Does internet culture create new values and how are they perceived by the Bulgarian society?

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Abstract
The thesis of the paper is that computers and the Internet create a cultural environment which influences people’s attitudes and values. The paper presents the special features of the view of life and values that make the surfing on the Internet generations different. The study focuses on three groups of Internet and computer users who are representative carriers of the Internet culture – hackers, gamers and social net users, and traces out and summarizes the characteristic features of their attitudes and values. The report summarizes hackers’ values like open source, creativity, networking; it presents gamers’ values of learning, achievement, intrinsic rewards; it also studies the social net users’ values of community, publicity and activity.
The conclusions of the analysis are: 1) there are value differences among Internet generations and pre-Internet generations, caused by the active involvement of the former in the Internet environment; 2) Due to the fact that the usage of the Internet in Bulgaria is well expressed among the young people and is weak among the population over 55 years of age, the Internet culture can be considered a “youth” culture. And 3) it could be expected that the differences caused by the Internet/information age can be easily perceived to express differences usually existing among younger and senior generations, but not as differences related to the real change of the environment.
Key words: Internet culture, hacker, gamer, social net user, values

Please, for citation refer to this article as: Ambareva, H. (2014). Does Internet culture create new values and how they are perceived in society? В: Дигитална култура и общество (сборник доклади)(стр. 78-86). Изд.: Югозападен университет “Неофит Рилски”. ISBN: 978-954-680-938-4.

Introduction
The paper presents a work in progress and is part of a study on the implications of the primary digital divide . The hypothesis here is that the existence of specific for the Internet culture values means that the primary digital divide could create a gap in terms of values between Internet users and non-users.
This study elaborates on the specific values, which are shaped by the Internet and computer technology usage. It summarizes and outlines arguments in support of the thesis that 1) there are specific values of the Internet culture and 2) there are differences between values of the Internet culture and the pre-existing cultural values (pre-Information age values).

Methodology
In order to distinguish the values of the Internet culture, I choose three types of specific Internet users and investigate their main values; I compare the values of these groups to their relevant “non-informational-age” values. The three groups of Internet users I examine here are hackers, social net (Facebook) users and gamers. What is typical for them is that they are heavy Internet and computer users and they represent very significant part of the Internet population.
In order to present the main values of the hackers I use the research results of the Finnish author Pekka Himanen, which are published in his work “The Hacker Ethic” ; I use also the essay-manual titled “How to become a hacker”, written by the famous hacker Eric Raymond .
For the purpose of distinguishing the main values of the gamers I use the research results of the American gamer, game-researcher and programmer Jane McGonigal .
For the purpose of identifying the values of the Facebook users I use the information available on the net about the history of the creation of the social net Facebook.

THE HACKERS
The definition of the hacker
The first hackers belong to the undergraduate students’ community of the Massachusetts Institute of Technology in the 60-s. These young students were fascinated by the emerging computer technologies and were spending a lot of time in writing codes and experimenting on the human-computer interaction. For years afterwards, the word “hacker” was used for enthusiastic people, who liked to experiment with computers in a clever, entertaining and generally constructive and useful way. Today the word “hacker” is used mainly in a different meaning, which denotes a person who is writing virus programs, steals identities and credit card numbers and crushes websites for money. These are the destructive hackers and according to Erik Raymond, there is a clear line between the “good’ and the “bad” hackers, who are respectively named “hackers” and “crackers”.
According to P. Himmanen, in order for one to be a hacker, he\she must meet two necessary conditions. The first is to know a lot about computers and codes. The second is the behavior of this computer specialist to comply with certain ethical principles. The hackers’ values I present below belong to the ethical code of the “hackers” in the original meaning of the word. These principles are important for the understanding of the values of the Information age, because the “good” and the “constructive” hackers are among the leading contributors to the creation of the three main symbols of the Information age – the Internet, the personal computer software and the operation system “Linux” .
A list of the hackers’ values (based on the essay “How to become a hacker?”):
• Antiauthoritarian values

According to Erik Raymond “…to behave like a hacker, you have to develop an instinctive hostility to censorship, secrecy, and the use of force or deception to compel responsible adults” .
Supporting this claim is the fact that hackers are actively engaged in the defense of the civil liberties online (freedom of speech, privacy, access to public resources and information online).
One of the earliest organizations established to defend Internet freedom from US government was the Electronic Frontier Foundation (1990). Its purpose was to educate people about the industry and to support civil liberties cases involving the Internet . The co-founders of the foundations were, of course, hackers: Mitchell Kapor, John Gilmore, and John Perry Barlow. The later is the author of the Declaration of the Independence of Cyberspace.

• The Open Source value

The Open Source movement is an expression of some of the most important values of the hackers – free access to software and free dissemination of knowledge. The Open Source movement formally starts in the 80-s with the GNU Project of Richard Stallman but it existed in the 70-s as well . In order to support the movement Richard Stallman found The Free Software Foundation (1985). The idea behind the GNU project was to organize the collaborative development of software, which users can freely run, share, study and modify. The GNU General Public License was created in order to protect these rights and bounds the resulting products with the same license.
Another organization defending the open source principle is the „Open Source Initiative” (1998) created by Erik Raymond and the programmer Bruce Perens. They created the Open Source License and the Open Source Definition. Although there was a kind of dispute on the open source and free software principles, at present the differences in the licenses are small.
• The values of networking
A very interesting demonstration of the hackers’ values is the story about how the Linux operating system was written .
This story starts with the announcement made by the 21 year old Finnish-American programmer Linus Torvalds, in which he says that he wants to develop an open source system, which “won’t be big and professional like GNU” and he wants feedback as to what other users and programmers liked or disliked in the available systems . He posts the message in a newsgroup on the USENET, the predecessor of the Internet in 1991.
This message encouraged many programmers to collaborate enthusiastically and voluntarily on the creation of the new free operating system Linux. They worked on it as a hobby. They all were working for the cause of this socially important project. They also had flexible working hours and their relations demonstrated new type of work organization, which was the network organization of free individuals instead of hierarchic supervision of subordinates.
The story of Linux demonstrates how fast and efficient can be the joint work of many people who like what they do so much that they do it even for free. As a result of the collaborative networking, the first version of Linux was written in a month. Linux is licensed as free software under GNU General Public License.
Here is the list of the hackers’ values which the story of Linux reveals:

o A hacker’s work feels like a hobby
o A hacker’s work is voluntary. No payment is expected.
o Internal motivation (enthusiasm, pleasure)
o Importance of the problem-solving attitude and creativity
o Flexible working hours
o Home-office
o Networking
o Work for causes and socially important projects

How the hackers’ values affect the Internet society?
The values of the hacker culture are broadly accepted in the Internet community.
Flexible working hours, voluntary contribution and enthusiasm are the basic principles of the development and growth of the World Wide Web. There are a lot of people who write blogs on-line, upload articles for Wikipedia, and publish cooking and medical advices, music, video, and pictures. People usually do not expect payment and upload, for free, great amounts of information. The World Wide Web at present is the result of the voluntary, collaborative and enthusiastic efforts of millions of users. Openness and sharing are among the most beloved and widely applied principles of the net.
Creativity, team-work and a problem-solving attitude have become requirements in the job advertisements. At present the growing importance of these qualities is an indicator of changes in the work environment towards pro-active and self-managing networking, a substitution for the traditional hierarchic and re-active work-organization.
Although hackers are not as numerous as social net users or gamers, their contribution to the rise of the contemporary Internet culture should be considered of primary importance. Their contribution could be said to form the core of the new value system, born by the information technologies, which social nets and computer games additionally develop.

