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The digital divide, health information and everyday life
Sally Wyatt, Flis Henwood, Angie Hart and Julie Smith The online version of this article can be found at: can be found at:
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2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Copyright 2005 SAGE PublicationsLondon, Thousand Oaks, CA and New DelhiVol7(2):199–218 [DOI: 10.1177/1461444805050747] The digital divide, healthinformation and everydaylife FLIS HENWOODANGIE HARTJULIE SMITHUniversity of Brighton Survey data confirms that health information is very popular with internet users yet relatively little qualitative social science research has been conducted about how people incorporate information from the internet into their everyday information practices. This article reports on an empirical study of the role of the internet in people’s efforts to inform themselves about menopause and hormone replacement therapy (HRT) in the case of women, and erectile dysfunction and Viagra in the case of men. These experiences are used to interrogate the notion of the ‘digital divide’. We develop the concept of access to incorporate not only physical connection and information literacy, but also gendered and generational social relations.
We also develop Barkardjieva’s concept of the ‘warm expert’ to draw attention to the different types of information that people need in order to make sense of generic medical information that is relevant to their own circumstances.
access • digital divide • everyday life • health information • 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
INTRODUCTION: A STORYIt is a dark and stormy evening. The library where Janet works is closedto staff and students. Only now can Janet go online for herself rather thanto track down references for others. She wants to buy some books and CDsand maybe order some more vitamin pills. Last month she bought somenatural progesterone cream online but has not yet tried it, so there is noneed to buy any more just yet.
Recently, Janet was diagnosed with breast cancer. This was a particular blow because she had cervical cancer a few years ago and needed to have ahysterectomy. Immediately after, both the surgeon and her family doctorrecommended that she start hormone replacement therapy (HRT). Shereally did not want to because she is a vegetarian and does not like takingsuch powerful drugs, especially as she was not actually experiencing anymenopausal symptoms. About 18 months later, she started to feel quitetired, so she talked with her doctor about taking some low dosage HRTpatches, a form of HRT which is similar to that which smokers use whenthey want to quit. She tried just one patch a month but it did not domuch, so she upped the dosage. The headaches were terrible, so she rippedoff the patch and has not used anything since. Maybe she will try thatnatural progesterone cream she bought via the web from the US.
Janet does not discuss her health with many people. She does not want to worry her children so does not talk with them. She does talk to her sister,and to a male friend who shares her interests in alternative health. She alsotalks with both her doctor and her homoeopath. The latter is more helpfulbecause he has more time to listen to her than the doctor, who is onlysupposed to talk to her for six minutes according to the guidelines issued bythe UK Department of Health.
She likes the internet because it is there when you need it, unlike the alternative health magazines she buys every month. She likes the variety ofinformation online, even though it can be bewildering. Even though she isa professional librarian, she tends to see where search engines take her whenshe is looking up information for herself, although she is careful to payattention to who put the information up there. Janet does have a computerwith an internet connection at home, but her 20-year-old son uses that soshe prefers to stay late at work when she wants to do something online forherself.
Janet’s story illustrates some of the problems associated with the single mostimportant public policy debate about the internet, the so-called ‘digitaldivide’. The digital divide has become the overarching concept to captureunequal access to information and communication technologies (ICTs) atglobal and local levels. There are huge gaps between more and less 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Wyatt et al: The digital divide and everyday life industrialized countries. For example, the United Nations DevelopmentProgram (UNDP) reports that Organization for Economic Cooperation andDevelopment (OECD) countries have 332 internet users per 1000 peoplebut developing countries have only 26.5 users per 1000 people (UNDP,2003).1 Even within relatively rich countries such as the United States andEU Member States, concern is expressed about the ways in which somegroups are particularly vulnerable to digital exclusion. These groups includethe unemployed, people with low levels of education or income, ethnicminorities, immigrants, refugees, women and the elderly. This type ofanalysis, based on summary data, points to a potentially important source ofinequality and disadvantage, but it masks the everyday experiences of peoplelooking for information and communicating with one another. It is theseexperiences that this article brings to the fore, in order to questiongeneralizations about the digital divide.
Janet is 51, and certainly not elderly. Nonetheless, she is an older woman and a single parent. She does not fit the stereotype of the young, maleinternet user and because of her age and gender, policymakers sometimesexpress concern that she may be one of the digitally excluded. Janet’sexperiences highlight the central argument of this article. First, her domesticsituation illustrates how the availability of technology in the home does notnecessarily mean that it is used there; in her case, because her son dominatesthe use of the home machine. Second, given her professional training she isnot particularly in need of help in finding information, nonetheless evenwith her training she sometimes finds health information bewildering. Later,we will introduce the concept of the ‘warm expert’ in order to drawattention to the range of skills that people need in order to be able to makesense of complex information.
