Background
Information on the internet has the potential to inform and empower patients to be active participants in their treatment. Still, it is possible that some of the population is excluded due to no accessibility or low digital and health literacy to make proper use of the electronic resources.

Purposes
(1) Map the needs, usage patterns and outcomes of using electronic resources by Israeli consumers; analyze the above as a function if their demographic background and eHealth literacy.
(2) Describe and analyze health sites in Hebrew, and conduct interviews with decision makers, builders and managers of sites in order to ascertain the quality and level of information, language, and assumptions embedded in the structure of the sites regarding the end-user – the client.
(3) Examine gaps between the availability and content of electronic health resources and the needs and skills of potential users.

Methods
Focus groups were run in order to integrate content from the literature to the particular population. A survey questionnaire was built and administered to a representative sample of 4286 Israelis, speakers of Hebrew and Arabic. Five health sites in Hebrew were analyzed, lying on the spectrum of government-public-private, and 23 interviews were conducted with decision makers, builders and website's managers.

Results
Only half of the Israeli population uses the internet and third of the population uses the internet for health purposes. The group of non-users is characterized by old age, low education, and a high rate of reported chronic illness. In addition, internet users who were high on eHealth literacy was younger, more educated and less chronically ill. Their use of the internet was marked by more search strategies and more scrutiny and skepticism towards the information. Lastly, those high in eHealth literacy gained more from using the internet cognitively, instrumentally, and in terms of their relationship with attending professionals.
Analysis of health websites and interview material uncovered that generally there is no planning of content and no cooperation or inclusion of users in the process. Websites' builders and managers use themselves and people they know as a benchmark; no focus groups are run, informants are not interviewed, and no segmentation of the population is carried out.

Conclusion
Hebrew-run health websites leave out two-thirds of the population, and do not engage in costumary/professional steps to include more of the Israeli public.

Policy recommendations
Policy makers should pale programs for enhancig digital litercies capabilities of disadanced group as exemplified in Europe and North America, We strongly suggest that stake holders from public & private organization will voluntarily collaborate in order to establish an agreed procees and standards for Health web site content & design

Ruppin Academic Center

Research number: R/44/2007