THE FACEBOOK USERS
The idea behind the creation of Facebook was to build a social net which connects students, rates users and allows exchange of information. The values of the hacker culture like openness, access, freedom of expression, collaboration easily communicate with the values of this social network like:
o Publicity
o Visibility
o Free communication

Additionally, the events of the Arab spring and anti-government protests in Bulgaria in 2013 made popular the capacity of this net to organize large groups of people to work together for causes. This function of Facebook has turned into a hallmark of the social network and is the reason why Facebook has been banned in China since 2009, and for some periods of time in other countries, as well.
Therefore, I add four more values:

o Facilitating different forms of social associations (communities, groups)
o Encouraging social activity (petitions, causes, events)
o Antigovernment activity
o Freedom of speech

The values, found to be common between the hackers and the Facebook users, are listed below:
o Networking
o Merging work and entertainment (hobby)
o Internal motivation (enthusiasm, pleasure)
o Work for causes and socially important projects (projects, petitions, causes, events)
o Creation of huge teams in short time
o Openness/free exchange of information
o Quick feedback
o Antiauthoritarian values: publicity, no or weak censorship, control and secrecy
o Voluntary participation at any place and time

THE GAMERS
The technological advancement in human-computer interaction and information processing creates a third type of culture, which is not too much different from the previous two. This is the computer gamers’ culture. The gamer’s behavior is often explained as an escape from reality and social surrounding to a fantasy world because of the childish inclination to play games. The life of the gamer is considered unreasonable, and his/her time – wasted. Many non-gamers disapprove as harmful the formation of gaming habits not only for adults, but for children as well. The question is: is it possible to understand what gamers do in terms of Internet culture values?
What is the value of playing computer games, according to J. McGonigal?
1. Games have rules, clear goals and algorithm for advancement in small steps.
2. Games give feedback in real time, which motivates users.
3. Computers allow individually paced learning and difficulty adjustment.
4. The reward system is performance based (immediate and transparent).
5. Gamers understand their work in terms of mission, mainly because their participation is voluntary.

What gamers find in games, they can’t find in real life. There are no clear goals and rules for success in life. Also, most often there is no clear feedback. There is individual pace for learning and difficulty adjustment (at school classes and etc). Success is not necessary related to reward. Necessity and duty are the main factors for activity in life.
A very important element of the computer games is the motivation of the players. Motivation reveals important values:
The meritocratic principle is basic for the hackers’ culture as well as for the gamers’ one. (It is not well presented on Facebook.) The one is recognized in the community because of the results he/she achieves. This recognition is not dependent on age or social hierarchy created by origin, money or position. It mostly depends on skills and contribution to the goals of a certain community.
Internal rewards are another source of motivation. Games are not played for money, career or material success, although some games offer even this. The internal rewards are the positive emotions created by advancement and success (chemistry of the game), social connections, and the opportunity to be part of something bigger than yourself . The non-consumerist attitude of the gamers is important. What do people usually do when they want a higher quality of life? They work, win money and buy a house, a car, fashionable clothes… What do gamers usually do when they want a higher quality of life? They buy upgrades for their machines, subscription for the “World of Warcraft”, and only wish for privacy.
The values of gamers are summarized in the following list:
o Networking
o Merging work and entertainment (hobby)
Why are gamers said to be “working”? Gaming requires many resources – physical, emotional, and mental. Gamers feel such passion for their mission that they are ready to play day and night, on Saturday, Sunday, even ill, hungry and sleepless. They are looking for very intensive experience of what they do and want to be challenged, to learn and to have achievements. The idea of not being intensively involved in an effort to overcome obstacles and solve problems is depressing and boring for them. Seemingly, the problem is that gamers are people very fond of having a rewarding mission. The responsibility of the gamers to what they do in their community is comparable to the responsibility of a worker to his/her team project.
o Internal motivation (enthusiasm, pleasure, internal rewards, achievements). Internal rewards against consumerist attitude
o Team work for causes in fantastic worlds
o Creating huge teams
o Meritocratic principle
o Individually paced learning and level of difficulty
o Real time feedback
o Voluntary participation
o Clear rules for success, clear goals

A list of the common values of the three groups and their relation to the pre-information age values.
The values of the three groups – hackers, social net users and gamers, have similar features. Although they have some differences and not all values are presented everywhere, they are not contradictory. Most of these values correspond to contrasting values in the pre-information age society. In his work P. Himmanen examines in details this contrast between the values of “informationalism” and the values of the pre-informationalism, which he discusses in terms of Weber analysis of the ethics of Protestantism and the spirit of capitalism.
The following left-right situated values point to the divide between the Internet culture (informationalistic values) and the pre-Internet culture.
1. Networking (Linux, social net environment)) vs. hierarchy (at work –place, in the state, and etc.)
2. Playful attitude to work vs. serious attitude to work
3. The internal motivation is the main reason to work (enthusiasm, pleasure, internal rewards) vs. external motivation to work (money, goods, status).
4. Work for causes and socially important projects – much more often than in real life, because it is much easier to sign a petition, to join a cause etc.
5. Opportunity to participate in massive collaborative projects, with thousands of people involved vs. life and work in small communities. Outside the Internet the formation and support of big teams is very expensive and very difficult.
6. Open source principle vs. copyright law. On the Internet for the first time millions of people have a platform where they can share information/files and sharing is more valuable than possession.
7. Quick feedback (email, comment) vs. slow or no feedback
8. Publicity, visibility, transparency vs. censorship, closeness and secrecy
9. Freedom (multiple identities, weak control, less restrictions of space and time) vs. bounds (of survival, political, moral, one fixed identity and etc.)
10. Voluntary work for the benefit of society vs. necessity to work for money
11. The meritocratic principle and the promotion of individually paced education and achievements are values which are not well presented on the social net Facebook, but their inclusion in the list is due to their importance for the hackers, gamers and on the Net in general.

Conclusions
Altogether hackers, social net uses and gamers represent the young and active people in society. The average age of Facebook users is 40 years with the biggest share of 18-29 years old users. Facebook users represent 67 % of the Internet population. The average age of the gamer is 30-35. The most important “blocks” in the initial architecture of the Information age were created by hackers in their 20s or 30s. If the concept of “youth” is applied broadly to people 35-40 years of age, than the Internet culture could be described as a kind of “youth” culture – as much by its origin, as by the three representative groups presented here.
As age is the main factor of the primary digital divide, a person’s age consequently may indicate value differences with reference to the Internet culture. In Bulgaria the number of Internet users rapidly decreases among the population over 55 years of age, which in its turn could account for more pronounced value differences among young and senior generations in comparison to countries where the Internet penetration is higher and usage is observed to be more equally distributed among the different age groups.