In this article, we draw on Janet’s story and those of others in order to explore the role of the internet in people’s efforts to inform themselvesabout menopause and HRT in the case of women, and erectile dysfunctionand Viagra in the case of men. In the next section, we provide somebroader context about online health information in order to locateindividual experiences and we introduce two related themes central to ourargument about the digital divide: access and the role of the warm expert infacilitating access. We then describe the study and provide some summaryinformation about our participants before looking at more individualexperiences.
THE DIGITAL DIVIDE: POLICY CONSTRUCT AND LIVED REALITYThe development of the world wide web and the increasingcommercialization of the internet began in the mid-1990s, making this hugenetwork of information sources and communication possibilities available toever-growing numbers of people (Castells, 1996, 2001; Slevin, 2000; 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Thomas and Wyatt, 1999). Many extreme claims, positive and negative, havebeen made about the social, economic, cultural and political implications ofthis rapid diffusion. However, since the collapse of the dot com boom, moremoderation is being expressed, as industrialists, policymakers and researchersremember that technological potentialities do not always translate into useand practice, and that new technologies are always introduced into existingsocial practices.2 Two genres of body-related material have proved verypopular with large sections of the internet population, namely pornographyand health information. Internet research has also burgeoned in this periodbut, perhaps surprisingly, relatively little qualitative social science research hasbeen conducted about either of these topics,3 although survey data confirmtheir importance.
The most extensive internet data is about the US situation. Within Europe we continue to look to the US to see what an internet future mightlook like, even though the social, political and economic context of the USis very different from Europe, especially in terms of the organization ofhealth care delivery. On the basis of US data, Castells (2001) and Compaine(2001) go so far as to conclude that the digital divide is a temporaryproblem which will disappear as equipment becomes cheaper, and that thiswill be the case not only within the US but also globally. The digital dividehas become a catch-all concept to frame unequal access to technologies,both globally and locally. Cammaerts et al. (2004) argue that dominantdiscourses concerning the digital divide represent the unequal distribution ofaccess to technology, content and capabilities as a linear and monocausalrelationship, whereby not having access automatically leads to social, politicaland economic exclusion. Elsewhere, some of us (Henwood et al., 2000)have, like Cammaerts et al. (2004) and Mansell (2002), questioned thesesimple equations of digital inclusion with social inclusion and technologicalprogress with social progress. It is important to understand the ways inwhich much digital divide policy and literature relies both on its binarystructure and its appeal to technological determinism in order to mobilizepolicy resources (Gunkel, 2003).
Anticipating Hargittai’s (2004) call to find out more about non-users, Wyatt et al. (2002) have gone so far as to suggest that some people mightchoose not to use the internet and that this choice does not always reflect aposition of disadvantage. They identify four categories of non-use: (1) the resisters – those who have never used the internet because (2) the rejecters – those who have stopped using the internet voluntarily, perhaps because they find it boring or expensive; (3) the excluded – those who have never had access but would like 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Wyatt et al: The digital divide and everyday life (4) the expelled – those who have lost access involuntarily.
These are the digitally excluded, but the first two groups may well be exercising agency in choosing not to have access and should not simply bedismissed as ‘laggards’ or ‘luddites’.
A problem with much of the literature about the digital divide, including Wyatt et al. (2002), is that it remains at an abstract level by focusing on thegeneric or ideal user without examining the everyday practices of peoplelooking for information, and if and how the internet is inserted into thosepractices. Increasingly, large-scale studies such as the Pew Internet andAmerican Life Project and the Oxford Internet Survey are developing morenuanced measures of internet use. Academic analyses, such as Katz and Rice(2002), which draw upon these and similar forms of analysis have much tooffer in understanding the ways in which larger patterns of use change overtime. However, these types of analysis need to be complemented by analysesof the everyday experiences of users in order to understand better themultiple and varied nature of both access and the digital divide.
In March 2002, the Pew Internet and American Life Project conducted a survey of US-based internet users. They conclude that 62 percent ofinternet users (73 million people) have used the internet as a source ofhealth information, which is up from 52 million in November 2000 (Foxand Rainie, 2002). Thus, on any single day more people go online forhealth information than visit their own doctors. Datamonitor, a commercialconsultancy organization, also published a report in 2002 about onlinehealth information, based on a survey of 4500 adults living in Europe aswell as the US. They found that of those who looked for health informationin the past year, 57 percent went online, compared with 76 percent whoconsulted their doctors, 73 percent who used mass media and 53 percentwho talked with friends and family.4 They also find that women and peopleunder 55 are more likely to consult online sites than men and people olderthan 55 (BBC, 2002; Datamonitor, 2002). As with all statistics about theinternet, these two surveys are inconsistent with each other and need to betreated with caution. Much internet data is produced by commercialorganizations with a strong interest in promoting sales of internetequipment, products and services (Jordan, 2001). Indeed, the conclusions ofthe Datamonitor report are all about the implications for industry and thereport itself costs US$1900.
