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This qualitative research synthesis of empirical studies, integrated by a theoretical perspective, focuses on the societal and personal factors influencing digital health communication by individuals. In a process-oriented perspective, it analyzes how Internet users interact with online health information by seeking, receiving, interpreting, and using online health content with varying complexity, utility value, and credibility. The reception process, based on user parameters such as information needs, perceived benefits and costs, digital literacy, and trust, is influencing in a second-step health-related knowledge, attitudes, and behavioral intentions of Internet users and stimulates overt health-oriented behavior.
Department of Communication and Media Research, University of Zurich, Switzerland
*Address all correspondence to: h.bonfadelli@ikmz.uzh.ch
1. Introduction
This qualitative research synthesis of empirical studies is integrated by a theoretical perspective and focusing on the underlying societal and personal factors that influence digital health communication activities by individuals such as health-related needs, perceived benefits and costs, and user experience on the hand and especially digital literacy or skills together with trust in online health offerings on the other hand.
The digitalization of society has transformed our lives fundamentally in all domains such as politics, economy, culture, and especially health communication [1, 2, 3, 4]. Today, 96 percent of the population are using the Internet in the United States of America [5] and many say they are almost constantly online [6], and in most countries of Europe, for example, 76% in Germany or even 95% in Switzerland, and 86% also use mobile Internet [7]. In addition, more than 70% use the Internet and Social Media as sources for news, for example, 84% in Sweden, 82% in Switzerland, 74% in the United Kingdom, 72% in the U.S., or 66% in Germany [5]. Today, the digital media have especially for younger people become the most important source of information. And for the majority of people, the Internet has as well become the most important source for health information [8, 9, 10, 11, 12, 13], for example, one in two EU citizens look for health information online, most popular in Finland and the Netherlands with about 75% [14].
This can be illustrated actually by the global health pandemic Coronavirus [5]: The coronavirus crisis increased news consumption substantially, especially for mainstream media like television, in all six countries with surveys before and after the pandemic had taken effect. And interestingly, trust in media’s coverage of COVID-19 in 2020 was relatively high in all countries with 59%. And even 60% agreed that “media has helped me understand the crisis.” [15].
But despite this society wide diffusion of the Internet and Social Media, there still exist gaps in access and especially disparities in usage of the Internet as the so-called digital divides in general [16, 17, 18, 19] and especially for online health information seeking and application [8, 20, 21, 22], not at least based on varying digital skills to use the Internet [23, 24], especially among older adults [25, 26, 27, 28]. In addition, there is the question, under what conditions health communication may eliminate health disparities [29, 30], especially in developing countries where still only about 45% have access to the Internet [21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31].
Not so long ago, experts from medicine and public health administration, together with the traditional mass media, possessed a monopoly as trustworthy top-down sources for health information. But this was weakened by the fast diffusion of the Internet since the mid-nineties under the label of eHealth and in particular by the new interactive Social Media with its participative Blogs or Apps as mHealth [32, 33, 34, 35]or serious games with health topics [36]. Despite the benefits of those new interactive opportunities for horizontal health communication, there are disadvantages and challenges such as social usage divides [21] and risks for the users as well, because the search processes, for example, by Google or on YouTube, are guided by hidden algorithms, [37, 38] favoring in most cases the economic interests of the manufacturers of health or medicine products, for example, by endangering privacy. But even in the traditional trustworthy print media such as newspapers or magazines, there is more and more of the so-called sponsored content by health industry stakeholders in a similar form like the editorial content by media journalists.
2. A theoretical perspective of digital health communication
Figure 1 displays a systematic theoretical framework to analyze the complex field of digital health communication and to locate the many empirical research studies, dealing with a wide variety of online health phenomena [39]. It starts process-oriented from left side with the existing supply of online health information for different target groups, the usage, personal motivation, trust, perceived benefits and costs, and varying experience with health communication and its effects on health-related knowledge, attitudes, and behavior. This input-output process is embedded in a macro societal context, consisting of the providers of online health information on the one hand and the digital infrastructure on the other hand, depending on communicative support [40] by interpersonal communication of social networks [41] and the available resources by communities [42, 43, 44, 45]. And individual characteristics of people such as age, sex, education, or a migrant background, together with individual information needs concerning health, perceived norms, for example, with regard to Corona vaccination, e-health literacy, and self-efficacy, for example, to handle Corona infection, influence on the micro level the digital health communication process.
