家深度訪談，建構出e-Health 2.0的定義、內涵與決定因子，並進行發展策略分析，評估未來環境可能發生的情況及其中的影響層次，整理政策制定時有用的資訊，協助公私部門決策及因應，最後，也歸納提出具體可行暨可管理的短中長期目標，供後續研究與實務應用時參考。 / E-Healh is a revolution to drive the radical change in health care services delivery. In spite of using the information and communication technologies, e-Health could integrate the different health care services into a customer-oriented service delivery system and benefit the different stakeholders. However, the mind set of e-Health is gradually changed as the services and applications extend from patients to healthy people. In order to provide better services and applications, e-Health needs to focus on not only supporting proper and trusted health care services but consolidating the value of prevention and health promotion. Internet developments that brought us sites such as Facebook, YouTube and Wikipedia are now set to revolutionize health care. The idea of web 2.0 is now driving far-reaching changes in healthcare systems, a trend it terms e-health 2.0. Compared with e-Health which is mainly aimed at patients’ medical care services, e-Health 2.0 is a process or phenomenon of paradigm shift by means of that health information diffusion and social networking to improve the citizens’ health literacy in order to redefine the value of health care among stakeholders. Meanwhile, medical expenditure grows up continually as a result of the new technologies, aging population and social environment in many countries. The financial pressure of medical care already impacted national health care services policy so that governments are developing their national e-Health policy to fit the future need. The goal of e-Health policy is a reengineering process of health care to provide proactive, low cost and high quality services. As the e-Health 2.0 can reduce the gap among stakeholders and speed up the social change, it is a truly important role in the reengineering process. Our study based on literature review, secondary data analysis and in-deepth interview with expertise to construct the definition, content and factors of e-Health 2.0. According to the strategic analysis of e-Health 2.0 development, the study proposed several important goals and suggestions. They can be used as a template or guideline for such evaluation by researcher and practicer both before, during and after the implementation of e-Health 2.0.

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Cette thèse explore les multiples rationalités à l’œuvre derrière la production et la publication en masse d’information de santé en langue française sur le web. Une clarification des notions essentielles entourant l’univers de l’e-santé facilite l’appréhension de l’état des lieux de ce domaine et du contexte de cette étude. La méthodologie mobilisée est décrite de façon détaillée : depuis la constitution d’un corpus à partir de contenus ciblés extraits de 367 sites jusqu’à l’interprétation des données collectées. Douze profils-types d’éditeurs composant le paysage du web de la santé ont émergé de l’exploitation de ce corpus, eux-mêmes classés dans quatre grandes catégories. Pour chaque type d’éditeur défini, quatre caractéristiques distinctives sont examinées : les différents acteurs concernés, les informations diffusées sur leurs sites, leurs modèles économiques, ainsi que les objectifs qu’ils déclarent. Les analyses approfondies menées sur ces critères déterminants sont confrontées aux résultats d’autres travaux de recherche issus de disciplines hétérogènes pour dégager les principaux enjeux qui sous-tendent la mise en ligne d’information de santé à destination du grand public. / This thesis explores multiple logics of action at work behind the production and widespread dissemination of health information in French on the Web. Key e-health concepts are clarified to facilitate understanding of the field and the study context. The methodology is described in detail from the constitution of a corpus of focused content from 367 websites to the interpretation of the data collected. Twelve standard publisher profiles in the e-health Web sector emerged from our analysis of the corpus, and were classified in four main categories. Four distinctive criteria were studied for each type of publisher: the stakeholders, the information available on their websites, their business models and their stated purposes. Analyses of these criteria were compared with results from other studies in a variety of fields in order to identify the key issues involved in launching e-health information for the general public.

