**2.2 Telemedicine**

Telemedicine is not a new concept but the technology has been extensively used in the last two years due to the corona virus (COVID-19) pandemic. This is not the place to enlist the history of telemedicine as a technology and as a method to enable access to healthcare services remotely. The World Health Organization [2009] defines telemedicine as "the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities" [25]. Telemedicine and telehealth are two concepts that are exchangeable despite the fact they differ as telemedicine focuses on provision of health services to an individual while telehealth focusses on provision and assessment of healthcare services to a population. In their systematic review, Monaghesh and Hajizadeh (2020) they indicated that "telehealth can become a basic need for the general population, healthcare providers, and patients with COVID-19, especially when people are in quarantine, enabling patients in real time through contact with healthcare provider for advice on their health problems" [26]. The promise and potential of telemedicine have been to provide timely, safe, and less expensive care, where the patient/individual does not need to be in the same place/room with the healthcare provider. This simply means that access to healthcare services does not have to move from where the patient is to get into the point of care. During COVID-19 social/physical distancing, has resulted in radical increase in the use of telemedicine services in all countries. This mode of service was provided to avoid contact between patients and healthcare providers who might have been diagnosed as positive COVID-19 and to ensure continuity of primary or secondary healthcare services and in some case tertiary care. Telemedicine services have been provided to ensure timely access to high quality information and care, including prevention and protection services, provision of public health support, provides a form of patient engagement with other patients, family members and healthcare providers, the more advanced form of support includes screening for diagnosis and disease discovery and supports eLearning for both care providers and recipients [27–29].

#### **2.3 Health on the Internet**

A number of concepts are being used to mean information accessed and delivered through the use of the Internet. Among these is the web, which has been defined as "a techno-social system that allows individuals to interact on technological networks, thus improving individual's cognition, communication and cooperation" [30]. Other applications on the Internet include email services and social media platforms. Consumers of health information have found these applications in multilingual forms, easy to access and many of them have been found to be

#### *Healthcare Access*

useful and relevant to their needs. The move from Web 1.0 to Web 4.0 has resulted in providing the end user with more power to control what is being posted and searched on the web using natural language processing. Consumer health, where web developers or owners directly reach out to people poses a challenge of quality of health information, timelessness and possible abuse by predators on the internet [31]. Eysenbach, and Diepgen, [32] provided a number of important issues emerging as a result of failure to control the quality of health information on the internet. They concluded:


The perceived value of information, the quality, usefulness, the level of trust and the language of the site are factors that influence the level of attraction to use a website to search for health information. The emerging quality management sites such as "Heath On the Net- HON" [33], that provides 8 principles (in 38 languages) to make a judgment of the web site is a good example of how health infuriation consumers may get guidance on quality of health information on the Internet. Meeting these principles will result in a certificate provided by HON to the website. It's important, however, to make sure that searching the web for health information, especially for self-diagnosis is no alternative to consulting ad as specialized healthcare professional as "the immediate and widespread sharing of medical and other scientific information outside of expert circles before it has been thoroughly vetted (eg, preprints) can be dangerous, especially in a pandemic [34].

As early as 1997 [35], the use of health information on the internet has been a major issue for consideration as a way to get information that may lead to further use of healthcare facilities and qualified health workforce personnel, while for others, it has been used as the sole source of information resulting to what has been described by WHO (2020) [36] as the "infodemic" being too much information including false or misleading information in digital and physical environments during a disease outbreak. It causes confusion and risk-taking behaviors that can harm health. It also leads to mistrust in health authorities and undermines the public health response. An infodemic can intensify or lengthen outbreaks when people are unsure about what they need to do to protect their health and the health of people around them. With growing digitization – an expansion of social media and internet use – information can spread more

rapidly. This can help to more quickly fill information voids but can also amplify harmful messages." The use of social media has aggravated the situation due to availability and finding unvetted information.

There are different uses of health information on the web such as:

