This literature search resulted in 46 unique definitions in 44 articles of Health 2.0/Medicine 2.0 in scientific databases and gray literature on the Internet. We distinguished seven recurrent topics: Web 2.0/technology, patients, professionals, social networking, health information/content, collaboration, and change of health care.
This study showed that the use of the terminology differed among the definitions mentioned in literature. The term Health 2.0 was included in 42 definitions, 10 definitions mentioned Medicine 2.0, and 6 definitions described Health 2.0 and Medicine 2.0 as equal. There were 36 definitions that only mentioned the term Health 2.0, and only 4 definitions that described Medicine 2.0. Although some authors indicated that little or no differences existed between the two terms [16
], others saw differences, for example that Medicine 2.0 is focused on the relation between professionals and patients whereas Health 2.0 is focused on health care in general [17
]. As most definitions described Health 2.0, this term may be more widely used and accepted than Medicine 2.0.
Overall, we found that the term Web 2.0 was mentioned often: 33 authors used the term directly in the definition, which suggests that they accepted this concept. However, others state that Web 2.0 does not exist at all [72
]. Authors’ interpretations of the meaning of Web 2.0 influenced their definitions of Health 2.0/Medicine 2.0 profoundly. We generally distinguished two meanings of Web 2.0. The first meaning is that Web 2.0 is a set or “mashing” (ie, a combination) of technological developments [51
]. The second meaning is that Web 2.0 is a new generation of the Internet where interaction is important, with more user-generated content that empowers people. In this interpretation, technology, or the mashing of different technologies, is only a tool, and Web 2.0 is more than technology. These meanings result in different definitions of Health 2.0/Medicine 2.0. A number of definitions referred to the technological developments embedded in health care, whereas other definitions stated that Health 2.0/Medicine 2.0 is a new generation of health care. We believe Web 2.0 is a facilitator for Health 2.0/Medicine 2.0, but not a necessity. Indeed, patients can still access health related information without Web 2.0; for example, a patient can go to a library and become well-informed without Web 2.0 technology. However, this would be far more difficult than becoming well-informed through the use of Web 2.0 technology. Second, the topic of stakeholders reflects who the main players are in the field of Health 2.0/Medicine 2.0. The two main stakeholders we distinguished were patients or consumers, mentioned in 35 definitions, and professionals or caregivers, mentioned in 26 definitions. Interestingly, other stakeholders such as payers of health care, scientists, students, and entrepreneurs were mentioned less frequently, whereas the government was only mentioned once. This is particularly interesting as the government has great influence on health care and changes in health care. Apparently the government is not yet an active party in the development of Health 2.0/Medicine 2.0.
Also interesting was that most definitions focused on the relation between patients and professionals. With Health 2.0/Medicine 2.0, patients and professionals were seen to collaborate, with patients transforming their role in health care using social networks and access to health information. Moreover, other relationships might also change; for example, the appearance of online communities could change the relationship between health professionals and specific groups of patients. This has been termed collaborative health care [18
Finally, it is expected that Health 2.0/Medicine 2.0 will lead to change of health care. Expectations concerning the speed of this change ranged from a “gradual shift” [27
], an “ever changing” [66
] or “continuous interactive process” [49
] to “revolution” [55
]. However, we advise caution in assuming that a revolution has taken place [27
]. It may be that communication, information exchange, and patients’ contribution to his or her care has improved or accelerated, but according to Engelen [8
], no fundamental changes in health care have yet occurred.
Authors of a Health 2.0/Medicine 2.0 definition generally seemed to approach the definition from their own perspective. For example, patients or patient federations saw patients as the main stakeholder and focused on empowerment of the patient. That is, definitions may be influenced by different stakeholders’ agendas. Therefore, it is important for future Health 2.0/Medicine 2.0 researchers to incorporate all stakeholders and thereby include all possible views and perspectives.
Our study has some limitations. First, we found 46 unique definitions, mostly in the gray literature, using the Internet. Only 9 definitions were found in peer-reviewed articles in the scientific literature. This can be explained by the fact that Health 2.0/Medicine 2.0 is a relatively new concept and is still developing. However, it is important to realize there is no evidence-based method available to determine the quality of online content yet. Consequently, proper assessment of the value of the definitions we found was not possible.
Second, it appeared that searches using Google, Bing, and Yahoo showed many results. Although these search engines displayed results by relevance using algorithms and ranking systems, we may have missed unique definitions as we only studied the first 100 results.
Finally, the exact way search engines display results remains unclear. The process can be seen as a black box. As a result, reproduction of searches is far from optimal, as the results literally change every second. Therefore, one might question the suitability of these search engines for scientific research. However, by combining the results of Google, Bing, and Yahoo and using four search queries, we believe we found the majority of all relevant definitions in the gray literature.
Health 2.0/Medicine 2.0 is still a developing concept. Our study identified 46 unique definitions of Health 2.0 and Medicine 2.0 with seven recurrent topics: Web 2.0/technology, patients, professionals, social networking, health information/content, collaboration, and change of health care. There is no general consensus of the definition of Health 2.0/Medicine 2.0 yet. We hope that this study will contribute to building the concept of Health 2.0/Medicine 2.0 and facilitate future discussion and research to achieve a clear conceptual framework.