Compra de los espacios publicitarios en televisión

The internet has also been explored as an interactional resource. Rather than assessing information, this research draws on users’ contributions in social spaces, such as forums, blogs or personal websites, to explore discourses around particular health issues (Hardey, 1999, Pitts, 2004, Adams, 2010a). This approach not only offers alternative data sources for accessing people’s experiences of health and illness but also provides an opportunity to explore how the online environment impacts on these experiences. A number of methods of analysis are used in interpretation of this type of data. Seale et al. (2006) have used a novel method of keyword comparative analysis; Gavin and colleagues (Gavin et al., 2008) used interpretative phenomenological analysis (IPA) and other researchers have employed discourse analysis (Guise et al., 2010). Many of these studies move away from questioning the quality of medical information online and instead focus on how health and illness is understood and enacted in online spaces (Hardey, 1999, Nettleton et al., 2005).

Exploring the online publication of health narratives by users has altered over the lifecourse of the internet. A number of studies have provided insights into the earliest modes of online user contribution, the personal homepage, and the possibilities for empowerment such websites provide. One of the earliest studies, which focused on users’ health-related homepages as a new site for the publication of illness narratives, explored how users drew on established medical information, personal experiences and commercial resources throughout their accounts (Hardey, 1999). The range and diversity of these accounts, highlighted by the study, suggests that the internet presents a particular opportunity for the shifting of boundaries around medical knowledge and expertise. A similar study, which

32 focused on women’s accounts of breast cancer in online spaces, attempts to interrogate the empowering or emancipatory notion which this re-drawing of boundaries implies (Pitts, 2004). Pitts’ analysis suggests that the processes of empowerment are complex and that in online spaces feminine norms are often reproduced rather than challenged. Her exploration highlights the alternative, and perhaps more realistic, portrayals of women’s femininity, bodies and disease that user-generated personal websites feature, but also draws attention to the compounding of social pressures on women to portray optimistic and resilient selves. The internet as an empowering space, therefore, is a notion which can be usefully analysed through research around user-generated health content and one which has been highlighted as overly simplistic in some cases.

More recently, the mechanisms by which users contribute health-related content have altered. Maintaining personal websites or homepages has been superseded by the production of content through a range of social media technologies.

Contemporary research which considers the internet as an interactional resource acknowledges this dynamic environment. Quantitative content analysis has been used to describe the diversity of health-related pages on Facebook, suggesting that marketing, patient awareness and information, and support are all represented on Facebook pages for a wide range of health issues, with AIDS generating the most marketing pages and cancer the most support pages (Hale et al., 2014).

Furthermore, weblogs or ‘blogs’ have been explored for the alternative possibilities they offer to individuals interested in health and healthcare in developing understandings of their own and others’ health. A preliminary study by Adams (2010a) presents two case-studies of blog-based applications utilised for health purposes, and raises a number of questions for future research and health-related policy. Her study suggests the advent of ‘web 2.0’ and proliferation of social media technologies make the processes of publishing health and illness accounts simpler and more accessible. This offers: diverse sources of information to users;

alternative means of constructing health and illness for users; and new opportunities for health promotion and health care. Although narratives of health and illness have always been of medical and sociological interest, the shifting

33 opportunities presented by dynamic online technologies foster novel means of creating and disseminating these accounts which present extensions to abiding questions around identity construction, health experience and social relations.

The presentation of individuals’ identities and meanings around health and illness has also been explored through interactional data from online sources. Analyses of participants’ interactions within online support groups and forums have provided particularly useful insights into groups’ shared understandings and constructions of health and illness in a number of contexts. Both contested illnesses, such as chronic fatigue syndrome (CFS), and culturally stigmatised illnesses, such as anorexia nervosa, have been researched in this way. Gavin and colleagues’ (2008) study focused on pro-anorexia forums used by women. Their findings suggest that in the interactions they studied, anorexia was constructed as a lifestyle choice rather than an illness. The users’ presentation of themselves as healthy women, striving for weight-loss, in a supportive space which was private from the judgemental public sphere, suggests the importance of improving understanding of the social pressures around anorexia and maintaining awareness of online spaces as sites where meanings and identities around anorexia are co-constructed. Alongside highlighting alternative representations of health and illness on the internet this type of research provides useful insights for practitioners, who might otherwise not gain access to these perspectives. Similarly important insights for practice are suggested by Guise et al.’s (2010) study of individuals with CFS. In this study, users posted about their experiences of interactions with health professionals. Guise’s analysis suggests users discussing CFS online draw on discourses around the ‘good’

patient. By presenting themselves as positive and active actors in maintaining their health, forum users rejected overtly negative accounts of health professionals and, in doing so, constructions of themselves as troublesome patients. These studies suggest that research which observes online accounts and users’ interactions around particular health issues, either covertly or openly, can inform the development of good practice around particular groups of patients, by emphasising particular constructions of identity and promoting sensitivity to these.

34 Another alternative body of research which draws on pre-existing online data, is the exploration of internet users’ health behaviours through personal and social data they post online (e.g. on social networking sites). In particular this research has been promoted as a means of identifying ‘risk behaviours’ in young people (Pujazon-Zazik and Park, 2010). For example, Griffiths and Casswell’s (2010) analysis of alcohol-related user-generated content on Bebo profiles of 16 to 18 year olds found that the online environment provided by social networking sites is permeated with references to alcohol, which may be contributing to the normalisation of underage drinking. Similarly, Moreno and colleagues (Moreno et al., 2009, Moreno et al., 2010a, Moreno et al., 2010b) conducted a series of studies into the content of social networking profiles focusing on various risk behaviours.

The authors examined alcohol references on MySpace and suggested that explicit references to alcohol are commonplace on young people’s social networking profiles and could, therefore, be influential across peer groups (Moreno et al., 2010a). Sexual references across user-defined friendship groups were also examined and the authors suggested that those young people who make references to sex on their profile are more likely to be friends with others who make similar references (Moreno et al., 2010b). Similarly, an analysis of blogs has been successfully used to help identify teenagers with depression, which could help engage teenagers suffering depression with social agencies (Goh and Huang, 2009).

In these studies, social media have been utilised as a source of interactional data to provide insight into young people’s risk behaviours particularly in relation to their social networks, made all the more visible through social networking sites.

As a result of the incorporation of the internet into people’s everyday lives (Wellman and Haythornthwaite, 2002) and the increasing incorporation of social media into many young people’s social lives (Williams and Merten, 2009), health interventions are beginning to utilise the interactional properties of the internet to promote young people’s engagement with health issues (Hyden and Cohall, 2011).

Much of the research around using social media for health interventions focuses on particular groups, which are broadly affiliated with social media technologies or have been considered ‘hard-to-reach’. Indeed, some have suggested that the

35 potential of social media lies explicitly in addressing existing health inequalities, by capitalising on existing communication pathways within specific groups which are made visible through social networking sites (Gibbons et al., 2011). For instance Ralph and colleagues’ (2011) study title, ‘Finding teens in TheirSpace’, reflects the intention of health communicators to relocate existing health promotion materials to sites which are more relevant to young people. Their research with low-income families in the US suggests that high-levels of internet access, high levels of presence on social networking websites, and pre-existing use of the internet for health information all point towards using social media for health information dissemination. The authors of one review synthesise a range of research literatures to suggest that social media technologies may also be a useful and socially acceptable way for young men in the UK to access to health-related resources (Robinson and Robertson, 2010).

While the potential and importance of developing a presence for health promotion in online spaces is well-noted, the complexities for utilising social media in this context are not fully explored in the literature. Studies which explore the acceptability and desirability of delivering health interventions through social media to specific target groups seem to be lacking in the literature. One of the few articles which explicitly details the process of attempting to comprehensively use social media marketing techniques for health intervention describes the process of developing and maintaining two arms of a health promotion campaign aimed at young people and men who have sex with men respectively. Gold and colleagues (2012) provide insights from their successful attempt to utilise social media which reflect the range of expertise needed and the importance of consistent evaluation.

However, few studies have successfully evaluated the use of social media for health promotion and intervention.

Some of the potential opportunities for research around health and the internet build on these studies around online interaction and health. As highlighted by a number of authors, these studies do not provide insight into the offline identities and experiences of individuals (Pitts, 2004). Much of this research would be usefully complemented by studies of users’ or potential users’ perceptions of

36 content, as well as exploring the consequences of engagement with online health resources, whether professionally produced as interventions or naturally occurring in user-generated content.