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SE CONTINUA EL TRABAJO EN EL WIKI DE EHEALTH http://wiki.ehealth.bvsalud.org/index.php/Knowledge_Networking:_Social_networks_to_share_%2C_create%2C_disseminate_and_use_information%2C_and_knowledge_to_Enhance_Health


Title: Knowledge Networking: Social networks to share , create, disseminate and use information, and knowledge to Enhance Health

Conference: Access to quality health information

General Objectives of the Conference:

• To identify path-breaking solutions to overcoming the barriers to access to health information for researchers, practitioners and the general public.

• To assess the existing state-of-the-art technologies as well as the barriers in publishing, contextualizing and using health quality information to impact health systems and society in general;

• To review and propose how information technologies, within an eHealth environment are contributing and/or will contribute to overcoming the identified barriers;

• To debate and recommend the strengthening and development of global south health information infrastructures based on converging developed and developing countries current and future initiatives.


Terms of reference Objective: The key functions and contributions communities of practices and online collaborative spaces bring to the sharing of scientific, technical and factual information, knowledge and evidences. This would highlight the importance of functioning health thematic networks within health systems (including research, education and care) as well as maximizing the inclusion of health workers, health systems users and citizens in general toward the development and operation of learning environment and community and individual online health libraries within a global common space;

Objective: Identify the key functions and contributions communities of practices and online collaborative spaces bring to the sharing of scientific, technical and factual information, knowledge and evidences.

(To document the evidence around the interaction between communities of practices and online collaborative spaces and access to scientific, technical and factual information, knowledge and evidences for health and to enable participants to pursue the attainment of collaborative environments that maximise access to knowledge for health.)

Draft Outline

Tabla de contenidos

Introduction

“Knowing is not enough, we must apply; willing is not enough, we must do.” - Goethe

Purpose of paper

What are the key functions and contributions that communities of practices and online collaborative spaces bring to the sharing of scientific, technical and factual information, knowledge and evidences within health workers, health systems and citizens to improve health

Participants: health workers, citizens, health systems (organizations)

Interventions: Integration of collaborative spaces and communities of practices with health information environments

Comparative: Knowledge networking environments vs Information supply side environments

Outcomes: Evidence based information and Knowledge creation, dissemination and translation to practice by health workers, health systems and citizens to enhance health

This would highlight the importance of functioning health thematic networks within health systems (including research, education and care) as well as maximizing the inclusion of health workers, health systems users and citizens in general toward the development and operation of learning environment and community and individual online health libraries within a global common space;

This Background paper could help to clarify how communities of practices and online collaborative spaces can improve sharing of scientific, technical and factual information, knowledge and evidences between communities that are trying to improve health.

Specifically considering "access to scientific information, knowledge and evidences as it relates to health for the purpose of addressing the needs of the global south¨, this paper reviews the relationship between social networking and access to and use of information for health.

There are many papers and works about Cops, virtual organizations and so on but this paper intends to contribute to the discussion about the central importance of social networks in the access, creation, transformation, dissemination an use of information and knowledge for health enhancing

The main idea that the paper propose is that with the proliferation of health information and knowledge, social networking and collaborative spaces are crucial to access, create, translate, disseminate and use those resources.

Creating and disseminating information is necessary but not sufficient to enhance health. Communities of practice and other social networking spaces offer an opportunity to make a better use of the information and knowledge available.

Background

Thomas Friedman in his book entitled The World is Flat discusses how globalization powered by access to information and communication technologies (ICT) is reshaping the world in which we live. Information flow in and out of previously inaccessible areas has resulted in the opening of isolated markets, resulting in economic gains that have benefited entire regions, reducing poverty rates, increasing wealth and improving health. Due in large part to the ICT induced reduction of information asymmetries, new treatments, therapies, and philanthropy now flow in to areas that were previously inaccessible. Decreasing costs and increasing ICT accessibility, particularly in the global south, is beginning to reduce technological apartheid.

This globalization process se manifiesta en una creciente diferenciación entre los sectores de altos ingresos de los países desarrollados y determinadas zonas del mundo en desarrollo por un lado que tienen acceso a servicios de salud cada vez más sofisticados y costosos, y una creciente masa de personas que viven en condiciones de pobreza y exclusión en las que el acceso a los servicios de salud es muy limitado o sufre de un deterioro acelerado. Estas zonas de exclusión, para el caso de los servicios de salud aunque tiene su manifestación más evidente en los países del sur no es eclusiva de los mismos y se constata en propios países desarrollados (Norris K, Nissenson AR. Race, Gender, and Socioeconomic Disparities in CKD in the United States. J. Am. Soc. Nephrol. 2008 Jun 4;)

Former WHO director, in a very cited editorial where he recognized those achievements remembered that "Yet the fruits of progress in health have been unevenly distributed, and for hundreds of millions of people, the possibility of a healthier and safer life for themselves and their families remains a promise unfulfilled." (Lee 2003)

In his book, Friedman discusses 10 major factors that have contributed to the "flattening" of the global playing field, including "the concepts of out-sourcing, off shoring and in-forming [sic]. In-forming is the term that the author uses in referring to access to rigorous knowledge resources as well as access to collective social intelligence that empowers. The impact of social intelligence powered by collaborative spaces and online communities of practice on health, health workers, health systems, citizens and governments is only beginning to be felt. Fortune magazine highlighted this aspect; “The Internet is old news. Buts its 700 million users are changing business and society so fast it’s sometimes hard to keep up, and the revolution is just beginning.” (Life in a Connected World, June 28, 2006).