Purpose: The Internet has provided an unprecedented opportunity for psychotropic medication consumers, a traditionally silenced group in clinical trial research, to have voice by contributing to the construction of drug knowledge in an immediate, direct manner. Currently, there are no systematic appraisals of the potential of online consumer drug reviews to contribute to drug knowledge. The purpose of this research was to explore the content of drug information on various websites representing themselves as consumer- and expert-constructed, and as a practical consideration, to examine how each source may help and hinder treatment decision-making. Methodology: A mixed-methods research strategy utilizing a grounded theory approach was used to analyze drug information on 5 exemplar websites (3 consumer- and 2 expert-constructed) for 2 popularly prescribed psychotropic drugs (escitalopram and quetiapine). A stratified simple random sample was used to select 1,080 consumer reviews from the websites (N=7,114) through February 2009. Text was coded using QDA Miner 3.2 software by Provalis Research. A combination of frequency tables, descriptive excerpts from text, and chi-square tests for association were used throughout analyses. Findings: The most frequently mentioned effects by consumers taking either drug were related to psychological/behavioral symptoms and sleep. Consumers reported many of the same effects as found on expert health sites, but provided more descriptive language and situational examples. Expert labels of less serious on certain effects were not congruent with the sometimes tremendous burden described by consumers. Consumers mentioned more than double the themes mentioned in expert text, and demonstrated a diversity and range of discourses around those themes. Conclusions: Drug effects from each source were complete relative to the information provided in the other, but each also offered distinct advantages. Expert health sites provided concise summaries of medications’ effects, while consumer reviews had the added advantage of concrete descriptions and greater context. In short, consumer reviews better prepared potential consumers for what it’s like to take psychotropic drugs. Both sources of information benefit clinicians and consumers in making informed treatment-related decisions. Social work practitioners are encouraged to thoughtfully utilize online consumer drug reviews as a legitimate additional source for assisting clients in learning about treatment options.

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Au cours des dernières années, les communautés virtuelles de patients se sont énormément développées sur l'Internet. Ces communautés permettent des échanges fréquents entre les patients, qui peuvent partager des informations liées à la santé dans un environnement interactif. Alors que beaucoup s'accordent sur l'opportunité représentée par ces communautés pour ses utilisateurs, les connaissances sur ce qui détermine l'action collective en ligne des patients ainsi que sur les fondamentaux de l'action collective en ligne dans ces espaces virtuels sont relativement peu développées. En conséquence, ce travail doctoral examine les raisons pour lesquelles les patients interagissent entre eux et comment ils procèdent. En nous appuyant sur le modèle du comportement orienté vers un but, la théorie de la valeur de l'attente, la théorie des forces du champ, les concepts de dons et les interviews menées, nous avons développé un modèle qui examine les interactions en ligne des patients dans un contexte d'action collective en ligne. Une approche multi-méthode, qualitative et quantitative, permet d'explorer les interactions des patients et de mesurer les déterminants de l'action collective en ligne sur ces espaces virtuels. L'analyse qualitative de 54 entretiens menés avec des patients, des proches de patients, des professionnels de la santé 2.0, des médecins et des soignants permet d'affiner le modèle de recherche, qui a ensuite été testé au travers d'une enquête quantitative auprès de 269 patients. Cette recherche contribue à la recherche en systèmes d'information en augmentant nos connaissances sur la dynamique individuelle et les interactions qui entourent les communautés de patients en ligne. / Over the last few years, virtual patients’communities have been developing tremendously over the Internet. These Web 2.0 communities allow frequent interactions among patients, who can share health-related information within an interactive environment. While many agree on the opportunity represented by those communities for its users, we know very little about what determines patients’ online collective action, specifically on virtual communities as well as the fundamentals of online collective action in these virtual spaces. Accordingly, this doctoral work examines why patients interact with others and how they interact on topics related to their disease through these virtual communities. Drawing on the goal-directed behavior (MGB), the expectancy-value (EVT) theories, the field force theory, gift concepts and field interviews, we have developed a model for examining patients’ online interactions and identified gift-giving behaviors in the context of online collective action. A multi-method, qualitative and quantitative approaches, enables us to explore patients’ interactions and measures the determinants of online collective action on these virtual spaces. The qualitative analysis of 54 interviews conducted with patients, patient’s relatives, Health 2.0 professionals, doctors and caregivers allows refining the research model, which has then been tested through a survey handled with 269 patients, members of patient’s communities. This research contributes to IS research by increasing our knowledge regarding the individual dynamics and interactions that surround online patients’ communities.