The Use of the Internet for Religious Purposes in Bulgaria

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Abstract: This article presents data analysis and information on the use of Internet for religious purposes in Bulgaria. The article focuses mainly on the Eastern Orthodox Church. The methodology includes use of international data bases (values surveys) and data obtained by web-analytics tools. The topic is discussed in the context of the following issues:

1.      Religion and religiosity in Bulgaria.

2.      The Christian church and its attitude to the Internet and new technologies.

3.      How many people in Bulgaria use the Internet for religious purposes

4.      The influence of new media on religious practices in Bulgaria

Please, cite this article as: Ambareva, H. (2013). The Use of the Internet for Religious Purposes in Bulgaria. In: B.Todorova (ed.) “The Balkans as Reality” (pp. 100-118). Sofia: Publishing House “St. Ivan Rilski” – UMG.

Religion and religiosity in Bulgaria.

The last census of the Bulgarian population by religion was done in 2001. According to the collected data 83% of the population professes the Eastern Orthodox faith, 12% are Muslim, 0.6% Catholic, and 0.5% Protestant. There are also small communities of the Armenian Orthodox Church (Gregorian Church) and Jews[1]. Nearly 4% of the population does not specify their religion. According to the Constitution of the Republic of Bulgaria the Eastern Orthodox Church is the main religion of the country with a century-long tradition.

What are the Bulgarian religious life specifics underlying the numbers?

The author of this article is a Bulgarian, not an exception from the majority of other Bulgarians who even if baptized in church are practically not educated in religion. The majority (40%) of Bulgarians attends church service two or three times a year, 24% of the population practically never attend church and about 20 % attend church once a year or less[2]. Most of the Bulgarian population have never read the Bible, don’t follow specific religious prescriptions in life and don’t know a single prayer. In Bulgarian society religion and religious institutions are separated from the educational and political system. However, religious holidays are celebrated as national holidays and it is possible to suggest that they are understood, like social and cultural events, as sacred ones. At Palm Sunday, Easter, St. George’s Day and Christmas, there are many people attending Church service although it is not associated with strong religious feelings. There are also many Bulgarians who follow some of the important religious traditions (feasts for example) and celebrate the biggest religious holidays but they do not attend church service and are only superficially educated in the specific principles of worship or metaphysical teachings of Christianity – creationism, proof of the existence of God, etc. Christian moral laws are embedded in the Bulgarian legal system and generally associated with the universal human morals. On this ground the ethical and behavioural norms of other religions (e.g. Islam) are an obvious mark of the difference between the representatives of both religions and this mark contributes to re-discovering one’s own identity as Christians for many (ethnic) Bulgarians.

This situation could be summarized in the conclusion that Bulgarians have their religious identification, but their religiosity is not strong. This is why, according to the surveys in 2012, 28% of the respondents claim they are “not a religious person” against 59% who say they are religious. It is noteworthy that only 2% percent of all the respondents say they are firm atheists[3].Why is this the case?

Although not active and firm believers, many Bulgarians will admit they share some metaphysical and superstitious beliefs. This, for example, includes the belief that 1) there must be a retribution for what one has done in life; 2) there is a kind of “fairness” that keeps the balance between good and bad in life; 3) what happens is not accidental (there is destiny); 4) afterlife exists; 5) premonitions about the future are possible which keeps alive the half-entertaining, half-superstitious practices of soothsaying; 6) magic could help solve a personal problem. This kind of spirituality is a mix of traditional religious beliefs, (metaphysical) fear and superstitions. It is far from Orthodox Christianity but sometimes it is mixed with it and is used (by practitioners of soothsaying and magic and by some Roma people with the clear purpose to deceive people for money.

According to the “Global index of religiosity and atheism” the richer and more prosperous a country is, the less religious its population becomes[4]. The majority of Bulgarians are too far from feeling prosperous and wealthy and this explains the very low rate of 2% of firm atheists. On the other hand, for nearly 60% of respondents religious spirituality is something important, but the very concept of God is very broad. A survey shows that for the majority of people in Bulgaria the Christian religion and institutions are not considered a source of help and support when a person faces moral, family or social problems[5]. To the same question in Romania and Poland nearly 70% of respondents say the Church is a source of support in family life problems[6]. Between 60% and 80% of Poles and Romanians, respectively, say that the Church is a source of moral support[7]. Around 40% of respondents from Romania and Poland agree that religion gives answers to social problems against 80% of Bulgarian respondents who say it does not[8]. This underestimation and exclusion of religion from the most important aspects of human life is an indicator that for many Bulgarians the connection between religious feelings and Christian institution as an authority has been suspended. This happened as much in the years of the totalitarian regime as in the years of democratically elected governments– due to the cultural and moral crisis, the lack of pastoral or missionary activity, and the non-religious character and influence of the contemporary global popular culture.

The Christian Church and its attitude to the Internet and new technologies.

Many times in the course of history new ideas and inventions have been met with opposing opinions by religious institutions. Approval and denial are expected reactions to innovations that bring change to life- style and thinking. Television, the press, the computer and the Internet brought about enormous changes in the way people get informed, influenced, educated  and entertained. The power of the media has grown because of the large audience it is able to reach in various locations and at various times, and because of the influence it exerts on the human mind.

The official position of the Vatican about new media and the Internet is expressed on the web-site of the Vatican. Media is “an outcome of the historical scientific process by which humanity “advances further and further in the discovery of the resources and values contained in the whole of creation”[9]. The media is a “gift of God”, which, in accordance with his providential design, unites men in brotherhood and so helps them to cooperate with his plan for their salvation”[10]. Media contributes “to spiritual enrichment in many ways”, calls attention “to authentic human needs, especially those of the weak, the vulnerable and the marginalized”[11].In his message in 2000, Pope John Paul II also said that “in  praising the Lord, the Church must make energetic and skilful use of its own means of communication – books, newspapers and periodicals, radio, television, etc., while Catholic communicators must be bold and creative in developing new media and methods of proclamation. However, as much as possible, the Church also must use the opportunities that can be found in the secular media.”There is no conflict between new media and the Christian faith. This is very clear in the position of the Vatican. In 1997 Pope John Paul II went as far as to proclaim St. Isidor of Seville as patron saint of the Catholics in their proper use of the Internet[12].

The Orthodox Church around the world is also actively using the opportunities the Internet offers to spread the Christian religion and to reach the people. In 2001 archbishop Alexander of the Russian Orthodox Church declared that their main task is the promotion of Orthodox-Christianity-related information and sources on the Internet[13]. The web-site of the Bulgarian Orthodox Church says that the Orthodox churches around the world have their own web pages which bring them closer to people’s lives and “reveals the universality of Orthodox Christianity and the various forms in which, with God’s blessing, it exists in different parts of the world.”[14]

In the same way, the Bulgarian Orthodox Church does not forbid any kind of print or electronic media and deems that the Church as a whole and any of its leaders and members could use all kinds of media, providing they follow the principles taught by Apostle Paul[15]: “but test them all; hold on to what is good” (Thessalonians 5:21 (NIV))[16]. People should use media considerately; they should keep to the moral and to what can bring salvation to their soul and body and society as a whole[17].