There is a general consensus that health information and good evidence is very important and that health care decisions should be based on the best possible evidence, and this is also important for third world countries. At the same time, there are concerns about the effectiveness of dissemination of information to health professionals as the main way to influence health workers. Sustainability, context and cultural sensitivities may impair impact however. Zembylas & Vrasidas (2005) believe that without attention to such issues, ICT in health may become a new age form of electronic colonialism, where existent cultures are bulldozed and assimilated. Deaton (2004) however, constrasts strongly with this point, stating that “The health and life expectancy of the vast majority of mankind, whether they live in rich or poor countries, depends on ideas, techniques, and therapies developed elsewhere, so that it is the spread of knowledge that is the fundamental determinant of population health” (p. 84).

In an editorial of the prestigious journal JAMA, there was a call for action in relation with the incredible differences of access to health considering that "The gaps are unacceptably wide and in some areas worsening. While one-fifth of the world's population enjoys an average life expectancy approaching 80 years and a life comparatively free of disability, two-thirds of the world's population living in the lower- and middle-income countries of Africa, Asia, and Latin America suffer overwhelmingly from the global burden of illness and premature death. Children are the most vulnerable as evidenced by the difference in infant mortality, with rates exceeding 100 per 1000 in many countries of the developing world compared with a rate of 6 per 1000 in high-income countries. More than 99% of mortality in children younger than 5 years occurs in impoverished settings." (Eiss RB, Glass RI. Bridging the Coverage Gap in Global Health. JAMA. 2007 Oct 24;298(16):1940-1942)

As Manuel Castells suggested years ago "En el nivel más elevado de la escala social existe una conexión común con la comunicación universal a las redes de comunicación mundiales y a un inmenso circuito de intercambios, abierto a recibir mensjaes y experiencias que abarcan el mundo entero. En el otro extremo, las redes localesfragmentadas, con frecuencia definidasétnicamente, utilizan su identidad como el recurso más precioso para defender sus intereses y hasta su propia existencia" (Castells M (1989) The informational city : information technology, economic restructuring, and the urban-regional process. Oxford, UK; Cambridge, Mass., USA: B. Blackwell. p 228)

"One month of combination treatment for coronary heart disease cost 18.4 days’ wages in Malawi, 6.1 days’ wages in Nepal, 5.4 in Pakistan and 5.1 in Brazil; in Bangladesh the cost was 1.6 days’ wages and in Sri Lanka it was 1.5. The cost of one month of combination treatment for asthma ranged from 1.3 days’ wages in Bangladesh to 9.2 days’ wages in Malawi. The cost of a one-month course of intermediate-acting insulin ranged from 2.8 days’ wages in Brazil to 19.6 in Malawi" (Mendis S, Fukino K, Cameron A, Laing R, Filipe A, Khatib O, et al. The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bull. World Health Organ. 2007 Apr ;85(4):279-88.)

The Know-Do Gap

"Many of the solutions to health problems of the poor exist, but are not applied. This is called the "know-do" gap -- the gap between what is known and what is done in practice." (WHO | Bridging the "know-do" gap in global health [Internet]. [cited 2008 Jun 18 ] Available from: http://www.who.int/kms/en/)

"In 2003, the WHO director coined this challenge the "know-do" gap: the growing body of knowledge that is not being translated into practice. Bridging the gap will require the development of delivery strategies that achieve effective and sustained coverage in diverse cultural and economic settings. The studies in this issue of JAMA by Pandey et al,9 Gakidou et al,10 Bolton-Moore et al,11 and Lagarde et al12 bring together new analyses and perspectives on interventions to improve health outcomes in impoverished settings and address the know-do gap with novel applications of known interventions." (Eiss RB, Glass RI. Bridging the Coverage Gap in Global Health. JAMA. 2007 Oct 24;298(16):1940-1942.)

"There is debate on what constitutes best available evidence and how to harness it in policy and practice. The research literature refers to a hierarchy of evidence from systematic reviews of randomized controlled trials, to common sense and expert opinion. Moreover, the definition of knowledge is sometimes used interchangeably with that of information or evidence. It has been argued that information is explicit and factual, while knowledge results from the integration of information with belief and context. This implies that while information can flow easily, knowledge is embedded in people. The perception of knowledge differs according to culture. Ultimately, it is knowledge that drives people to act." (Pablo-Méndez A, Chunharas S, Lansang MA, Shademani R, Tugwell P. Knowledge Translation in Global Health. Bulletin of the World Health Organization. 2005 Oct ;83(10):721-800.)