Figures such as these clearly indicate that health information is important and interesting for internet users. Such data provides a profile of the genericuser, of interest especially to pharmaceutical companies, health carepractitioners and policymakers. It can be used to support the widespreadassumptions in policy literature, as well as in medical sociology and internetstudies, that the greater availability of information via the internet 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
necessarily leads to more informed patients and more equal patient–providerrelationships. However, such data do not reveal anything about the situatedpractices and everyday experiences of people grappling with their health andwith a multiplicity of information sources, and it is those experiences whichare the focus of this article.
In the past decade, everyday life has come more to the fore within technology studies (Bakardjieva and Smith, 2001; Lie and Sørensen, 1996;Silverstone and Hirsch, 1992). Instead of focusing on sites of production andwork-related uses of technologies, scholars have drawn attention to theeveryday practices in which uses and meanings of technologies arenegotiated, appropriated and lived by ‘ordinary’ people. This does not meanthat private or household use becomes the sole locus of study, but rather thefocus is on the individual who negotiates meanings and practices in a varietyof settings. Clearly, this work builds on the insights of Bourdieu (1977,1984) and de Certeau (1984) by taking seriously both the symbolic andmaterial nature of artefacts and the roles of both in producing socialrelations. We share with them a concern for inequality and its reproductionas well as a perception of the active nature of consumption, and thepossibilities for resistance that people can exercise in their daily lives. In thefollowing pages, we are concerned primarily with gender and generationaldifferences as they are articulated in everyday practices of internet use.
We begin with the individual internet user, following Turkle (1995) and Bakardjieva (2003). Whereas they focus, respectively, on the ways in whichpeople use the internet for games and on processes of domestication, wefocus specifically on whether and how the internet is incorporated intoeveryday practices for retrieving health information. We recognize thatpeople have a wide range of sources of health information available,including the mass media, health care professionals, family and friends. Weare interested in how the internet fits into these existing informationlandscapes and how it is incorporated into people’s constantly evolvingpractices.
We also draw on the work of Bakardjieva (2001) who introduces the notion of the ‘warm expert’ – someone with technical competence who isin a position to help a new internet user. A warm expert mediates betweenthe specialized knowledge and skills necessary to use the technology and thespecific situation and needs of the ‘novice’ with whom the warm ‘expert’has some kind of more personal relationship. In her study of internet users,Bakardjieva finds that warm experts are essential in assisting in the process oflearning and appropriation, even when novice users have followed formalcourses of instruction. Of course, this is not confined to ICT and nor is it acompletely new concept. First, for example, many people make use offriends, neighbours and relatives when learning to drive a car or installingtheir video recorder. Second, the value of informal learning has been shown 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Wyatt et al: The digital divide and everyday life repeatedly to be important for helping inexperienced users to becomefamiliar with the new machines in their midst (Stewart, 2003; Sørensen andStewart, 2002). In our study, we look at whether warm experts areimportant for our participants in helping them to gain access to theinternet. We also attempt to extend the concept by examining whether ornot people draw on warm experts or intermediaries (Ellis et al., 2002; Wuand Liu, 2003) to help them make sense of health information itself.
STUDY AND PARTICIPANTSWe drew upon the experiences of men and women living in the south-eastof England who were seeking to inform themselves about some of thehealth changes associated with ageing, specifically erectile dysfunction andmenopause, and their most widely-used treatments, namely Viagra5 andHRT.6 Neither menopause nor erectile dysfunction is acute or life-threatening, and symptoms can persist over a long period of time. Thus,people have time to inform themselves both about the condition andpossible treatments, should they so wish. We examine the ways in which theinternet is used as a medium for accessing and communicating healthinformation.
Interviews were conducted with 32 women and 15 men which included questions about their reasons for considering HRT or Viagra, theirunderstanding of how the medication works and their perception of itsadvantages and disadvantages. Participants were asked about their awarenessand use of alternative treatments. In addition, they were asked aboutwhether and how they looked for health information generally, as well asfor HRT, Viagra and other treatments for their symptoms. People wereasked where they look for and where they find information; by what meansthey find it; how they interpret and make sense of it both for themselvesand in negotiation with others, including in consultation with health carepractitioners. If people used the internet, they were asked for how long theyhad done so and for what purpose they used it. If they used it for findinghealth information, they were asked how they did this, as well as theadvantages and disadvantages of the internet as a source of information.