There is no censorship, content filtering or ban on the use of any kind of media technology in Bulgaria based on religious grounds. Yet, the Bulgarian Orthodox Church declares as improper media content which is considered harmful for the nation and the individual and contravenes the basic moral laws. This includes[18]:

  • Images of violent acts
  • Erotic or pornographic  images, media encouraging prostitution
  • Expression of intolerance and hatred to people of different racial, religious, ethnic origin
  • Teaching relativism of moral values
  • Disrespectful attitude to Church and religiosity
  • Lies, slander, manipulation of information in the media, bad language

Pornography and violence in the media is of great concern not only to the Christian church. Islam is even much more conservative. Saudi Arabia, for example, is known for the censorship and filtering of web-access to many web-sites, mostly with pornographic and erotic content. The related Catholic Church position is expressed in a pastoral response:[19] it says that pornography and violence depicted by the media are “violations of human dignity, human rights and Christian values and ideals”. They are considered harmful for young people and children, the group most vulnerable to being influenced by the messages in the media. In this sense the media is explained to be a means which some “individuals can use… in a manner contrary to the commandments of the Creator” and can be converted “into instruments of evil”[20]. Both Christianity and Islam are very critical of erotic, pornographic images and violence.

With the increase of Internet use on a global scale, antireligious propaganda also obtains an opportunity to strengthen its network online. Concern, expressed by representatives of the Bulgarian Orthodox Church, is the distortion of the words of the Gospels and misinterpretations of the life and death of Christ in popular movies or books (resp. “The Passion of the Christ” and “The Da Vinci Code”). On the website of the Bulgarian Orthodox Church is published a short list of anti-Christian titles.

Another challenge comes from the numerous Christian sects and other cults which gain visibility by means of the Internet. As of 1 October 2001 there were 31 registered religious organizations in Bulgaria including the Bulgarian Orthodox Church[21]. The number of registered religious organizations as of 4 January, 2010 is significant: according to the Bulgarian National Trade Register this number is 1,310[22]. Among them are: Jehovah’s Witnesses, the Church of Jesus Christ of Latter-day Saints, Hinduist sects, Islamic sects, Satanism, Hinduistic-Christian sects (New Age, Scientology), Danovism – “White Brotherhood”, and many others. Some of these organizations have very well developed web-sites and use audio-visual media to attract, persuade, and support their followers.

In this quite complicated situation a significant challenge raised by the television, press and Internet to the authority of the Bulgarian Orthodox Church seems to be the critical attitude to the deeds of the members of the Church. The Church and its teachings are not cherished, nor protected in public media and as a rule the Church is regarded as a secular institution, without the due respect for its sacred meaning and authority in the sphere of values and spirituality[23].

The critical public attitude to the Church, religious sects and cults, antireligious propaganda, and immoral and non-spiritual attitude, presents some of the subjects of reproach and deprecation, expressed in religious materials and religion-related publications.

How many people in Bulgaria use the Internet for religious purposes?

45% of Bulgarian households have access to the Internet[24]. Among the National Statistical Institute surveys there is no specific study of how many and how much people use the Internet with religious purposes.  Web-statistics show that in the top 500 (both international and national) web-pages most popular in Bulgaria, there is no website with religious content[25]. The online catalog of “Orthodox Christianity”[26] lists 137 web-sites in the Bulgarian language, hosted in Bulgaria, that have religious purposes. Included are websites of organizations of the Bulgarian Orthodox Church, web-sites of Bulgarian monasteries and churches, websites for tertiary religious education in Bulgaria and websites disseminating news and Eastern-Orthodox-Christianity-related materials; one web-site presents a TV course with educational materials for children; however traffic information is not available[27]. The traffic for the following three Bulgarian religious sites, as registered by web analytics,[28] is about 200-500 visitors a day. Traffic increases around large religious holidays or events, so the following table can show different numbers in different periods [29].

 Website Daily visits Monthly visits Visitor profile
1.       Official web-site of the Holy Sinod and the Bulgarian Orthodox Church: www. Bg-patriarshia.bg 231 – 489 14,670 45-54, predominantly male, with children
2.       Website “Doors to Orthodox Christianity”, created with the blessing of the Bulgarian Orthodox Church: http://www.dveri.bg/ 577 17,310 45-54, with children, no big difference men-women
3.       “Church Newspaper”, official newspaper of the Bulgarian Orthodox Church: http://synpress-classic.dveri.bg/index.htm 120 3,672 N/A
4.       The Orthodox religion in Bulgaria, a catalogue of Orthodox resources online: http://www.pravoslavie.bg/ 441-673 20,190 More male and people between 18-34, without children

There is detailed analysis of the traffic of the website of “Church Newspaper” since 2002, when the newspaper went online. The number of users has grown from about 14 people per day in 2002 to 273 in 2007[30]. After 2007 there is a decline in the number of users, and in 2012 it reaches 104 visitors per day[31]. At present 65 % of the visitors are from Bulgaria and Europe. As the statistics shows, there are many people not living in Bulgaria who are interested in the newspaper and subscribe to the mailing list on the “Church newspaper” website. We can only guess that many of the Bulgarian readers belong to the church clergy or are professionally related to it.

Although it is not possible to say how many Bulgarians use the Internet for religious purposes in Bulgaria, it is a fact that the trend in Internet usage for religious purposes in the country is getting more pronounced. This increase could be explained by the growing Internet penetration among the population and by the development of a tendency to look for religious information and religious-experience-related communication online. Around 2002 there were only about 20 web-pages with Orthodox religious content in Bulgaria that were professionally done and not anonymous[32]. There is no data about the traffic at that time. At present the number of web-pages has grown and the traffic is more active.

The analytic from Google Trends[33] gives information on how often the keyword “Bulgarian Orthodox Church” is used in the search engine. It can be seen the searches are done irregularly and there are peaks in keyword search around two big holidays – Easter and Christmas. There are also peaks in October when the celebration of the St. Dimitar’s day takes place and in August when the Holy Virgin Mary’s Day is celebrated.

After 2009 the searches become much more regular. Actually in 2009 the present design of the web-site of the Holy Synod of the Bulgarian Orthodox Church was created. The other existing websites have also improved their design and enriched their content since then.

Except for the development of the cultural habit of looking for religious resources on the Internet, Google analytics show one more thing. Many searches with the keyword “Bulgarian Orthodox Church” are registered in the United States. They are marked in blue in the “location” analytics. There is no additional information about the geographical distribution of the searches (for example – Bulgaria), but these results draw attention: the USA is one of the countries with the highest number of Bulgarian immigrants – around 300,000[34] (the same number as in Turkey and Greece). The Bulgarian Orthodox Church, just like most of the autocephalous Orthodox churches around the world, is a national church and for this reason being related to it reinforces the feeling of national identity for many Bulgarians, especially outside the country where more than 2 million people live[35]. It can be expected that part of them use Bulgarian websites for religious information.