Barriers to access to health information for researchers, practitioners and the general public

Infrastructure continues to be a limitation

Misen CC and Cook TM insisted about the contradictory situation of developing countries. "Many of the solutions to global health problems exist, but are not applied.(...) However, it is not enough that “someone, somewhere” knows about best practices; it is also essential that the very people who are dealing with health problems know what to do. Ironically, regions of the world with the least resources for solving health problems often have the least access to needed health information." (Missen CC, Cook TM (2007) Appropriate information-communications technologies for developing countries. Bulletin of the World Health Organization 85:245-324. Available: http://www.who.int/bulletin/volumes/85/4/07-041475/en/index.html. Accessed 18 June 2008.)

Cada vez más, la primera respuesta a una necesidad de información para quienes viven en el mundo hiperconectado es buscar en Internet. La facilidad con que hoy puede diseminarse infomación y ofrecer acceso a las misma a través del Web ha llevado a que muchas personas y organizaciones piensen en un enfoque muy centrado en la oferta de información en línea olvidando que a pesar del enorme crecimiento de la red, sólo un sexto de la población mundial tiene acceso directo a la misma. Aún considerando las altas tasas de crecimiento de Internet, la mayor parte de la población mundial sigue sin acceso a la red. Para marzo de 2008 el 79,9% de la población mundial no contaba con acceso. (World Internet Usage Statistics News and World Population Stats (n.d.) Available: http://www.internetworldstats.com/stats.htm. Accessed 19 June 2008). Además, los costos de las conexiones en el caso de muchos países subdesarrollados siguen siendo considerablemente altos si se comparan con los ingresos medios. Muchas instituciones de salud en estos países, que han logrado una conexión que de menor calidad a la de un usuario residencial de Europa o Norteamérica, deben pagar cifras equivalentes al salario de 20 profesores. (Ver Missen CC, Cook TM (2007)

Estas conexiones generalmente se concentran en algunas instituciones élite lo que obliga a considerar seriamente el tema de la infraestructura y los modelos para el acceso, creación, diseminación y uso de la información de salud en esos contextos y particularmente su relación con los espacios sociales para la colaboración y el intercambio. Lo anterior significa que, es necesario un replanteo de la forma en que se encara el tema de la infraestructura en relación con el acceso a la información para la salud. Any serious project trying to overcome the barriers to access to health information for researchers, practitioners and the general public in developing countries need to assess the reality of each scenario and must recognize the character of public good of information and knowledge, the political will needed and the crucial importance of human capacity development.

The today recognized importance of social determinants of health is close related with the social character of the creation, communication and use of information. The social infrastructure needed to improve the relationship between information, knowledge and health is more important and limits the impact of technological infrastructure although they are very tied.

"A series of changes in the technologies, economic organization, and social practices of production in this environment has created new opportunities for how we make and exchange information, knowledge, and culture. These changes have increased the role of non market and non proprietary production, both by individuals alone and by cooperative efforts in a wide range of loosely or tightly woven collaborations. These newly emerging practices have seen remarkable success in areas as diverse as software development and investigative reporting, avant-garde video and multi player online games. Together,they hint at the emergence of a new information environment, one in which individuals are free to take a more active role than was possible in the industrial information economy of the twentieth century." (Benkler, Y., 2006. The wealth of networks : how social production transforms markets and freedom, New Haven [Conn.]: Yale University Press. Available at: http://habitat.igc.org/wealth-of-networks/. pg 2)

Human resources

A Critical review of the virtual collaborative tools and spaces in relation with the access, creation, dissemination and use of information, knowledge and evidence

Assess the existing state-of-the-art technologies as well as the barriers in publishing, contextualizing and using health quality information to impact health systems and society in general

The missing link: Data, information, knowledge, wisdom

In an article published in year 2000 in the Health Forum Journal, Flower and Guillaume asked themselves "What's missing from information?" They said that computer scientists are always taking information out of context, putting this information in databases , and then putting it back. (Flower Joe and Guillaume Patrice 2006)

What is missing is people and context.