Nearly half of the participants – 16 women and five men – wereinterviewed a second time, six to nine months after the first interview, inorder to discuss any changes in health, treatment and information-seekingbehaviour.7 The women were recruited via a family doctor or gynaecological clinic in a city in the south-east of England. The men were recruited via a urologyclinic, psychosexual counselling service for men suffering from erectiledysfunction, or diabetes clinic. Women and men who are taking, haveconsidered taking, or have recently stopped taking HRT or Viagra wereconsidered for inclusion in the study. Interviews, each lasting between one 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
and two hours, were conducted between November 2001 and January 2003.
All interviews were audio-recorded and fully transcribed.8 Most interviewstook place within participants’ own homes, although some were conductedin offices located within healthcare settings.
Of the 32 women interviewed, the average age was 55, with the youngest being 39 and the oldest 73. Eighteen were in a relationship. The men wereolder, ranging from 54 to 81, with an average age of 66. Ten were currentlyin a relationship. Our sample included people from a range of socio-economic groups, with varied educational experience and qualifications.
Most, but not all, were heterosexual and most were white British.
It would be reassuring to believe that ageing is a ‘natural’ and unproblematic process, yet among both the male and female participants inthis study, the medical situations were often complex. The range ofsymptoms, the prescribed treatments and the after-effects that wereexperienced all varied. The possible sources of information were enormous.
So, how did our participants inform themselves about health matters? Alldrew more or less actively on a range of sources. For both men and women,the family doctor was the most important source. Family members, usuallywomen, were the second most frequently cited source, with friends,pharmacists and alternative practitioners also mentioned. The media usedincluded magazines, television, world wide web, self-help books, newspapersand other items such as leaflets from pharmacists or those provided bypharmaceutical companies with drugs. The most striking difference betweenthe women and the men is that women have much more diffuse socialnetworks, including family, friends, neighbours and colleagues, which theydraw upon to talk about their health, whereas men talk primarily with theirdoctors and sexual partners.
This overview provides some clues as to the everyday life experiences of these people as they try to live with and inform themselves about differentaspects of ageing. But let us now look more closely at some of them inorder to discover more about how the internet fits into their informationlandscapes, and to reflect on the extent to which the digital divide is a livedexperience by focusing on the conditions of access and the warm expert.
ACCESS: EQUIPMENT, SKILLS AND FEELINGS OF ‘WARMTH’Nine out of the 15 men had internet connections, though one had accessonly at his workplace where he was not allowed to use it for personalmatters. A few others were almost connected. One man had recently movedhouse and had not yet unpacked his PC or arranged reconnection with hisinternet service provider. Another had a new mobile phone with access, buthe had not yet figured out how it worked. Yet another, Roger, did getaccess to the world wide web via his wife’s work and with the help of herboss in order to find out about his health problems, but this was a one-off 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Wyatt et al: The digital divide and everyday life occurrence and did not prompt him to seek more regular internet access.
We will come back to Roger later. Of the 32 women, 24 had internetconnections at home and/or at work.9 Eight of the men and 20 of thewomen used the internet at home or work, but not all of them used it tofind health information: three of the men and 18 of the women did so.
Only two participants, one man and one woman, used the internet to visitonline communities related to their health problems. Neither of themactually participated in online discussions.10 Not all of the women with home internet connections used them; including Janet, introduced at the beginning of the article, whose homemachine was used mostly by her son. Barbara also talks about how her sonused to dominate the home machine but he recently left home to go touniversity, so now Barbara can get access. Unfortunately, her son did notclean up the machine before he left. She discusses this with quite somefeeling: I’ve had a teenage son around for years who has been hogging the internetand he won’t show me how to use it because I’m too slow. He’s actually justgone to university so I have actually this week been trying to get it up andrunning and sort it out but it’s in such a mess . . . The thing is, I turn it onand it takes 20 minutes to crank up . . . because he’s put so much junk onthere as they do, screensavers and this bit and that bit . . . I’ve got variousneighbours who keep promising to come round and help me, so I’m gettingclose to it. I’ve actually been on a basic course now. I don’t like it. I hate it. . . I have no interest in it at all. I just think it’s absolutely boring. Thethought of switching it on is like doing the ironing to me.
Even though Barbara’s son tried to construct her as an older woman with no interest in or ability to use either computers or the internet, Barbaraherself is resisting that construction. She understands why the machine isslow and has taken steps to inform herself further and develop her skills,through consulting neighbours and attending courses. She remainsambivalent and draws upon her domestic role when expressing her feelingsof lack of interest and boredom.
