Information about health online has grown explosively with the rest of the Internet. But that doesn't mean everything out there is good. One area that has grown is so-called interactive health communication applications—whole packages of computer-based health help for patients that include information and some kind of support, such as a way for you to discuss your illness with other patients, help changing your behavior, or help making decisions. The Cochrane Collaboration has published a review article on these applications, looking at their potential for help and harm.

What the researchers wanted to know: Do interactive health communication applications help people with chronic diseases?

What they did: The researchers searched for published and unpublished studies of computer-based packages; they came up with 28 randomized controlled trials, involving more than 4,000 patients. (In a randomized controlled trial, patients are randomly assigned to get the treatment—in this case, using the computer program‑or not.) Each study tested a particular interactive health communication application, for a condition such as asthma or diabetes. For each trial, the reviewers were looking at whether the patients came out knowing more and feeling better, and also at whether their disease improved or worsened. Chronic diseases are particularly well suited to interactive health communication applications, because people with chronic diseases are, by definition, sick for a long time. This can be frustrating or depressing, and it's also hard work; they may have to manage their disease with medications or diet.

What they found: People who used the computer programs knew more about their disease, on average, than people who didn't; they also had better social support. But healthwise, they actually did a little worse, on average, than people who didn't use the computer applications. The patients who weren't using computers got different information in different studies—in some studies, they got no help besides their regular treatment for the disease, while others were given brochures, verbal education, or other help. Not all the applications were bad, though; four of the 11 studies that looked at the patients' health found that patients using the computer application did better.

What the study means to you: The negative effects of some computer applications on health are quite a surprise. It could be that people who have all that support feel more reassured than they should or are more likely to search for more information and come across the vast quantities of bad health information that appear on the Internet. Or maybe it's just difficult to write a good interactive health application.

Caveats: Since the patients in four of the studies did better while using the computer applications, this evidence could safely be called "mixed." The studies being compared varied widely in design. More research might help show what kinds of applications work best; maybe the applications tested in those four studies were better, and other designers could learn from them.

Find out more: Several years ago, the U.S. Department of Health and Human Services convened a scientific panel to discuss these health applications, including their potential for harm.

Read the article: Murray, E., Burns, J., See Tai, S., Lair, R., and I. Nazareth. "Interactive Health Communication Applications for People with Chronic Disease." Cochrane Database of Systematic Reviews. October 2004, Vol. 18, No. 4.

Abstract online: www.ncbi.nlm.nih.gov