What is the influence of the Internet on religious practices?

The most common types of online religious activities described in the research of religion and the Internet are:[36] looking for religious information online, participating in online worship or rituals (e-prayer, virtual pilgrimages), online missionary activities and joining religious online communities. How these forms are present in Bulgaria?

Looking for religious information online

At present, in Bulgaria, the use of Internet with religious purposes has various expressions. As demonstrated in the web content, it is used: 1) to disseminate official information and official documents of the Bulgarian Orthodox Church; 2) to share teachings, moral, and sacred texts of Orthodox Christianity; 3) to present information or news about events, places, etc.; 4) There are many private Christian bookshops that offer free download of Christian sect books or advertise free books. These bookshops are also advertised on different web-sites such as Vimeo, Vbox7.com, YouTube and Facebook. Some religious organizations are very actively taking advantage of audio-visual media and the Internet to present their materials. 5) There are several journals publishing articles on religious topics and some of the articles are available (in part or in their entirety) online. Some of these are “Svet”, “Christianity and Culture” and “Svetilnik” newspaper, which are predominantly oriented to Orthodox Christianity. There is a running project for digitization of the archive of the 19-th century Orthodox newspaper “Zornitsa”, started by the Institute for the History of Orthodox Christianity[37]. 6) A project for a TV program about Orthodox Christianity is also advertised online[38].

Participating in online worship or rituals:

The fact that half (55%) of the population of Bulgaria does not have Internet access[39] and the majority of Bulgarians rarely attend religious service (offline) hinders the development of local church web-sites towards offering on-line services for the local people. Non-traditional forms of religious activity such as worship in cyber-churches or on-line worship and rituals are still a game-like experience. These non-traditional forms of religious activities, which could include asking for e-mail pastoral advice, ordering prayer online or life-video streaming are also not cost-effective if offered to the very small religious congregations in Bulgaria.

 Online missionary activities:

The presence of the Bulgarian Orthodox Church online and the use of the different channels (web, press, RSS feed, mailing-list, YouTube channel) creates some conditions for a new kind of pastoral activity.

Use of online media Use of traditional media
  • Main web-site: http://www.bg-patriarshia.bg/
  • RSS feed from the official web-site
  • You tube channel:
  • BGPATRIARSHIA927
  • Online Church Newspaper – official newspaper of the Bulgarian Orthodox Church (since 2002)
  • Online journal for church theology: “ Orthodox Thought” (Pravoslavna misul)
  • Doors to Orthodox Christianity web-portal
  • Diocese web-sites
  •  Local churches web-sites
  • TV program with religious purposes http://www.plovdivskamitropolia.bg/ekip.html
  • Church Newspaper 1900-2002
  • Paper journal for church theology: “Orthodox Thought” (Pravoslavna misul)
  • Journal for Spiritual Culture (“Duhovna cultura”)
  • Journals of the dioceses
  • Parish brochures

The table summarizes the media channels used by the Bulgarian Orthodox Church -Bulgarian Patriarchate.

The Internet and new media reach a broader audience at home than the traditional pastoral activity could. Using Internet and media, the Orthodox Church spreads its messages, images, music, sermons, teachings and moral, and this virtual presence is available on demand 24 hours a day. Most probably, when used, the Internet is not a substitute, but an extension of religious education or experience. It provides sources of information when other sources are not available at the moment. In its true sense, no missionary activity has been implemented yet, but some pastoral activity is possible. This is true also for the influence of the different cults and sects, whose missionary activity relies mostly on meeting and communicating directly with people.

Joining religious online communities:

Online religious communities use virtual space where people meet via instant-messaging programs or exchange emails to communicate on matters of faiths. The form of community could be a Facebook group or forum and also a blog space with enabled comments. A kind of community is created on the Facebook page of “Christianity” TV program[40], which presents the teachings of one of the non-Orthodox religious organizations. It has over 800 subscribers and received nearly 8,000 “Likes”, but the comments and exchange of opinion are not active.

There are at present a number of personal “Orthodox blogs” but most of them do not include a “comment” function. However the YouTube videos in the official channel of the Bulgarian Patriarchy allow comments. (In comparison, the comments in the official channel of the Russian Orthodox Church are disabled.) The strong interest in these videos is notable in the Bulgarian context: some of them have been seen thousands of time.

Creating on-line communities with religious purposes does not seem to be an important part of the religious activity in Bulgaria at the moment. However, this, as well as the other types of religious activity online, marks a trend whose development could be studied further and deeper in the near future, when the main carriers are better manifested and features are clearly distinguished.


[1] Structure of Population by Religion, National Statistical Institute, http://www.nsi.bg/Census/StrReligion.htm , retrieved 23.10.2012.

[2]World Values Survey Online Data Analysis:Religion and Moral, V186.Selected countries/samples: Bulgaria [2006]. Retrieved on 23.10.2012 from http://www.wvsevsdb.com/wvs/WVSAnalizeQuestion.jsp.

[3] Global Index of Religion and Atheism (table 6, page 14). In: WIN-Gallup International Global Index of Religiosity and Atheism – 2012. Retrieved on 25.10.2012 from http://redcresearch.ie/wp-content/uploads/2012/08/RED-C-press-release-Religion-and-Atheism-25-7-12.pdf.

[4]See: Global Index of Religion and Atheism. In: WIN-Gallup International Global Index of Religiosity and Atheism – 2012. Retrieved on 25.10.2012 from http://redcresearch.ie/wp-content/uploads/2012/08/RED-C-press-release-Religion-and-Atheism-25-7-12.pdf

[5]World Values Survey Online Data Analysis: Religion and Moral, V188, V189, V191. Retrieved on 25.10.2012 from http://www.wvsevsdb.com/wvs/WVSAnalizeIndex.jsp.

[6]World Values Survey Online Data Analysis: Religion and Moral, V189: Churches give answers: the problems of family life.Retrieved on 25.10.2012 from http://www.wvsevsdb.com/wvs/WVSAnalizeIndex.jsp.

[7]World Values Survey Online Data Analysis: Religion and Moral, V188:Churches give answers: moral problems Retrieved on 25.10.2012 from http://www.wvsevsdb.com/wvs/WVSAnalizeIndex.jsp.

[8]World Values Survey Online Data Analysis: Religion and Moral, V191: Churches give answers: the social problems. Retrieved on 25.10.2012 from http://www.wvsevsdb.com/wvs/WVSAnalizeIndex.jsp.

[9] Pontifical Council for Social Communications, The Church and Internet. Retrieved on 24.10.2012 fromhttp://www.vatican.va/roman_curia/pontifical_councils/pccs/documents/rc_pc_pccs_doc_20020228_church-internet_en.html

[10] Pontifical Council for Social Communications, The Church and Internet. Retrieved on 24.10.2012 fromhttp://www.vatican.va/roman_curia/pontifical_councils/pccs/documents/rc_pc_pccs_doc_20020228_church-internet_en.html

[11] Message of The Holy Father John Paul II for the 34th World Communications Day , “Proclaiming Christ in the Media at the Dawn of the New Millennium”, [ Sunday, 4 June 2000]. Retrieved on 24.10.2012 from: http://www.vatican.va/holy_father/john_paul_ii/messages/communications/documents/hf_jp-ii_mes_20000124_world-communications-day_en.html.