Figure 1.
Digital health communication: societal context, personal situation, use, and effects.
Online Health Information as input can be differentiated according to its form and content. Of importance for the user are especially aspects such as accessibility and security [46], the visual structure of a Web site [47], the ease of use and user friendliness, and the complexity of online health information [48], together with its utility value, and not at least the quality and credibility of online health information and its underlying sources. There are many content analyses dealing with health information in general or with topics such as HIV/AIDS, cigarette smoking, cancer, body images, in the classic print media or television [49, 50], but there are still not so many comparative analyses of health Web sites with varying interactivity and quality on the one hand and health videos in Social Media on the other hand [51, 52, 53] as a prerequisite for developing Web site quality standards [53, 54, 55, 56].
Usage and Experience incorporate the many aspects of a wide variety of concrete interactions between online health offerings and its users, starting with information needs, perceived benefits and costs [57] and the process of seeking online health information and its exposure to it [8, 58]. And there are many underlying mediating factors such as self-efficacy [59, 60, 61] online user experience [62], trust, based on perceived quality and credibility of online health Web sites and its content [63, 64, 65, 66], and not at least eHealth literacy [67, 68, 69, 70, 71, 72, 73, 74, 75, 76].
Knowledge, Attitudes, and Intended Behavior of people are the effects of the varying use and reception of online health information, depending not at least on health information needs as motivation, perceived benefits and costs, eHealth literacy, and self-efficacy or trust, and are a prerequisite of the actually performed health behavior. Usually, there exist gaps between knowledge, attitude, and performed behavior, because of existing barriers such as costs or not having enough incentives or self-efficacy and empowerment [60, 61].
The above-mentioned interaction between online health content on the one hand and seeking and usage of this information by people and its effects on health behavior of users are influenced on the macro- and meso-level by the societal context, for example, with the amount and distribution of Internet access, the diversity of online health providers, and the social networks together with the urban or rural context of its users. On the micro-level of the individual person, there are mediating factors as well such as age, gender, education, or a migrant background that influence the existing health information needs, perceived norms, health literacy, and especially the self-efficacy of a person to seek, use, and implement online health information.
It is the aim of this contribution, to summarize and integrate the existing research and its manifold insights, focusing first on the processes of health information seeking, and second on the underlying and mediating factors of online health information such as user experience, involved credibility and trust, and health literacy, as well as the individual characteristics of the more or less active user of health online.
The following summarized findings about the topic of health communication online and its influencing factors such as literacy and trust are based on a qualitative research synthesis of empirical studies from different countries and covering about the last twenty years. The considered results have been included on the one hand due to published relevant original research studies and on the other hand by citations in summarizing thematic publications, both have been searched in important journals of the field like “Journal of Health Communication” or “Journal of Public Health” and in relevant handbooks like “The Routledge Handbook of Health Communication,” with a focus on publications in English language. Thus, the subsequent presented findings and insights of this review chapter are not based on a standardized quantitative meta-analysis, but as a limitation is only the result of a qualitative integrative synopsis of the topic by the author.
Today, an immense number of online offerings for health promotion exist in a variety of forms such as Internet Web sites and videos on Social Media such as YouTube, Facebook, or Twitter, and with different levels of quality. And it seems that health Web site quality influences the intention to use it [77]. In addition, people use more and more the so-called mobile wearables such as Smartphone Apps that count undertaken steps or measure the cardioplegia, and give tips for healthy behavior like physical activity, but unfortunately often not based on clear evidence [10, 78]. Rossman and Karnowski [79] created a classification, based on five dimensions, that enables the contextualization of the wide variety of new eHealth and mHealth Phenomena (Table 1):
Provider
Addresses
Interests
Interactivity
Functionality
Economy: For example, Health Insurances
Politics: Health Services
(Health) Sciences
Mass Media
Lay People
Health Services
Politicians
(Health) Sciences
Lay People: General Public, Target Groups, Persons Concerned
Non-Profit in the Public Interest
Commercial with Financial Interest
Information: one-sided
Interaction: two-sided
Transaction: two-sided
Content
Community
Provision
Table 1.
Classification of health offerings on the Internet.