"Given the amount of biomedical data generated, it is impossible to envisage a situation where each item of information can be assessed for its quality by a single authority or individual. An alternative is to group information by the way in which it has been managed before reaching the public domain. This would require an understanding of the effects of peer review and other processes applied to scientific information before publication." (Jefferson T; Rudin M; Brodney Folse S; Davidoff F; . Editorial peer review for improving the quality of reports of biomedical studies (Cochrane Review). In: The Cochrane Library, Issue 2, 2008. Oxford: Update Software. Available at:http://cochrane.bvsalud.org/cochrane/show.php?db=meth_reviews&mfn=3&id=&lang=es&dblang=&lib=COC&print=yes consulted: June 18 2008 8:44 am)

"Following the discussion of the role of information systems, a number of research imperatives emerge. First, what is the relationship between information systems and the emerging opportunity structures for knowledge sharing? Do certain information systems characteristics tend to broaden or narrow opportunity structures? Second, how can a certain information systems design promote helping behavior in the community? Moreover, what is the appropriate balance between physical meetings and virtual communication for the development of trust in the community? Is there a way to better integrate information systems in the physical meetings as well, and thereby make the use of such systems an integral and natural part of the ways of working? What are the organizational consequences of giving affiliates anonymity when sharing (explicit) knowledge? How is the norm of authenticity affected by the use of information systems?" 1. (von Krogh G (2002) The communal resource and information systems. The Journal of Strategic Information Systems 11:85-107. Available: http://www.sciencedirect.com/science/article/B6VG3-46FJ8GV-2/1/154745b4a4a03fcdcf2702eb56d82d46.)



The Knowledge networking Framework

Seufert Andreas et al 1999 proposed an integrated view on knowledge management and networking being a very powerful combination. They proposed a framework for knowledge networking. This framework can be useful to understand the relationship between information and collaborative spaces. It integrates the knowledge management framework with networking.

Seufert et al. (1999 p 184)define ¨knowledge networking" as "a number of people, resources and relationships among them, who are assembled in order to accumulate and use knowledge primarily by means of knowledge creation and transfer processes, for the purpose of creating value"

Baladi, P. (1999) “ A key concept in Ericsson’s knowledge management strategy is Knowledge Networking — the company’s philosophy for encouraging employees to share and reuse knowledge and experiences, and establish networks of specialists to improve organizational performance and innovation. These networks consist of different “communities of knowing,” representing Ericsson’s adaptation of the Boland and Tenkasi (1995) term, that involve global collaboration both internally in the company and with customers and business partners. The knowledge networks are based on interpersonal connections, taking place both virtually and face-to-face. The virtual interaction is supported by a variety of IT-based collaboration technologies (Munkvold, 2003), such as e-mail, audio and video onferencing, local intranet portals, virtual project rooms, bulletin boards and discussion groups, and knowledge and experience databases. For face-to-face interactions, “manual” collaboration techniques and forums in use include knowledge-sharing seminars, training in specific topics, brainstorming, and network meetings to organize core teams and reference groups. Through the common focus on facilitating interpersonal communication, this blend of face-to-face and IT-supported interaction addresses the potential limitation of a “technology-centric” approach to supporting communities of knowing"

Wenger defines CoP: http://www.ewenger.com/theory/index.htm

Alavi and Leidner (1999, p. 1) define KMS as “information systems designed specifically to facilitate the sharing and integration of knowledge."

Sandars J and Heller R concluded that "Knowledge management offers a structured process for the generation, storage, distribution and application of knowledge in organizations. This includes both tacit knowledge (personal experience)and explicit knowledge (evidence). Communities of practice are a key component of knowledge management and have been recognized to be essential for the implementation of change in organizations. It is within communities of practice that tacit knowledge is actively integrated with explicit knowledge."

McDonald PW and Viehbeck S (2007 p 142) said that "Health promotion practice, like most human endeavors, takes place within, and its meaning is derived from the history, experience, and comparisons created through social interaction (Brown & Duguid, 2001; Gherardi, Nicolini, & Odella, 1998; Lave & Wenger, 1991). Merely creating and disseminating data is not sufficient for enhancing practice."

"We greatly benefit from discussing ideas and data with people we know and trust. They help us put new knowledge in the context of our existing knowledge and existing practices of the larger field. An essential component of true knowledge translation rests with creating systematic opportunities for meaningful, focused interaction or exchange between parties that share a desire to improve a common practice." (Ibid)


"Through a well-designed randomized controlled trial, Pandey et al test the hypothesis that if rural communities in the north Indian state of Uttar Pradesh are better informed about health and social services to which they are entitled, new knowledge may have the combined effect of improving existing services through better accountability and improving health outcomes through greater usage. As the authors note, the importance of empowering local communities through information increases as many countries, such as India, decentralize control of public services to local authorities." (Eiss RB, Glass RI. Bridging the Coverage Gap in Global Health. JAMA. 2007 Oct 24;298(16):1940-1942.

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Knowledge management and networking a necessary integration
The social side of knowledge sharing

"Theory holds that the social networks within which individuals are embedded have an important impact on their attitudes and behaviour. Networks provide channels for the transmission of information and influence and network characteristics, such as density, centrality and centralisation affect the speed and distance that information travels. Further, because information is an important resource in our society, access to and control over information is related to power and independence." (1. West E, Barron DN, Dowsett J, Newton JN. Hierarchies and cliques in the social networks of health care professionals: implications for the design of dissemination strategies. Social Science & Medicine. 1999 Mar ;48(5):633-646.)

