Internet, Health and Society: Analyses of the uses of the Internet related to Health in Catalonia

Notes from the PhD Dissertation defence by Francisco Lupiáñez entitled Internet, Salud y Sociedad: Análisis de los usos de Internet relacionados con la Salud en Catalunya (Internet, Health and Society: Analyses of the uses of the Internet related to Health in Catalonia), directed by Manuel Castells.

The research (partly) belongs to E-Health and Society: An Empirical Study of Catalonia, at its turn belonging to the Project Internet Catalonia (PIC).


Francisco Lupiáñez-VillanuevaFrancisco Lupiáñez-Villanueva

Historically, the concepts of health, healthiness, public health, etc. lack of consensus. The scientific revolution brings a new approach to these concepts, secularizing the way it is dealt with drawing the biomedical model. But social sciences imply a disruption in the building of consensus and a separation from the usual biomedical model, relating it with society, the relationships of power, human structures, etc. Castells goes one step further stating that the informational paradigm, within the Information Society, brings in yet another change: how (specially) the Internet newly interrelates the different authors around the concept of Health.

The thesis wants to identify and characterize these authors and how and why they use the Internet to get informed and interact amongst them.

  • The Internet is a space for information
  • Decision taking determines the uses of the Internet for Health related issues
  • A new profile arises between the health professionals: the networked health professional


Data come from surveys answered by patients, physicians, nurses and chemists.

(Complex) Information is simplified by factor analysis and cluster analysis.

Binomial logit regressions are used to find the determinants of Internet use for health related issues.



patients tend to browse the Internet to get information about their diseases or other health related issues, somewhat limited by the lack of personal infrastructures (hardware, connectivity, skills, etc.). This means that patients are empowered by the Internet to decide about their health based on better grounds. Those are the connected citizens. At the other end, we have the disconnected citizens, mainly due to their socio-economic background: income, education… The relationship (not the causality) between connected citizens, better health and higher socio-economic status is evident.

The Health digital divide excludes 40% of the total population.

Interaction does not happen: Internet is out of the equation in the physician-patient relationship.


Three types of Internet use: focus towards research, health information dissemination and institutional information.

The network physician: uses the Internet to get information and communicate with their peers, disseminate their research and spread information about their institutions. These are just 5% of the total physicians.

Networked physicians believe that the Internet is good for their patients, but only half of them encourage their patients in browsing the Internet.

Orientation towards research and intensive search and use of international information mostly determines a physician being or not being a networked physician.


The networked nurse follows a similar path than the networked physician: focus on research and lowest proportion in relation to the whole population of nurses (4.5%). As the physicians, networked nurses also believe that the Internet is good and empowers their patients.


Just like the prior professional profiles, the networked chemist is research and international information focused, and they also believe that the information in the Internet is good for their patients and has a positive impact on them being autonomous.


  1. Internet is a space for information, not interaction.
  2. The e-patient is determined by access to information and intensive use of the Internet to get information about health.
  3. The health e-professional is determined by orientation towards research and access to international information.
Future lines of research
  1. What are the determinants of innovation processes in the health system, including its impact on productivity.
  2. What are the determinants of the state of health in the framework of the Information Society
  3. What are the public policies to improve the health system in the framework of the Information Society,
  4. How the biomedical paradigm evolves within the framework of the Information Society


Answers to Joan Torrent

There is a lack of available data about the impact of the use of the Internet on the health of the patients. It is, undoubtedly, a future line of research.

The e-patient paradox: the networked patients are the ones — because they are healthier — that benefit less from e-Health.

The public health system tends to use the Internet to inform, while the private health system has a more intensive use of information technologies for management issues (e.g. e-invoicing), though not necessarily related with physician-patient — or interaction — focused applications.

While physicians see the Internet as a gate to access better information, they are also threatened by a potential use of authority in front of their patients. Thus why they are intensive Internet users, but only for information related issues, not for interaction with their patients. On the other hand, chemists have to ensure their customers’ loyalty, so they have more incentives to share information and open new channels of interaction with them, which might explain why they are more eager to encourage their customers/patients to enter the Internet.

Answers to Gustavo Cardoso

It is very likely that both the methodology and the findings of this research can be applied into other economies that are in their transition towards the Information Society, provided their health and social systems are similar.

It seems there is a new health paradigm: the technoscientific health paradigm, where technology plays an important part along with health infrastructures (e.g. hospitals), culture, etc.

Internet does not replace — in the eyes of the patient — the professional: it’s complementary. Actually, patients are fully aware on who’s behind the information on the Internet, and asks for a professional backup of this information to consider it quality information. But the professionals don’t usually feel alike. A further research, indeed, should analyse the actual relationships of power between patients and professionals, and how these relationships change or can change due to the Internet and the information that it makes broadly available.

A technological layer, in combination with an evolving social layer, has enabled Health “getting out of the closet” and being present in all aspects of life, way beyond the walls of the hospital. This is new, and this issue should be addressed seriously in further research about society in general and Health especially.

Answers to Miquel Àngel Mayer

It’s very difficult to define “quality” in the Internet, specially when speaking about websites about Health. Maybe, the focus should be not quality of the information, but the skills of the one that searches and accesses this information. Indeed, the concept of quality is closely related with the authors that issue and access the information, thus why the stress in capacity building, digital skills and, in general, digital literacy.

Internet is becoming not an exogenous, dependent variable of the Health system, but an endogenous, independent one that should be included in the equation of Health studies.

Answers to Eulàlia Hernández

The e-patient, unlike the networked professionals, cluster around patient associations, engaging into interaction amongst them and not restricting themselves only to access to and use of information.

Answers to Ferran Sanz

There are dire problems in most researchers about Internet uses: how to define the population, how to define the actual use, how to define authorship, how to define jurisdiction, etc. These problems make it difficult to state with statistical significance some findings that might be perfectly valid for the sample.


For a complete listing of references for the PhD Dissertation, please see The definitive references’ collection of my thesis.

NOTE: summa cum laude. Congats!!

Extended information

Thesis defense: The Internet, Health and Network Society, by Francisco Lupiáñez-Villanueva.