[12]Kelly, B. (2010). Patron Saint for the Internet, Isidore of Seville.  Retrieved on 24.10.2012 fromhttp://catholicism.org/patron-saint-for-the-internet-isidore-of-seville.html

[13]Спирова, П. “Въ-църковяването на интернет.”Retrieved on 24.10.2012 from: http://synpress-classic.dveri.bg/09-2004/9-vacarkovyavaneto.htm

[14]Поместни православни църкви (Autocephalous Orthodox Churches) in the website of the St. Sinod – Bulgarian Orthodox Church.Retrieved on 6.11.2012 fromhttp://www.bg-patriarshia.bg/index.php?file=located_church.xml.

[15] By materials of an e-mail Interview with D. Panayotova, PhD, Main editor of the official web-site of the Bulgarian Orthodox Church and Expert in the Cultural Department of the Holy Sinod (31 Oct. 2012).

[16]Biblegateway.com. Retrieved on 6.11.2012 from http://www.biblegateway.com/passage/?search=1%20Thessalonians%205&version=NIV1984

[17] By materials of an e-mail Interview with D. Panayotova, PhD Main editor of the official web-site of the Bulgarian Orthodox Church and Expert in the Cultural Department of the Holy Sinod (31 Oct. 2012).

[18] This information is based on materials of e-mail interview with D. Panayotova, PhD, main editor of the official web-site of the Bulgarian Orthodox Church and Expert in the Cultural Department of the Holy Sinod (31 Oct. 2012).

[19] Pontifical Council for Social Communication, Pornography And Violence In The Communications Media: A Pastoral Response. Retrieved on 24.10.2012 from: http://www.vatican.va/roman_curia/pontifical_councils/pccs/documents/rc_pc_pccs_doc_07051989_pornography_en.html.

[20]Pontifical Council for Social Communication, Pornography and Violence in the Communications Media: A Pastoral Response. Citing Inter mirifica, 2a.Retrieved on 24.10.2012 from: http://www.vatican.va/roman_curia/pontifical_councils/pccs/documents/rc_pc_pccs_doc_07051989_pornography_en.html.

[21] Report of Republic of Bulgaria in accordance to Article 25 , Paragraph 1 from the Framework Convention for the Protection of National Minorities. Retrieved on 20.11.2012 from http://www.ncedi.government.bg/03rh091-pril.htm.

[22] This information is retrieved from a personal blog “Law and Religion in Bulgaria”on 20 Nov. 2012 from http://hpberov.blogspot.com/2009/12/2010_30.html.The Trade Register in Bulgaria is available for public on-line, but access to the data requires annual subscription of 15 000 euro, which practically denies the access of any citizen, investigating journalist or researcher to the information.

[23]Тодорова, Г.Църквата през погледа на медиите. Retrieved on 11.11.2012 fromhttp://synpress-classic.dveri.bg/05-2002/medii.htm

[24] National Statistical Institute data base: “Internet access of the households”. Retrieved on 11.11.2012 from http://www.nsi.bg/otrasal.php?otr=17&a1=2405&a2=2406&a3=2407#cont

[25]Alexa. The web information company: The top 500 sites in Bulgaria. Retrieved on 11/4-10/2012 from http://www.alexa.com/topsites/countries;19/BG. The rank of the web-sites is estimated by their one month Alexa traffic rank.

[26]Orthodox Christianity web-page. Retrieved on 11.11.2012 from  http://www.pravoslavnoto-hristianstvo.com/

[27] http://www.verouchenie.eu

[28]Alexa and Statscrop.com web analytics.

[29]WideStat website worth calculator. The data are retrieved on 11 Nov. 2012 from http://widestat.com.

[30]Web Counter analytics.Retrieved on 27.11.2012 from: http://bgcounter.com/?sts,period,,,,synpress

[31]Web Counter analytics.Retrieved on 27.11.2012 from: http://bgcounter.com/?sts,period,,,,synpress

[32]Спирова, П., Спиров, К., Българският православен интерне – настояще и бъдеще. Retrieved from http://synpress-classic.dveri.bg/07-2002/internet.htm on 22 Nov. 2012.

[33]See Google Trends. Retrieved on 20.11.2012 from http://www.google.com/trends/explore#q=Bulgarian%20Orthodox%20Church&cmpt=q.

[34]Web-site of “Tuk-tam”(“Here-There”) association. Retrieved on 27.11.2012 from http://www.tuk-tam.bg/2036092-bulgarians-live-abroad/

[35]The Bulgarian Media Portal in Chicago: EuroChikago.com. Retrieved on 27.11.2012 from http://www.eurochicago.com/2012/04/v-tchuzhbina/

[36] Campbell, H., Religion and Internet, p. 5-6. In: Communication Research Trends. 4 — Volume 25 (2006) NO. 1. Retrieved on 2.11.2012 from http://cscc.scu.edu/trends/v25/v25_1.pdf

[37]Web archive of newspaper Zornitsa. Retrieved on 27.11.2012 from http://zornitsa.net/.

[38]Plovdiv Bishopric Television. Retrieved on 27.11.2012 from http://www.plovdivskamitropolia.bg/ekip.html.

[39] National Statistical Institute data base: Access of the households to internet, 2011. Retrieved on 21 Nov. 2012from: http://www.nsi.bg/otrasal.php?otr=17&a1=2405&a2=2406&a3=2407#cont.

[40] See http://www.facebook.com/865tv

 

Please, cite this article as: Ambareva, H. (2013). The use of Internet for religious purposes in Bulgaria. In: B.Todorova (ed.) “The Balkans as Reality” (pp. 100-118). Sofia: Publishing House “St. Ivan Rilski” – UMG.

Влияние на здравната информация в Интернет върху отношенията лекар-пациент.

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Статията е публикувана в: Амбарева, Х. (2014). Етически аспекти на влиянието на здравната информация в Интернет върху отношенията лекар-пациент.” В:  „Европейските етични стандарти и българската медицина“. Маринова, Е., С. Попова (съст.). (стр. 380-386).  София – Изд. на БЛС.

 

Ползване на здравна и медицинска информация в Интернет.

Според американската статистика за 2008 г., ползването на Интернет за здравна информация е сред първите най-разпространени онлайн активности в САЩ: тя стои след дейности като изпращане на имейл, използване на търсачка, пазаруване и проверка на прогнозата за времето[1]. Според статистика за 2012 г., която съставителите представят като световна и използват данните на четири източника, търсенето на здравна и медицинска информация онлайн заема трето място сред най-популярните активности в Интернет[2]. Според едно американско изследване от 2013 г., средният американец ходи три пъти в годината на лекар, но прекарва 52 часа годишно в Интернет, за да търси здравна информация[3]. Тези изследвания показват нещо много важно, а именно, че Интернет създава ново поколение пациенти.

Участвайте тук в анкета, която събира данни за ползването на здравна и медицинска информация онлайн в България, за да мога да разширя тази статия.