"Do differences in network characteristics matter? We draw on the literature on structural holes (Burt, 1991), the strength of weak ties (Granovetter, 1973) and social influence (Marsden, P.V., Friedkin, N.E., 1994. Network studies of social influence. In: Wasserman, S., Galaskiewicz, J. (Eds.), Advances in Social Network Analysis. Sage, London, pp. 3–25Marsden and Friedkin, 1994), which suggests that some network features are beneficial in terms of access to information whereas others are more effective in terms of social control. Our empirical measures of the theoretical concepts are density, centrality and centralisation." Ibid

The Communities of Practice framework

Wenger (1998) proposed the concept of CoP where social construction is central to the process of creation and use of knowledge and information. For Wenger "Communities of practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly." (Wenger E. Communities of practice [Internet]. [cited 2008 Jun 14 ] Available from: http://www.ewenger.com/theory/index.htm)

A community of practice defines itself along three dimensions:

  • The goals, what joins its members
  • How it functions, the relationships that bind members into a social entity
  • The commons or capabilities produced by the community and shared (Wenger 1998 p 4)

CoP have been related with the possibility to integrate tacit knowledge with explicit knowledge (Sandars, J 2006)

Communities of practice functions

In the Wenger framework, communities of practices main functions are:

  • They are nodes for the exchange and interpretation of information (Wenger, E 1998 p 6)
  • They can retain knowledge in "living" ways, unlike a database or manual (Ibid)
  • They can steward competencies to keep the organization at the cutting edge (Ibid)
  • They provide homes for identities (Ibid)


"Intangible, tacit knowledge embedded in an organization's members is an asset that is not easy to capture. CoPs, however, offer a practical mechanism to help their members share and internalize tacit knowledge. Furthermore, through the communities, people can deepen their expertise by discussing work-related activities with others in their field. As well as enabling members to share existing knowledge, CoPs also provide opportunities for new knowledge creation. Several researchers have noted that CoPs appear to be a more effective tool for dealing with unstructured problems and knowledge sharing/creation than traditional and formal ways of structuring interaction in organizations" (Wang C, Yang H, Chou ST (2008) Using peer-to-peer technology for knowledge sharing in communities of practices. Decision Support Systems 45:528-540. Available: http://www.sciencedirect.com/science/article/B6V8S-4P1P6PJ-D/1/b2dbd2558e97068b962947ba4076d58e.

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The importance of communities of practice in health

Russell et al. 2004 concluded in an evaluation of the process of knowledge exchange in an informal email network for evidence based health care that ¨"knowledge for evidence based health care can be targeted, personalized, and made meaningful through informal social processes. Critical success factors include a broad based membership from both the research and service communities; a loose and fluid network structure; tight targeting of messages based on members' interests; the presence of a strong network identity and culture of reciprocity; and the opportunity for new members to learn through passive participation."

Communities of practice and organizational development
Limitations

"here are also limitations to the community of practice approach itself. Self-organized networks, like a CoP, require commitment and investment of resources from a large number of committed, engaged members of the community who often receive little compensation for their involvement. Without broad investment across the network, there is increased susceptibility to it falling apart should key individuals leave the network. Collective action requires leadership and resources, and without a centralized command or individual responsible for the network, they can easily dissolve, particularly if they fail to provide the knowledge value that community members expect. In this study, we discovered that many potential members of this community were identified as not present at the meeting. If a representative community is to be established, these individuals on the periphery of the network need to be engaged in the CoP initiative.

For a self-organizing, adaptive, and responsive learning system such as a CoP to succeed, it must engender broad engagement and enlist leadership." (Norman CD, Huerta T. Knowledge transfer & exchange through social networks: building foundations for a community of practice within tobacco control. Implementation Science: IS. 2006 ;120.)



Evidence based practice

"However, evidence in the clinical care context differs from evidence in the public health and health policy domains. It is often difficult to apply rigid hierarchies of evidence to public health policy. Although randomized controlled trials and systematic reviews are methods of choice when assessing the effectiveness of medications, complex health-care problems pose different challenges.1–3

"Evidence providers and health policy-makers from developing countries have insisted that evidence needs to be broader than that based solely on randomized controlled trials. Observational studies, qualitative research and even “experience”, “know-how”, consensus and “local knowledge” should also be taken into account.

"For example, Indonesia tapped into village wisdom to formulate actions and policies to combat avian influenza.4 Locally-generated evidence reformed social health insurance in Mexico5 and Thailand; it also improved primary health care in the United Republic of Tanzania6 and mental health-care policy in Viet Nam.7 In these five examples, findings were interpreted and utilized against a background of global evidence and experience from different settings.

(Pang T. Evidence to action in the developing world: what evidence is needed? Bulletin of the World Health Organization. 2007 Apr ;85(4):245-324.

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Virtual organizations, thematics networks, virtual teamworks and other collaborative spaces
Evidence based practice and knowledge networking

The Web 2.0 phenomenon an its relationship with information and knowledge

Kishore A (n.d.) Challenge-2.0-Social-Networking-Drives-New-Requirements.pdf (application/pdf Object). Available: http://www.level3connects.com/down/Challenge-2.0-Social-Networking-Drives-New-Requirements.pdf. Accessed 20 June 2008.