Source: Adapted from Rossmann & Karnowski 2015: 273 [79].
There are on the one hand providers and on the other hand addresses of online health offerings, namely from governmental public health services or health insurances, from politics, (health) science and mass media, but as well from lay people, for example, as communicators and recipients, the so-called prosumers, of Social Media. These providers of health offerings do not always represent non-profit public interest, but act as well as commercial agents with financial interests, for example, to sell medicines and drugs, however not always openly declared like in the many new health magazines. The online health contents can offer different levels of interactivity like one-sided information only, two-sided interactive communication, or even two-sided ways of transaction. And functionality means the purpose or the objective target of the online health offering like “content” as one-sided information for more or less passive receivers as distinguished from “community” as enabling two-sided interactivity between providers and addressees, and “provision” stands for supplying, for example, orientation in the doctor-patient relationship.
Not surprisingly, the Usability of Health Information Websites and eHealth Offerings [80, 81, 82]or the observed aesthetics [83] are judged differently by age groups: Whereas younger people prefer visually appealing and interactive content such as videos, games, or quizzes, and find too much text difficult to handle [57], older adults instead have difficulty in identifying and access relevant, reliable, and trustworthy sources of health information on the Web [27, 28]. In addition, sociodemographic factors like education influence the use of eHealth as well. It is a challenge that eHealth is still least used by persons who need it most [58]. To overcome these barriers, health information Web sites should not be generalized for all people, but suitably tailored to the needs of its specific target groups by taking into consideration barriers as well facilitators to enhance access, usage, and implementation [39, 84].
In most surveys, dealing with personal concerns, health has a high priority. As a consequence, it is not surprising that information seeking about health on the Internet and Social Media is performed by most people on a regular basis. Table 2 lists data from different countries: In the Pew Internet Survey from 2013 [86], 59% of U.S. adults have looked online for health information in the past year, which means 73% of Internet users. And in 2013, 75% of the European population used the Internet and 59% of the Internet users were seeking online health information; the highest rates have been measured in Germany with 69% and Finland with 65%, and the rates increased in 2019 to 53% overall, but, for example, to 80% in Finland. There are as well survey data for Switzerland [85]: 92% used the Internet in 2019 and 76% of the Internet users have been searching for health information online.
Percentage of health information seeking for all people.
Only for people using the Internet.
Taken together, at least 90% in the Western Information Societies have access to the Internet today, and around 70% of the Internet users are seeking for health information. It should be kept in mind that most studies focus on conscious and active searches for health information, but not on “random contacts” with the topic, for example, on YouTube or Instagram. Furthermore, the effects of health information seeking on knowledge, opinion forming, and health behavior have so far been largely unexplained.
But despite the widespread use of online health information, there are still barriers such as costs and groups such as the elderly, the disabled or those living in rural areas, because of not having physical access, a lack of relevant digital skills or negative experiences with computer use [26, 29]. Ren et al. [87] analyzed the perceived benefits and costs of seeking and using online health information. Based on 282 questionnaires, obtained from patients and their family members, they summarize the following key finding: perceived functional, learning, social and personal integrative benefits positively affect online health information seeking, whereas cognitive (search) costs influence information seeking negatively.
Besides active health information seeking, a German survey by Bertelsmann Foundation [88] asked for the communication channels used, and the underlying motivation to use the Internet for health-related questions: 88% of the 18 to 80 years old adults have been seeking information about health in the past year, and 46% of these used the Internet as information source; the classical sources were still more used: 62% used mass media, and 56% had interpersonal communication with doctors or nursing staff or 54% with family or colleges. The most named motivation of health information seeking with 73% was to be informed about health risks and diseases in general; 58% mentioned to look for tips about healthier behavior, and the own need for help in concrete situations of illness (52%) or to be able to give help to family members and friends concerning health problems (46%).
But there are dysfunctional aspects of seeking and using online health content as well, especially in Social Media are the rarely transparent underlying algorithms a problem, together with health misinformation [38, 89, 90], as the public debate about COVID-19 is showing. As a practical consequence, there are essential challenges for the providers of prevention marketing [91, 92] and public health campaigns [93, 94, 95, 96, 97].