Какво е различното в профила на това ново поколение пациенти в България от пациентите преди появата на Интернет?

  1. Онлайн статистикатата за конкретен български уебсайт, който продава лекарства и има листовки, качени онлайн, показва, че жените са по-активната група в ползването на здравна информация онлайн[4]. Това има обяснение предвид почти равния брой мъже и жени онлайн у нас[5], плюс това, че жените по-често търсят информация за второ лице – дете или друг член на семейството.

Данните на НСИ за ползването на Интернет в България показват, че най-представена в Интернет е възрастовата група от 16 до 44 години, тоест предимно млади хора в трудова възраст.

От двата вида данни профилът на новия пациент, който се оформя с развитието на Интернет за България и частично съвпада с профила на българския Интернет ползвател, може да бъде обобщен като: жена, която е трудово заета, с образование над средното и вероятно градски жител.

Въпреки че няма статистически данни какъв процент от българските Интернет ползватели четат здравна информация онлайн, фактът, че имаме утвърдени сайтове за обмен на здравна информация, както и много публикации на здравни теми в Интернет, показва, че такъв интерес и активност има в България. Към така скицирания демографски профил трябва се добавят две важни качества.

  1. Чувство за компетентност и контрол.

Трябва да се подчертае изрично, че „чувство” не означава реална компетентност и контрол. Самото качество е изследвано и потвърдено в резултатите от проучване, направено сред 2275 души, посещавали канадски уебсайт за здравна информация[6]. То вероятно е валидно за повечето активни потребители на здравна информация в Интернет и неговото формиране има следното обяснение:

До развитието на Интернет медицинската информация е достъпна и се ползва основно от професионалисти – лекари и студенти по медицина. Създаването на големи бази данни онлайн, разпространяването на популярна здравна информация в онлайн изданията, и увеличаването броя на хората, ползващи Интернет, са фактори, които значително променят ситуацията. За разлика от преди 20 години, пациентът днес разполага с източник на медицинска информация 24 часа в денонощието, 7 дни в седмицата, в собствения дом. Според някои данни, към 2006 г., „“Гугъл”” е давал достъп до над 3 милиарда медицински статии[7]. Днес Интернет предлага огромни възможности за самообразование на ad hoc принцип. Специализираната медицинска информация онлайн дава възможност на пациентите не просто да получат повече знания, но почти по всяко време и място да могат да потърсят и да получат отговор на въпрос относно симптоми и възможни решения.

  1. Второ важно качество в профила на новото поколение пациенти е активността.

Бърз поглед върху здравните форуми показва как Интернет работи като инструмент за решаване на здравни проблеми. Когато има проблем, пациентът чете в Интернет, докато чете намира общност, която споделя същия проблем, намира предложения за възможно лечение и решава дали ще ходи на лекар веднага или може да изчака. Сайтове и форуми в България предлагат съвети и терапии, в повечето случаи с билкови препарати и лекарствени средства отпускани без рецепта. Факт е, че информацията в Интернет може да бъде неточна или непълна, а някои сайтове показват висока степен на комерсиализация на информацията[8]. Все пак оценявана критически и прилагана разумно здравната и медицинска информация онлайн дава възможност за ефективна самопомощ. Тази самопомощ се изявява в две основни форми.

В единия вариант активният пациент намира решение на проблема си без да стига до лекарския кабинет. Сред причините болният да не търси лекар са липсата на време, средства и др., но най-често са свързани с оценяването на проблема като малък или с подценяването му. В едно изследване се разграничават три типа поведение на потребителите на здравна информация онлайн: стриктно изпълнение на предписанието в Интернет, избор между няколко варианта в зависимост от собствената преценка, и решаване на проблема чрез взаимопомощ в група[9]. Самолечението обаче крие своите рискове и затова умението да се подбира източника на информация, както и да се оценява собственото състояние е важен проблем на неофициалното присъствие на Интернет в здравната практика.

Във втория случай активният пациент допълва с дейността си работата на лекаря. Той отива на преглед, получава диагноза и след това отделя време за онлайн проучване, в което си отговаря на допълнителни въпроси. Така Интернет става важен източник на информация за хора с хронични заболявания, алерии, търсещи профилактика и др. Ще напомня отново американското изследване, според което средният американец ходи три пъти в годината на лекар, но получава здравна информация средно 52 часа годишно в Интернет[10]. Както изглежда, резултатът от това неофициално присъствие на Интернет в здравната система, е увеличаване на здравната и медицинска култура, без да е нужно пациентът да се среща със своя лекуващ лекар и съответно без да се правят допълнителни разходи.

Какви са следствията от чувството за компетентност и активността на пациента за взаимоотношенията между лекар и пациент?

За етиката в отношенията между лекар и пациент.

Взаимоотношениета между лекар и пациент, при което лекарят предлага решение, а пациентът го приема, е изцяло основано на доверието на пациента към лекаря и на авторитета на лекаря. Това отношение е във висша степен етическо, доколкото предполага, че лекарят няма да излъже пациента, нито ще действа в негов ущърб, и ще изпълни своя лекарски дълг. То е етическо отношение от страна на лекаря към пациента. Поради особената професия на лекарите обаче, която е на границата между живота и смъртта, отношението на пациента към лекаря не винаги е просто етическо. То има характеристики на религиозно отноншение. С лекаря не се спори, на него се уповаваш. За много хора, особено тези, които дължат своя живот или живота на свои близки на медицината, лекарят е бил и е абсолютен авторитет. Това е отношение, което Интернет не променя, както показват проучвания на нивото на доверие към лекарите – и в условията на информационната епоха то остава високо[11]. Но това доверие има една „практическа” особеност. В изследване на 6369 души в САЩ, 62.4 % изрязяват силно доверие в лекарите. В същото изследване на въпроса къде са смятали да отидат първо, за да получат специфична здравна информация, 49.5 % от респондентите отговарили, „при лекар”. На въпроса, къде наистина са отишли първо, 48.6 % са посочили Интернет. Директно при лекаря отговарят, че са отишли 10.9 % от респондентите[12].

Както може да се очаква, взаимоотношенията на лекар с пациент, който отива на преглед със знанията си от “Гугъл”, стават по-различни.

Традиционните отношения между лекар и пациент се градят на авторитета на лекаря, който авторитет означава, че има асиметрично отношение на компетентност. Лекарят е този, който е отговорен за взимането на решениято, пациентът е пасивен и търпелив. Самообразованието в Интернет променя баланса в асиметричната връзка не като прави пациента по-компетентен от лекаря, а като поставя и лекаря, и пациента на активната страна, където и двамата имат своята отговорност. Факт е, че лекарската грижа не може да бъде успешна в дългосрочен план, ако го няма активното съучастие на пациента, тоест ако и пациентът, и лекарят работят за една и съща кауза. А последното не може да стане, ако пациентът не полага усилия да се информира. Пациентът може да се информира от различни източници, но предвид факта, че Интернет предоставя достъп до най-голямата възможна база с информация безплатно и веднага, включително статии на професионално ниво, популярни текстове и снимки, лекарствени листовки, онлайн консултации, конкретни случаи и групи за подкрепа, нормално е да се мисли именно в тази посока – основна роля за информираността на пациентите и потребителите днес има Интернет.

