1. Online health information and use of online health services among the chronically ill in Israel Rita Mano University of Haifa Cologne, March 2015

2. Research Purpose I.Focus on CD individuals. II.Tap into OHI behavior for CD individuals III.Predict OHS for CD individuals IV.Control for socioeconomic variations

3. Research Framework use of online health services chronic illness use of online health information

4. Communication Studies Media- Synchronicity theory: “the Internet support synchronous and coordinated exchange of information (Dennis, Fuller & Valacich, 2008). Media-System Dependency: “dependency on a specific CMC medium will expand use into additional media” (Baran & Davis, 2000).

5. Psychological focus Self-efficacy approach (Bandura, 1997 ) Social-cognitive means to improve health (Bandura, 2004) Desired outcomes do not necessarily lead to additional action Health empowerment (Dutta-Bergman, 2006). Motivation to search for OHI -medications, symptoms,cure (Dutta- Bergman, 2006) Health consumers seek optimal health behaviors (Fox et al. 2005)

6. Sociological perspective Digital divide hypothesis (Korp, 2006): (a) increases gaps in health literacy (b) increases gaps in OHS Social diversification hypothesis (Mesch, Mano & Tsamir, 2012): (a) decreases gaps in health literacy (b) diminishes gaps in OHS

7. An interdisciplinary approach The study draws upon: (a) communication theories (b) health empowerment models (cf: Bandura, 2004; Dutta-Berman, 2006) © social diversification approach (Mesch et al., 2012).

8. Hypotheses Chronic disease (CD) OHIOHS

9. Methods First level  Basic sample: N=4001 representative by (a) geographic location (b) language / ethnicity (Hebrew, Russian or Arabic). Full questionnaires : N=2,008 (50.2%) Second stage  Sample Internet users: N= 1,406 (67.6%)  OHI seekers: N=633 (45.0%)  CD: N=255 (33.2%)

10. Findings It is shown that:  CD increases use of OHI  CD differential effect for OHS Hypertension OHS Heart condition OHS

11. Theory contribution CD relationship to Internet No support for communication models (media-dependency hypothesis). Partial support for psychological models (self- efficacy, health empowerment only for OHI). Partial support for social diversification hypothesis (OHS vary by CD type). Indication for developing interdisciplinary models

12. Practice contribution OHS is a growing area for health prevention and health promotion. If CD does not ensure OHS, “second level” digital divide effects are possible. CD will be the source for gaps in health outcomes (lack in quality of self-management, lower health care quality, larger gaps in the future).

13. Thank you !!!