Social networking is exploding. In October 2007, Alexa found that 7 of the top 10 most visited Websites globally were Web 2.0 sites. A month earlier, ComScore reported that MySpace, with more than 55 million unique visitors, is still growing at a healthy rate of 23% year over year. Over the same time period, Facebook increased its number of unique visitors by 129% and Bebo grew 83%. But the fastest growth came from Imeem, which boasted year-over-year growth of 1,590%. That's an astounding 16 times the number of unique visitors the site had last September. Nor is this phenomenon restricted to the U.S.: Research by the Oxford Internet Institute in March- April 2007 showed that 17% of U.K. Internet users have created a profile on a social networking site. In India, 51% of online urban adults use social networking sites and sites such as Orkut and Facebook now account for 44% of time online, with more than 11 million Indians getting hooked on them, according to the India Online 2007 survey. Home-grown sites such as GoYaar are also emerging in India, to tap into the potential of social networking. In China, sites such as Zhanzuo, Xiaonei, Yeejee, ChinaRen Xiaonei, and 5Q are attracting millions of members from the younger generation. And Morgan Stanley research has determined that Brazil has the highest usage of social networking sites in the world. Data from U.K. regulatory body Ofcom, presented in Figure 1, illustrates that people all around the world are using the Internet for social interaction.


El fenómeno identificado como Web 2.0 se ha extendido a diferentes campos de manera muy rápida y así hoy se habla de Empresa 2.0, medicina 2.0 y muchos otros modos como biblioteca 2.0.

Siendo conscientes de las limitaciones de estas extensiones simples del concepto, es válido analizar cual es la relación entre el proyecto de la Biblioteca Virtual de Salud y Web 2.0.

El movimiento Web 2.0 es un proceso que venía conformándose como parte de la evolución de Internet, y la BVS es una iniciativa que desde sus inicios ha tratado de sacar el mayor provecho de Internet para facilitar el acceso a la información de salud y desarrollar una comunidad activa de personas involucradas con su construcción. Es por ello que el tema no es algo que sorprenda al proyecto y que por el contrario se convierte en un impulso a la iniciativa.

Las fuentes de información de la BVS se han construido con la participación activa de muchas personas y las herramientas que se han utilizado se han alineado en la dirección de permitir el mayor nivel de interacción posible. Esta construcción tiene una fuerte base social y de redes por lo que los Blogs, los Wikis, los enlaces compartidos y toda la pléyade de herramientas que hoy surgen con tanto dinamismo se han comenzado a usar por usuarios, desarrolladores e intermediarios de la BVS. La visión de disponer servicios web en forma de aplicaciones que faciliten la integración de las fuentes de la BVS por cualquier otra aplicación dan una gran versatilidad a todo lo que se ha acumulado por años a la hora de integrarlo a los nuevos escenarios de acceso de los usuarios.

Ahora bien, esta vinculación natural de la BVS con el desarrollo del Web no puede llevarnos a ignorar que una vez que se ha desplegado y ha adquirido momento propio, el fenómeno Web 2.0 asume características específicas que deben ser revisadas, reconocidas e integradas crítica y abiertamente por la BVS.

De tal forma, web 2.0 y BVS tienen hoy una relación dialéctica que se amplía continuamente. Ello va desde la activación de servicios de RSS para diseminar la información de las fuentes de información existentes y las nuevas que se creen, hasta el desarrollo de servicios que favorezcan una mayor participación de todos los actores sin renunciar a los principios de calidad, equidad en el acceso y colaboración que defiende el proyecto.

Se trabaja en una acción consciente y sistemática para alinear donde quiera que sea viable y positivo, los servicios de la BVS con los patrones que distinguen a este movimiento.


Boulos MNK, Maramba I, Wheeler S. Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. BMC Medical Education. 2006 ;641.