Съвместното действие на двата фактора – личната отговорност на човека за неговото здраве и информативните възможности на Интернет – насочват към новото разбиране на баланса на отношенията между лекари и пациенти, в който е важна както професионалната подготовка на лекаря, така и активната здравна култура на пациента.

В поредица от медицински публикации от 90-те години насам се обсъжда така нареченият evidencebased patient choice”, избор на пацианта, базиран на доказателства[13]. Тази тенденция се заражда в медицинската практика още в края на 80-те години и не изглежда да е специален резултат на информационната епоха. Тя обаче се вписва добре в ситуации, при които пациентът иска да знае повече и да има участие и избор в процеса на своето лечение. Един нов, съобразен с възможностите на активния пациент модел на здравеопазването надгражда идеята за „избор на пацианта, базиран на доказателства” с т.нар. „patient-centered health care”, здравеопазване, което се центрира около пациента.

Идеята на „избор на пацианта, базиран на доказателства”, е пациентите, които в условията на пазарно ориентирано здравеопазване се явяват получатели на здравна услуга, да могат да участват във взимането на решение за лечението си, като преценяват и избират лечение на базата на доказателства за неговата ефективност. Тук авторитетът на лекаря отстъпва като фактор на решението пред информацията и доказателствата, които се предоставят на пациента с идеята за неговата активност и отговорност. Въпросният принцип за „избор на пацианта, базиран на доказателства”, има поне четири положителни ефекта:

  1. Играе ролята на получаване на второ и трето мнение по даден здравен казус.
  2. Със знанието и участието на пациента се прави оценка на риска, като съотношение между ползата и вредата от различни варианти на лечението;
  3. Намалява вероятността от назначаване на ненужни манипулации/изследвания или силни лекарства, ако пациентът може да се лекува без тях;
  4. Подобрява възприятието за качество на здравната услуга за пациенти, които искат активно да участват в процеса на лечението си.

В подкрепа на активността и информираността на пациента са редица ситуации, при които качеството на пациента да бъде информиран, работи по-добре, отколкото авторитетът на лекаря.

  1. Например, през последните години се увеличава пазарният дял на индустрията за хранителни добавки и козметичната индустрия, където медицинската и козметичната информация са тясно свързани и изискват специфични познания. Така възникват ситуации, при които специфични въпроси на пациента, не са от компетентността на лекуващия лекар. Било с цел да се открие подходящия специалист, било с цел да се намери отговор на въпросите, които пациентът си задава, посещението на специализирани сайтове е от първостепенно значение.
  2. Безрезервното доверие в лекарите и фармацевтите е в противоречие с маркетизирането на здравеопазванито и силата на фармацевтичната индустрия. Откриването или дори само съмнението за наличие на пазарни отношения в решенията на лекарите е рушително за традиционните етически форми на отношение между пациенти и лекари.
  3. За някои лекарски решения могат да бъдат намерени други алтернативи, които по своята безболезненост и слаби странични ефекти са предпочитани от пациента. Разнообразната информация в Интернет от различни медицински школи, както и влиянието на алтернативната медицина (колкото и оспорван да е нейният ефект) е важен източник на допълнителна информация и възможност да се направи личен избор.

Заключение

  • Слаби диагностични възможности на Интернет.

Интернет не предлага инструмент, който да поставя винаги вярна диагноза. В много случаи потребители могат да се ориентират правилно относно симптоматиката, която ги безпокои, но например експеримент проведен в болница в Брисбейн, Австралия показва успеваемост от около 50 %: 15 от 26 случая[14], чиито симптоми били пуснати в търсачката на “Гугъл”, били диагностицирани правилно, като между тях имало три редки заболявания с уникални симптоми (тоест по-лесно са били „уловени” от търсачката). Що се отнася за осталите под 50 % неуспешни диагнози, става ясно, че ползването само на Интернет за (само)диагностика не е приемливо.

  • Добри терапевтични възможностти на Интернет при правилна оценка на информацията.

Ползването единствено на източници от Интернет за терпевтични цели крие трудности и рискове. Макар интелигентни и образовани, хора, които не са медицински специалисти, не винаги осъзнават риска, който поемат, като се заемат сами със здравните си проблеми. В някои случаи пациент може да открие несъответствия между информацията и терапията от лекуващия лекар и информацията и препоръчителната терапия онлайн. Също така има несъответствия между информацията, която е качена на български език, и информацията, която е на английски. Предвид възможните противоречия в източниците, ползването на Интернет за здравна информация съвсем не е толкова просто. В много случаи е важно тези различия да бъдат обсъждани с лекар.

  • Пациентът – активен и отговорен за собственото здраве (?).

През последните 20 години във философията и културата на здравето настъпи много важна промяна, свързана с разбирането на участието на пациента в неговото лечение. Увеличаването на знанието за рисковите фактори за редица болести увеличи влиянието на принципа, че човек носи отговорност за своето здраве с избора си на начин на живот. Известно е, че пушенето, обездвижването, лошата храна са сред първите фактори, които влияят на здравето. Знае се, че ако човек пуши, рискува белодробно заболяване, ако поддържа наднормено тегло, увеличава риска от диабет, сърдечни заболявания и някои видове рак[15], ако пие много алкохол, е възможно заболяване на черния дроб. Превенцията на болестите чрез избора на начин на живот е силна идея на нашето съвремие – наистина повече позната, отколкото следвана – но която също намира подкрепа в разпространението на здравна информация в Интернет. Превенцията на болестите е много важен принцип, без който здравните системи по света няма да могат да се справят с нарастващото бреме на здравните разходи свързани с демографските процеси, увеличаването на хроничните заболявания и заболяването на млади хора. Осъществяването на този принцип е тясно свързано с възможностите на новите технологии и Интернет.

  • Диалогът между лекари и пациенти е необходимо условие за минимизиране на рисковете от Интернет здравеопазването и за увеличаване на ползите от него.

През последните 20 години у нас постоянна стана темата за финансовата, управленската, кадровата криза на здравната система. В резултат от тези кризи страда пациентът и качеството на здравната грижа. Положителният потенциал на Интернет да омекоти проблемите в системата на българското здравеопазване е огромен. Част от усилията трябва да бъдат насочени към увеличаване на социалното потребление на здравна и медицинска информация онлайн. Интернет създава не само ново поколение пациенти, но и ново поколение лекари. Най-простото нещо е лекари да насърчават пациентите да четат информация в Интернет и да насочват пациенти към качествени сайтове с информация. Само при диалог, а не напрежение между лекари и пациенти, Интернет ще бъде полезен инструмент за решаването на здравни проблеми. И тъй като и финансовата, и кадровата криза в здравната система няма да намерят решението си отведнъж, дори в богати страни това е проблем, целенасоченото въвеждане на Интернет като инструмент на здравната система ще има голямо значение и за здравната култура, и за качеството на общественото здравеопазване.

БЕЛЕЖКИ


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