Other women talk about their male partners rather than their sons and recount how these men have computers with internet access in the home,but the women themselves never use it. For example, Betty explains howthere used to be a computer with an internet connection in the house, butit belonged to her ex-partner: He took it when he moved out. I haven’t got one any more . . . He used itmainly for work . . . I was going to think about starting to use it butunfortunately we split up.
2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
He’s got four computers upstairs. He does his work on them. He’s retired . . .
he’s an architect . . . and he does extensions and insides and all like that but hecan do it all on the computer. I wouldn’t know how to switch it on.
These examples reinforce the earlier point regarding the care with which large-scale surveys about access to the internet need to be interpreted. Thesewomen live, or have lived, in homes with connected computers, but forvarious reasons have not used it themselves. Access is not simply a matter ofkit and connections; nor is it only about providing people with theeducation and skills necessary to use the equipment. Access involves feelingcomfortable with the technology and not being afraid of it. It also involvesliving in a household where the sexual division of labour enables women toget involved with the machines.
A traditional gendered division of labour exists in many households, with male partners and sons using computers so that women either did not use itat all or were forced to find some other place where they could get access.
This gendering does not always follow stereotypical patterns, as in the caseof Peter. Peter is 66 and separated from his wife. He has four sons, two ofwhom live with him. Peter left school before he was 16, and had his ownsmall retail business until he retired shortly before the interview took place.
There is a connected computer in the house, but his sons use it. While hefeels some pressure to become a user, he says: I don’t use it. I can’t be bothered . . . I should use the computer more, I just, Idon’t know, I just can’t be bothered. I’m lazy about that. It’s not my sort ofthing. I’d rather pick up a phone and talk to somebody rather than send theman email which I find takes too long.
When prompted about earlier experiences with email, he replies: I don’t get on with it at all. I sort of mess up the thing. I either lose my lettersomehow, press the wrong button or it does not go through properly. Alwaysloads of trouble with them.
Peter’s preference for the immediacy and presence offered by the telephone, and his self-confessed incompetence in dealing with emailsuggests that age and generational factors, as well as gender, are important inpeople’s experiences of using the internet.
Victor’s story is an even greater challenge to traditional stereotypes which equate masculinity and technology. Victor is 59 years old. He is married andhas three adult children. He has a managerial job and a tertiary levelqualification. For about a year, he has felt he has had a low sex drive. Hegets an erection but then does not feel like engaging in sexual activity. Hefelt this was very disappointing, although his wife never indicated it was aproblem. He has taken Viagra and did get an erection but then did not feellike sex.
2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Wyatt et al: The digital divide and everyday life Victor talks first with his wife about health problems, and then with health professionals. He does not look at self-help books but does glance atthe health pages in the newspapers, both a tabloid and quality newspaper.
He looks at notices in waiting rooms, and says that he tends to takeinformation at face value. He says he has never been in the situation ofhaving conflicting information about health matters. He likes to talk withhis wife because it enables him to explore all the possibilities and/orconfirm what he is feeling. He does not look things up before going to amedical appointment. Victor has never used the internet but is thinkingabout getting a home computer for business purposes. This part of theinterview is reproduced below: Interviewer (I): Do you have access to the internet at all at the moment?Victor (V): I could get access to it via my daughter or her boyfriend.
I: But you don’t use it?V: No.
I: Have you ever used it?V: No.
I: But you’re thinking about it, aren’t you?V: Reluctantly.
I: You say ‘reluctantly’ because . . .?V: I find technical tasks not easy to get to grips with.
I: Not your scene?V: No.
I: So why are you considering using it now?V: I think if I could master it it would make my part-time work a lot easier.
I: Do you think you’ll ever consider looking up health information on the V: I think it’s unlikely.
I: Because?V: Because I think I’d rather look it up in a book if I really wanted it, or talk I: I’m wondering why that might be the case.
V: [irritated] I’m not interested in computers. I just want to get on with my life in the easiest way. I can’t see what benefits it would give me. I’d ratherhear it from the horse’s mouth and talk to someone, not get lost incyberspace. Seems bloody obvious, and a waste of time doing this research Ireckon.
Victor was pressed by the interviewer to be explicit, and clearly feels defensive when attention is drawn to his non-use of the internet.
Nonetheless, his hostility to computers, the internet and our research seemsgenuine and perhaps can be interpreted in two ways. First, he could be seenas a challenge to the usual male-technology equation (Faulkner, 2000; Lie,2003; Wajcman, 2004) in which men are considered to have privilegedaccess to technology and technical skills. Clearly, Victor does not feel he hasany such privileged access, neither in relation to computers nor in relation 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
to technical tasks more generally, as he says he finds it difficult to grasptechnical tasks. Second (and this is speculation), it might be easier for himto express his frustration at computers, the internet and the interviewer thanit is for him to express his frustration at not being able to have intercourse.
