eHealth communication and behavior change: promise and performance

Traditional health communication interventions have often failed to show significant changes in people's behaviors. Guidance from social semiotic frameworks suggests that health communication interventions can be improved by incorporating greater participation by the intended audiences of users, paying greater attention to social contexts, and increasing broad use of integrated multimedia dissemination strategies. The use of eHealth communication has great promise to influence behavioral health outcomes, given its enhanced features of interactivity, multimodality, mass customization, and the opportunity for users to also be producers. The first 15 years of scientific evidence about the use of eHealth interventions suggests that, overall, such strategies are gaining rapid acceptance worldwide, improve user engagement, and often show significant positive effects on health behaviors in diverse populations and across a wide range of health conditions. Challenges remain, however, to learn how to best use eHealth communication to improve information access for vulnerable populations, to effectively leverage the power of new media channels, and to discover the longer-term effects of eHealth communication on public health. This article reviews key issues and evidence from eHealth studies and recommends a greater application of strategic semiotic principles in future eHealth communication research and interventions.