The above presented findings on the active search for information on the Internet and their underlying motives in relation to perceived benefits and costs [11] will be deepened in a further step by the discussion of some relevant mediating factors [87, 98, 99, 100], which influence the modality of handling health information on the Internet: namely (1) user experience like eHealth literacy [101], (2) salience of information about the topic, (3) beliefs that the behavior is producing the expected outcome, (4) perceived behavioral control, (5) subjective norms as beliefs about whether significant others think the behavior should be undertaken, (6) perceived credibility together with trust of site information [64, 70], and (7) characteristics of users. These mediating factors are relevant for providers of online health information, the tailoring of their messages, and the specification of relevant target groups. But it has to be emphasized that most of the existing studies focus on the so-called top-down offerings such as Web sites and online health campaigns; studies on interactive communication on the Social Web have so far been rare [22, 102, 103].
User experience during online health information seeking and use has a decisive influence on the success of an online offer and on its impact on users. The term user experience includes all experiences when interacting with an (online) health offer, starting with navigational needs [104]. Usually, the subjective impression of health content, its usability or user-friendliness, and the attractiveness or visual aesthetics of online health contents [83] are examined in corresponding studies [82, 105].
The way in which user experience as a whole and its various components work with classic Web sites has meanwhile been researched quite well, especially in the German-speaking countries. Right at the beginning of a visit, for example, access to a Web site or an advertisement in a social media feed, visitors get an impression of the visual attractiveness in less than a second, and this perception remains mostly stable [106]. And a high visual attractiveness increases the likelihood that an offer will be used for a longer time [107, 108]. For the willingness to revisit or recommend a Web site, content evaluation plays a decisive role [109]: Beneficial users are willing to accept any hurdles in usability for particularly good and exclusive content. Finally, usability is crucial for visitors to find search information immediately—or whether their experience of use is clouded by confusion, slow page construction, or navigational hurdles. And Uwe Hambrock [110] in his summary for the Bertelsmann Stiftung used qualitative interviews to investigate health information-seeking behavior of men and women in their role as patients in Germany. The interaction between doctor, patient, and Internet repeatedly revealed challenges, for example, when doctors advise against visiting the Internet. A key finding of the study was that information that serves one’s own motives is more familiar in the sense of consistency theory.
For online offers, all the above-mentioned factors such as clarity, informativeness and likeability of content, its visual attractiveness, usability, credibility, and rating are essential. However, the research is still rather undifferentiated. Meinald T. Thielsch and his colleges [106] have presented benchmarks based on user experiences with Web sites as the so-called user experience measures. With the freely available collection of validated scales as a “Website Evaluation Toolbox,” the key aspects of Web site perception can be recorded reliably. However, the subject of the investigation was classic Web site formats. Appropriate tools for analyzing the quality of other online formats have so far been largely lacking.
Another relevant factor for the assessment of online health information is credibility of the information from a user perspective. The credibility of information, or trust in (print) media and public authorities, but also in experts from academia, linked to keywords “fake news” and “lies press,” has not only in Germany [111] been controversially discussed recently. Politicians are therefore trying to use new tools such as the “Network Search Law” (Netzwerkdurchsuchungsgesetz) in Germany to be able to follow relevant penal content better, especially by Social Media.
Research about the credibility of information and trust in these and their sources has so far been a priority for political news in the online sector. For example, the Digital News Report by Reuters of 2020 [15] shows that 45% of respondents in Germany still trust most news, with the extent for “news I use” being as high as 59%; however, only 14% trust the news on Social Media. Further findings also show that people rate online misinformation more credibly when they see it frequently [112, 113]. In addition, users with above-average social media experience tend to rate online information more trustworthy [114]. And the attempt to limit the spread of misinformation through warnings can even increase its spread [115, 116]. Information is also considered to be more credible when arguments are made for different sides of a point of contention. However, this rule of thumb depends on the extent to which the ability to think flexibly is pronounced among the beneficials [65, 117].