BACKGROUND: We have witnessed a rapid increase in the use of Web-based 'collaborationware' in recent years. These Web 2.0 applications, particularly wikis, blogs and podcasts, have been increasingly adopted by many online health-related professional and educational services. Because of their ease of use and rapidity of deployment, they offer the opportunity for powerful information sharing and ease of collaboration. Wikis are Web sites that can be edited by anyone who has access to them. The word 'blog' is a contraction of 'Web Log' - an online Web journal that can offer a resource rich multimedia environment. Podcasts are repositories of audio and video materials that can be "pushed" to subscribers, even without user intervention. These audio and video files can be downloaded to portable media players that can be taken anywhere, providing the potential for "anytime, anywhere" learning experiences (mobile learning). DISCUSSION: Wikis, blogs and podcasts are all relatively easy to use, which partly accounts for their proliferation. The fact that there are many free and Open Source versions of these tools may also be responsible for their explosive growth. Thus it would be relatively easy to implement any or all within a Health Professions' Educational Environment. Paradoxically, some of their disadvantages also relate to their openness and ease of use. With virtually anybody able to alter, edit or otherwise contribute to the collaborative Web pages, it can be problematic to gauge the reliability and accuracy of such resources. While arguably, the very process of collaboration leads to a Darwinian type 'survival of the fittest' content within a Web page, the veracity of these resources can be assured through careful monitoring, moderation, and operation of the collaborationware in a closed and secure digital environment. Empirical research is still needed to build our pedagogic evidence base about the different aspects of these tools in the context of medical/health education. SUMMARY AND CONCLUSION: If effectively deployed, wikis, blogs and podcasts could offer a way to enhance students', clinicians' and patients' learning experiences, and deepen levels of learners' engagement and collaboration within digital learning environments. Therefore, research should be conducted to determine the best ways to integrate these tools into existing e-Learning programmes for students, health professionals and patients, taking into account the different, but also overlapping, needs of these three audience classes and the opportunities of virtual collaboration between them. Of particular importance is research into novel integrative applications, to serve as the "glue" to bind the different forms of Web-based collaborationware synergistically in order to provide a coherent wholesome learning experience.

1. Kamel Boulos MN, Wheeler S. The emerging Web 2.0 social software: an enabling suite of sociable technologies in health and health care education. Health Information and Libraries Journal. 2007 Mar ;24(1):2-23.

Web 2.0 sociable technologies and social software are presented as enablers in health and health care, for organizations, clinicians, patients and laypersons. They include social networking services, collaborative filtering, social bookmarking, folksonomies, social search engines, file sharing and tagging, mashups, instant messaging, and online multi-player games. The more popular Web 2.0 applications in education, namely wikis, blogs and podcasts, are but the tip of the social software iceberg. Web 2.0 technologies represent a quite revolutionary way of managing and repurposing/remixing online information and knowledge repositories, including clinical and research information, in comparison with the traditional Web 1.0 model. The paper also offers a glimpse of future software, touching on Web 3.0 (the Semantic Web) and how it could be combined with Web 2.0 to produce the ultimate architecture of participation. Although the tools presented in this review look very promising and potentially fit for purpose in many health care applications and scenarios, careful thinking, testing and evaluation research are still needed in order to establish 'best practice models' for leveraging these emerging technologies to boost our teaching and learning productivity, foster stronger 'communities of practice', and support continuing medical education/professional development (CME/CPD) and patient education.

Web 2.0 will generate new and rich types of data that will have utility in many different domains.

We can mention the significance of the maturation of web technologies and specially the web 2.0 movement in relation with the collaborative tools ready to be used and the social maturity needed to use this tools. I think that today we have more experience in both sides and a more deep understanding of the crucial importance of the social side of the problem. There are examples of the use of web 2.0 technologies for collaboration that can make easier the process. The relationship between different specialized communities could be integrated with these tools more easilly but the social aspects of this interrelationship must be considered in depth. The recent Wikiproteins (http://www.wikiprofessional.org/conceptweb/) project is an example of a combination of such tools as the wiki and social annotation combined with new ones as the semantic web technologies and data mining. Nature network is building a collaboration network using web 2.0 technologies. We here in Infomed are combining the more traditional collaborative tools with blogs, social bookmarking and wikis.

Networks that are already established, they could profit from this technologies in a framework that recognizes the other points that we have agree.

Kishore A (n.d.) Challenge-2.0-Social-Networking-Drives-New-Requirements.pdf (application/pdf Object). Available: http://www.level3connects.com/down/Challenge-2.0-Social-Networking-Drives-New-Requirements.pdf. Accessed 20 June 2008.



Information and communication technologies for social collaboration

Email, Web portals, forums, audio video conferences, bulletin boards, mailing lists, web 2.0 services

The Cases

GANM

For instance, the GANM electronic CoP that I run has excelled in this type of collaboration and sharing. There is a combination of hard science interwoven with traditional and contextually/culturally sensitive knowledge and wisdom. In a recent discussion we had in the GANM between nurses, midwives and traditional birth attendants, we found that while some of the traditional ways of supporting the birth process were dangerous, there were many that were based in understanding of the process developed over hundreds of years of experience. For example, the groups from Peru were commenting on medicalized birth with, women laboring on tables with stirrups versus vertical positioning where gravity eased the birth process. The point here is that much of the westernized medicine clashes with cultural beliefs - but allowing the participants to share their views ended up in both groups moving closer to a centralized belief of something in the middle. The traditional birth attendants learned the scientific rationale for many of the actions that the midwives and nurses were supporting - and the midwives/nurses gained a new appreciation of why the local women preferred the traditional birth attendants.