Masculinity and technical competence are mutually constitutive. As both theability to use technology and the ability to have intercourse are oftenequated with masculinity, then perhaps his frustration with the latter is beingexpressed in terms of the former.
Peter is a ‘rejecter’, the second category of non-use described above. On the basis of admittedly limited experience, Peter finds the internet, at leastemail, rather boring. He has tried it, but feels it is not for him as he prefersthe immediacy of other communication media. Victor, however, is clearly anexample of a ‘resister’, the first category of non-user identified earlier. Hereally cannot see any value for himself in using the internet. As far as he isconcerned, there are perfectly adequate alternative ways of informinghimself.
So far, we have extended the concept of access by looking at the gendered and age-related social relations which affect people’s ease of useand access. We now turn to the role played by warm experts in helping ourrespondents to gain access. There are many examples of family members,particularly younger ones, helping our respondents to get online, forexample, by giving them old computers when they upgraded, showing themhow to use the internet, doing searches and sending the results via email ortraditional post.
Sue’s daughter played the role of a warm expert. Sue, aged 51, does not have any educational qualifications. She has had a linked PC at home andwork for two or three years. Her daughter helped her to get started and Sueis now confident in her own ability to find information. She tries differentsearch engines and search terms and if she thinks something is interesting,she prints it. She looks at the site to help her decide whether it istrustworthy and she compares information from different sites forconsistency, one of only a small number of participants to do so.11 Sue: I notice [the type or source of a site] and I must admit when you get a lot of American stuff up, it really . . . Why can’t I have some English medicalknowledge or something like that? So I do notice where it comes from.
Interviewer: What’s better about English medical knowledge?Sue: I just find the American stuff too precious really. They go on and on.
She likes the internet because you can look things up immediately but she thinks it could make you ‘worry more’ and sometimes the volume ofinformation is a bit much. Sue’s wish to have ‘English medical knowledge’as opposed to American, suggests how important it is to have health 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Wyatt et al: The digital divide and everyday life information that is relevant to one’s own situation, and how trust may beinfluenced by contextual factors.
The concept of the warm expert is a useful one because it draws attention to the social relations of new technology. We extend the conceptby introducing another dimension; namely, helping people interpret andmake sense of the information found. One of the more elaborate exampleswas referred to earlier: Roger went to his wife’s workplace, an accountsoffice, where her boss helped them both to find information about prostatecancer, with which he had been diagnosed. Roger was amazed at theamount of information they were able to find: There’s pages and pages. Some of it was just irrelevant. I suppose it was stuffthat I did not really want to know. I suppose doctors and surgeons . . . wouldwant to know that but it was well beyond me . . . It [felt like a problem]because of not being familiar with PCs and how to get into them.
The wife’s boss, an accountant, was able to provide physical access and even help to find information that was broadly relevant. Perhaps the bossdid not have the appropriate medical skills or perhaps the two men did notknow each other well; in any event, the boss was not able to help Roger tointerpret the information that was found in a way that was meaningful forRoger. Roger feels his son might have been able to provide more assistanceand in the more comfortable setting of a home rather than an office, as hesays: Probably if I’d used my son I’d have been all right. I could have sat down withhim at home in his own home.
But Roger did not consult his son because he did not want to worry his children about the cancer diagnosis. Fulfilling the role of warm expert is notstraightforward. Roger’s son has the equipment, the skills and seems to sharea close relationship with his father, but because of the sensitivity of thetopic Roger did not feel he could ask his son for help on that occasion.
Thus, the conditions in which warm expertise is asked for and offered alsoneed to be contextualized.
John, aged 57, is gay although he was married for 18 years. About two and a half years ago, he began to have problems achieving an erection. Hebought some ‘natural Viagra’ from a magazine but it did not work for him.
He uses ‘real’ Viagra, but that only works if both he and his partner arearoused. He talks with his sexual partner(s), stepdaughters and health careprofessionals about his health. John has been using the internet at homesince the end of 2001 for email, finding out about holidays, cars and workbut he does not look up much health information. He finds it takes toomuch time and would prefer to talk to his doctor. When talking about hisinternet use, he says: 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
I was interested in holidays . . . But I wasn’t interested in looking up my healthissues, because I got it sorted. It’s only when you want the information thenyou go and find it. So, if you’re not ill, why look up how to mend a brokenarm if you haven’t got a broken arm? When he first experienced erection problems, he and his partner did look up information. This now ex-partner, an information technology consultant,fulfilled the role of warm expert: he helped John to get online and find thehealth information. Like Sue and Roger, John also wanted information thatwas relevant for him personally. When he or his partner thought that theymight have found relevant health information, they often checked out theindividual and the institution: Some of it came from American case studies . . . We actually checked up onsome people and some were from the universities themselves . . . A lot of itwas nothing to do with my case but it was interesting to see how they putthings together and how they arrived at an end result . . . It takes time to findthe actual information about me . . . You’re reading stuff through to see if doesconcern you and, say, 70–80 percent of the time it doesn’t. It’s interesting butit wasn’t my problem and it didn’t concern me.