In the field of health communication, the research situation on trust has so far been rather thin; most of the analyses are limited to overall measures of “Internet” and “trust” without differentiating the formats and concepts [63, 118]. In Germany, Sarah Fischer [119] empirically investigated the influence of the type of information source and scientific uncertainty on trust in health services on the Internet with two studies. And Yeolib Kim [64] found in a systematic literature review up to 2013 only 20 English language studies that used differentiated measures of trust in Web sites. And he classified the factors that determine trust into individual difference antecedents, Web site-related antecedents, and consumer-to-Web site interaction-related antecedents. And among the antecedents of trust, socio-demographics such as age, gender, and perceived health status, information quality, design, and perceived reputation of a Web site have been analyzed most frequently, but without consistent results. Sbaffi und Rowley [66] analyzed 34 studies until 2015. And they also were not able to find uniform results. Besides the role of information quality as a factor for the credibility of web-based health information, health literacy [70, 75] seems to influence perceived trust as well.
“Literacy” is a rather broad theoretical concept from diverse disciplines that constitutes a heterogeneous and complex research topic [67, 69, 70, 73, 74, 75, 120, 121]. It includes different subtypes that are strongly interconnected [71]: 1) traditional literacy as ability to understand texts, 2) health literacy together with eHealth literacy as ability to understand and process health information in everyday life as well as in the Internet and social media, 3) computer literacy as ability to use computer hardware and software, 4) science literacy as ability to understand scientific research and results, 5) media literacy as ability to access, understand, and use media content and its quality, and 6) information literacy as ability to know, use, estimate and process information. And health literacy and online health literacy, labeled as eHealth literacy, are strongly interconnected, not at least because most people today access, receive, and process health information not only by interpersonal communication in the form of conversations or the classic journalistic media such as newspapers, radio, or television, but as well by the Internet and social media.
So it is not surprising, that many definitions of eHealth literacy exist: According to Gunther Eysenbach [32], “e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.” In contrast, Cameron D. Norman and Harvey A. Skinner [122] defined eHealth literacy in a more concise way as the “ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem.” Not surprising, the concept of eHealth got many definitions over time, and a systematic review by Hans Oh and his colleges [123] found 51 unique definitions according to different persons like health professionals, consumers of health services, or lay persons using the Internet. In addition, there have been many attempts to operationalize and measure eHealth literacy on the individual’s level, for example, in the form of literacy scales like eHEALS by Cameron D. Norman and Harvey A. Sinner [122]. But there is critique that the empirical measurement of (health) literacy was and still is mostly not based on a theoretical background, and literacy together with eHealth literacy is mostly measured based on subjective ratings by individuals and not on an objective factual basis. In addition, there still is not the so-called gold standard of measurement. And another weakness is that medical professionals have been only weak included in the process of definition and measurement of ehealth literacy [71].
As a significant factor in the field of health communication, eHealth literacy has been investigated and still is in many empirical studies. But most studies are measuring the level of eHealth literacy hold by the citizens of a specific population or by subgroups of a population only in a descriptive way, and especially in survey studies only as subjective assessment. As an example, the Flash Eurobarometer 404 survey investigated “European Citizens’ Digital Health Literacy” with the following key insights by the European Commission in 2014 [23]: 1) Around six out of 10 respondents and 75% of the Internet users (80% of the population) had searched online for health-related information within the last year, the highest in the 25–34 age group. 2) Over three quarters of all respondents agreed that the Internet was a good tool for improving their knowledge of health-related topics. 3) Nearly 9 out of 10 people who looked for health information online said they were satisfied with the information they found. 4) Eight out of 10 people thought that the health-related information they found online was useful and that it was easy to understand. 5) And even more than 9 out of 10 respondents agree that their research on the Internet helps them improve their knowledge of health-related topics. 6) Over 80% agreed that they know where to find reliable health-related information on the Internet, and even 90% agreed that they know how to use the health-related information they found on the Internet. 7) But still 40% did not think the information came from a trustworthy source and did not trust information from the Internet to make health-related decisions. These results indicate an overall high level of online health literacy but can also be interpreted as an uncritically overestimation by many persons.
Beyond that, there has been the question if eHealth literacy as a significant independent factor is influencing whether an online health content is perceived and evaluated as useful and credible [75], a layout as aesthetically satisfying, or a media source or sender is perceived as trustworthy or not [70]. And besides empirical research, in practice there have been many interventions in the form of programs to improve the eHealth literacy of potential user groups like older adults [124]. The underlying goal especially in media education at school is learning how to deal with media by enhancing media knowledge and media competency of the pupils in form of skills to judge media reality more critically and, for example, to detect Fake News [125, 126].