So, the notion of shared and collaborative spaces, I believe, has tremendous potential for improving the health of communities. With that said, the difficulty may be in the lack of connectivity in many locales, but I believe that to be changing rapidly. In the GANM, we have 1,540 nurses and midwives from 124 different countries. Language can be a barrier, but we are finding ways to work around that. Our last discussion on traditional midwifery was bilingual (English and Spanish). We have a group who wants to develop another CoP for Francophone West Africa and parts of Polynesia. So, when I think about the question you posed earlier about evaluation of shared spaces in developing countries - I agree - there is not much to evaluate yet - but as you said, you have INFOMED and I have the GANM that we could use as case studies. I am also involved in a CoP that is being used by the Global Health Workerforce Alliance (GHWA) run by the WHO and Honorable Mary Robinson in regardws to using this collaborative space for the development of a global policy for ethical workforce recruitment. This might be a case study of the use of such a space by policy makers around the globe. It has (in a way) "leveled the playing field" allowing for more open contribution from a panel of over 30 very high level people from around the world. Of course, simply enabling communication does not ensure change - but it does open avenues for expression of thought and documented sharing of beliefs.

In regard to capacity building (I see it mentioned below in the email) - I do believe that these collaborative spaces can be used to decrease outmigration to some degree. I have many in the GANM who are using the CoP as a lifeline for communication because they are so isolated. Also, the ability to deliver education in many different forms via ICT (developed by people with common interest and understanding of the cultural social context) Is another way to scale up AND reduce outmigration.

Infomed

En Infomed se ha combinado el desarrollo de la Biblioteca Virtual de Salud con la creación de espacios colaborativos con la participación de especialistas y trabajadores de la salud. Con el nombre de Sitios de Especialidades, desde 1998 se han venido creando estos espacios los cuales son hoy día mas de 30 y se caracterizan por su dinamismo y por una relación activa con los contenidos disponibles en la BVS ya sea participando como creadores, evaluadores, diseminadores y/o usuarios de esa información.

Caracterizarlos y ver su relación con el modelo de comunidades de práctiva y de conocimiento en red.

Virtual Health Library
Other examples

Fung-Kee-Fung M, Goubanova E, Sequeira K, Abdulla A, Cook R, Crossley C, et al. Development of communities of practice to facilitate quality improvement initiatives in surgical oncology. Quality Management in Health Care. 17(2):174-85.


BACKGROUND: The process of developing clinical guidelines and standards for cancer treatment and screening is well established in the Ontario health care system; however, the dissemination and implementation of such guidelines and standards are more recent undertakings. Traditional implementation strategies to improve surgical practice and the delivery of cancer care have not been consistently effective. There is a recognized need to develop integrated models that offer direct support for implementation strategies. Such a model should be feasible, adaptable, and open to evaluation across diverse surgical settings. DISCUSSION: Research suggests that successful implementation should consider tools and expertise from other disciplines. This article considers a community of practice (COP) model to provide a supportive infrastructure for quality improvements in cancer surgery. The COP model was adapted for cancer surgeons. It is supported by 5 enablers referred to as tools: communication system, project development support, access to data, access to evidence review, and accreditation with continued medical education and continued professional development. These tools need to be part of an infrastructure that is both provided and supported by a team of administrators and health care professionals, who have active roles and responsibilities. Therefore, the primary objective of this article is to describe our COP model in cancer surgery including the key success factors necessary for providing the infrastructure and tools. The secondary objective is to offer the integrated COP model as a basis for future research and the evaluation of various collaborative improvement projects. SUMMARY: Building on knowledge management concepts, we identified the 4 essential processes that should be targeted by implementation strategies. A common COP evaluation framework uses the outcomes of 4 knowledge conversion modes-organizational memory, social capital, innovation, and knowledge transfer-as proxies for actual provider and organizational behavior. Insights from different collaborative improvement projects described in a consistent way could inform future research and assist in the collation of systematic reviews on this topic.

Discussion: A Knowledge Networking Framework for Global Health Information Infrastructure

To review and propose how collaborative information technologies, within an eHealth environment are contributing and/or will contribute to overcoming the identified barriers;

A conceptual framework to call attention to the relationship between collaborative tools and information, knowledge and evidence in health

To debate and recommend the strengthening and development of global south health information infrastructures based on converging developed and developing countries current and future initiatives

The knowledge networking evidence based framework

We propose a framework that integrates knowledge management, networking, social networking and communities of practice approaches with evidence based information and information management

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Glosary

  • Knowledge networking
  • Communities of practice
  • Online collaborative spaces
  • Thematic networks
  • Learning environments
  • Evidence based medicine and health
  • Knowledge Mangement Systems (KMS)
  • Social Networks
  • Web 2.0
  • Social Web

Recommendations

To create a network of researchers empowered to study the impact of collaborative environments on access to health information, and to use the evidence generated to enable health authorities and civil society to participate in and engage in evidence-based health information and knowledge policymaking aimed at increasing access to knowledge.


To foster the development of communities of practice and social networking in order to increase the participation of health actors to increase access and use information and knowledge for health

Authors

Patricia Abbot | Pedro Urra

Herramientas personales