While John found the process of finding information interesting, he experienced some frustration at not being able to distil the information thatwould be appropriate for his own health condition. Like Sue and her desirefor ‘English’ medical knowledge, and Roger who recognizes that some ofthe information might be useful for health care professionals although notfor him, John wants to move beyond the generic medical body of medicalliterature for something that is useful to him. Sue, John and Roger all drewon the help of warm experts to help them gain access to the equipment andto the internet and world wide web specifically. Their experiences suggestthat this kind of physical access and help is not always enough, as warmexperts are also needed to negotiate the complexity of the informationfound.
CONCLUSIONWe have focused on women and men in mid-life seeking information aboutmenopause and erectile dysfunction in order to ground this study in aparticular experience, and to enable us to focus on the middle-aged, arelatively under-studied group of internet users. In this article, we havedemonstrated that a perspective based on an examination of people’severyday life experiences of using the internet and looking for healthinformation has proved to be a fruitful way of moving beyond the stasis andpolarization reflected in the digital divide concept. The digital divide cannotbe understood simply in terms of ‘haves’ and ‘have nots’. While we havepresented the example of Victor, who neither uses nor accesses the internet, 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Wyatt et al: The digital divide and everyday life the article focuses primarily on people who would appear as ‘haves’ instatistics about people with domestic internet access. We have shown that‘access’ is not a simple case of having connected computers. Data about thenumber of households with access obscure the complexities of domesticrelationships. Although Janet uses the internet at work for personal purposes,she does not use it at home very much because her son dominates thatmachine. Other respondents, women and men, report that they lived inhouses where there were connected PCs but that they did not go online,usually because the home machines were dominated by sons or malepartners. Access involves much more than being in the vicinity of the righttype of equipment: it also includes the gendered and generational socialrelations which form the context in which people’s daily interactions ornon-interactions with the internet take place.
The categories developed by Wyatt et al. (2002) are useful in understanding both passive and active resistance (Bauer, 1995; Rogers, 1986)as well as drop-outs (Katz and Aspden,1997). Peter and Victor’s storiesrequire that we think again about the optimistic and universalist claims madefor the internet. These stories also require that we think again about thestructure–agency problem (Giddens, 1984). Given that Peter and Victor arerelatively ignorant abut the internet and its possibilities, is it correct to saythat they are exercising agency in their lack of engagement? Even if thebehaviour of Peter and Victor is better characterized as passive avoidance, theeffect, as far as policymakers and suppliers are concerned, is still resistance.
Inspired by Bakardjieva’s (2001) concept of the warm expert, we were able to develop it further based on our analysis of the issue of access toinformation. Providing access to equipment is certainly not enough, neitherat the individual nor social level, to enable people to make sense of thecomplex information they may find when seeking to inform themselvesabout health matters. Just as in the broad digital divide debate, we arguethat it is important to consider the different levels at which warm expertscan operate, providing access to equipment, skills and information. As wediscussed in the second section, it is recognized increasingly that accessincludes the ability to find and make sense of information found online. Wego further, suggesting that it also includes the ability to make sense ofgeneric information that is relevant to one’s own circumstances. Generalinformation about health conditions and treatments is not always whatpeople want or need. Warm experts can facilitate access and be importantmediators of technical know-how and the use of search engines anddatabases, as in the case of Roger and his wife’s boss. But people also needhelp in order to make sense of complex medical knowledge. Warm expertsare vital, not only in helping people to incorporate computers and theinternet into their everyday practices, but also in helping people to 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
understand the relevance of medical literature and other health informationfor their own situations.
In the study reported here, we have found mainly instances of ‘good’ warm experts. We do not wish to suggest as a result that warm experts arealways and necessarily helpful. As Katz and Aspden (1997) found, peoplewere more likely to stop using the internet if they had learned about it fromfriends and family than if they had received more formal training. Moreover,people already exist whose task it is to help others understand complexinformation, such as librarians or doctors, in the case of medicalinformation. Increasingly, software (Gobel et al., 2001) is available to helppeople choose which information is most suitable for their interests andcircumstances, versions of Negroponte’s ‘Daily Me’ (1995). Clearly, moreresearch is needed in order to understand the different human–machineconfigurations which may (or may not) help both novice and moreexperienced users make sense of an ever-increasing volume of information.