Besides trust and eHealth literacy, there are additional factors influencing health online communication. Demographics of persons and target groups such as age, gender, or education on the one hand, and the personal context of online use on the other hand also have an impact on the accessibility of the users as well as the use and appraisal of online offerings. And the significance of each factor depends not least on the personal context of health online usage. Older people for instance may not have access to the Internet together with the necessary skills to use eHealth. Otherwise, many young people today are particularly well accessible via an entry in their Instagram feed, which is scrolled through around lunch. In order to be considered in this context—for example with information on the effects of alcohol—a health campaign, for example, must be able to attract formal attention and interest in terms of content and be able to be captured in a very short time as well: This is not least because in this context of use the attention span is narrow and cognitive processing is rather superficial. On the other hand, young people are informed about a particular topic, for example, about the effects of alcohol on the occasion of a lecture at school, and seriousness, comprehensibility, and scope of information come to the fore. In this context, the ELM-Elaboration-Likelhood Model [127, 128] is distinguishing two contrasting “routes of information processing”: A central and in-depth processing deals discursively with the arguments of a message, while a peripheral and superficial processing is oriented toward images and emotions. The consideration of such and other factors as well as the corresponding theoretical perspectives allows a more efficient approach of the respective target groups. A comprehensive model for online communication in the health sector would have to systematically integrate these conditional mediating factors and processes for seeking, accessing, and handling health information on the Internet as precondition of health behavior.
Valuable and useful information about mediating personal factors of health information-seeking behavior can be found in various models and theoretical perspectives of social psychology such as the Theory of Planned Behavior [129, 130] or the Social Capital Concept [131], and in communication science the ELM Model [127] or in health sciences [132] the Health Belief Model [133, 134] or the Protection Motivation Theory [135, 136], which deal specifically with health-related factors such as the magnitude of threat of a health problem and the vulnerability of people, together with costs and barriers but as well the usefulness and motivation of health behavior based on personal self-efficacy and coping assessment of how to deal with health risks. Not least the so-called Transtheoretical Model [137] also is of relevance for addressing the respective target groups, which distinguishes process-oriented six different stages of change in the management of health problems in which a person is looking for health information on the Internet as precontemplation, contemplation, preparation, action, maintenance, and termination.
This contribution—initiated by Salaschek & Bonfadelli in 2020 [138]—provides an application-oriented overview of the development of digital health communication in the face of the Internet and Social Media, with a focus on online search for health information and its reception and effects, influenced by factors such as credibility and trust of health offerings by media and medicine, together with eHealth literacy as necessary precondition. In the studies carried out for this purpose, the user experience and skills on the side of the Internet audience, and the perceived quality and credibility on the side of the offerings of online health information are emphasized.
This results in practical challenges for providers of health information on the Internet and Social Media, but also for the planning and implementation of prevention marketing [68] and online health communication campaigns [93, 94, 95, 139], in order to still reliably reach the target groups in the new and constantly changing digital environment with informative, interesting, and convincing tailored health information that is perceived as useful and trustworthy [140] and should not deepen existing social inequalities [8]. And last but not the least, empirical evidence-based evaluations for quality assurance [141, 142, 143] play an important role for online health services, but also (certified) quality labels for websites such as the quality label “Health On the Net” (HON) based on criteria such as expert knowledge, data protection, transparency, and balance [144].
In addition to the active reception and implementation of the existing knowledge in communication practice [145], and in view of the existing shortcomings, further basic research on factors such as user experience, trust, and credibility of target groups of new interactive digital formats is important, especially for interactive communication on Web 2.0 [146]. And for application-oriented, various questions play a role, for which there is still too little reliable knowledge: In which reception context which target group can best be addressed with which formats? Or: What is needed to achieve trust, acceptance, and implementation in different user segments? Such research questions should take up the existing diverse practical experience, examine, and systematize evidence-based, to be able to communicate online more effectively and efficiently on health issues in the future. This is relevant not least because individual target groups like young people can already be reached almost exclusively online. But despite the ubiquity of the Internet, successful health communication will have to continue to work in future on an evidence-based basis with a combination of online and offline channels and offerings.
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Written By
Heinz Bonfadelli
Submitted: 22 May 2022Reviewed: 14 June 2022Published: 08 February 2023
Open access peer-reviewed chapter