AcknowledgementsThe research on which this article is based was supported by the Innovative HealthTechnologies Programme, funded jointly by the UK Economic and Social ResearchCouncil and Medical Research Council (Project No. L218252039). Further informationabout the Programme can be found at An earlier versionof this article was published in Dutch in the Amsterdams Sociologisch Tijdschrift (Wyatt etal., 2003). We are grateful to the editors of that special issue; to the editors andanonymous referees of New Media & Society and to the participants of the AmsterdamSchool of Communications Research (ASCoR) Internet PhD Club for their comments.
1 Warschauer (2003) analyses the process of diffusion of internet technologies in poorer countries. He pays particular attention to issues of literacy and education.
2 See Woolgar (2002) for a systematic questioning of the hype around new ICTs, including the internet and an explanation of the approach of ‘analytic scepticism’.
See Williams (1990[1975]) for a reminder of his dictum, ‘new technologies and oldsocial forms’.
3 There are, of course, exceptions to this generalization; for health, see Burrows et al.
(2000), Hardey (1999, 2001), Rice and Katz (2001); and for pornography, see Slater(1998) and Thornburgh and Lin (2004).
4 This adds up to more than 100 percent because respondents were allowed to list 5 Viagra has been available as a treatment for erectile dysfunction since 1998, and has since become Pfizer’s best-selling drug. As any internet user knows, the internetseems to be an ideal medium for distributing information about Viagra, regardless ofwhether one is actually looking for it or not.
6 HRT is a general term for a range of treatments which have been available since the 1960s. It is often offered to women during menopause or following a hysterectomy.
7 In addition, interviews were conducted with 10 health care practitioners, and 16 consultations between patients and practitioners were observed. This data is notdrawn upon in this article.
2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
Wyatt et al: The digital divide and everyday life 8 See Henwood et al. (2002) for a fuller discussion of our methodological approach.
9 The Oxford Internet Institute (2003) conducted its first UK survey in May–June 2003, in the middle of the period during which we conducted our interviews. Theyfound that 64 percent of working-age women and 74 percent of working-age menused the internet, but only 18 percent of retired women and 25 percent of retiredmen did so. Our respondents span the working age-retired age range.
10 As Burrows et al. (2000) suggest, online groups based around health problems can provide patients with an important source of emotional support as well as knowledgewith which to engage with healthcare professionals. However, our study suggests thatnot all patients are keen to take up this opportunity. In the case of women andmenopause, this may be because menopause is so common that women have manyother opportunities to discuss it. In the case of men and impotence, while onlinegroups provide a potentially anonymous and perhaps easier environment, many ofour respondents indicate that they are not actually keen to discuss such problems, inany fora, online or otherwise.
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SALLY WYATT is Associate Professor in the Department of Communication Studies and the Amsterdam School of Communications Research (ASCoR), University of Amsterdam, the Netherlands. She is President of the European Association for Studies in Science and Technology (EASST). Together with Flis Henwood, Nod Miller and Peter Senker, she editedTechnology and In/equality, Questioning the Information Society (Routledge, 2000).
Address: Amsterdam School of Communications Research, University of Amsterdam,Kloveniersburgwal 48, 1012 CX Amsterdam, the Netherlands. [email:] FLIS HENWOOD is a reader in the Social Informatics Research Unit, University of Brighton, UK. She is a social scientist with over 20 years’ experience working on the relationship between technology and society. She has published widely in the areas of gender and techology and, more recently, health informatics. In addition to Technology and In/Equality (see above) she also edited (with Helen Kennedy and Nod Miller) Cyborg Lives? Women’sTechnobiographies (Raw Nerve Press, 2001).
Address: Social Informatics Research Unit, University of Brighton, Watts Building, Lewes Road,Brighton BN2 4GJ, UK. [email:] 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.
ANGIE HART is Principal Lecturer in the Centre for Nursing and Midwifery Research, University of Brighton. She has a background in medical social anthropology and sociology.
She has published widely on the social aspects of health care practice and has a particular interest in the relationship between service users and professionals.
Address: Centre for Nursing & Midwifery Research, University of Brighton, Westlain House,Village Way, Falmer, Brighton BN1 9PH, UK. [email:] JULIE SMITH has a background in the politics of mind. She completed an MA in the socio- cultural applications of psychoanalytic theory at Goldsmiths College, University of London and studied subjectivity and social exclusion at doctoral level at Brunel University. She was a part- time researcher on this project for 18 months, undertaking a large proportion of the first interviews with women.
Address: Social Informatics Research Unit, University of Brighton, Watts Building, Lewes Road,Brighton BN2 4GJ, UK. [email:] 2005 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.


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