The number of breast cancer cases in Korea has been increasing significantly, and it has become one of the most common types of cancer in women, making up 16.1% of all cancer incidence in 2001. It is reported that most Women with Breast Cancer (WBC) felt abandoned by health professionals when the treatment was over, and they needed assistance in the transition from being a cancer patient to a cancer survivor [1Pelusi J. The lived experience of surviving breast cancer Oncol Nurs Forum 1997; 24: 1343-53.]. This phenomenon is supported by many Korean research studies [2Hur HK. Information needs of women with breast cancer Korean J Acad Adult Nurs 2000; 12: 286-95.-4Yi M, Lee EO, Park YO, Noh DY, Choe KJ. A descriptive study on educational and counseling needs of breast cancer patients based on the treatment stages Korean J Oncol Nurs 2003; 3: 5-14.] which indicate that WBC are eager to obtain breast health information, primarily in the areas of prevention of recurrence, etiology, diagnostic tests, and prognosis, as well as symptom management, diets, exercises, and alternative therapy [2Hur HK. Information needs of women with breast cancer Korean J Acad Adult Nurs 2000; 12: 286-95., 3Kim GY, Hur HK. Information needs of patients with cancer in Korea Korean J Acad Adult Nurs 2002; 14: 135-43.]. This finding is consistent with the study from 102 WBC investigating the key educational and counseling needs of WBC in Seoul area [4Yi M, Lee EO, Park YO, Noh DY, Choe KJ. A descriptive study on educational and counseling needs of breast cancer patients based on the treatment stages Korean J Oncol Nurs 2003; 3: 5-14.]. The highest, educational need was to know about the method of recurrence prevention. In the pre-admission period, etiology diagnostic tests, treatment and prevention of the breast cancer were needed the most. During the admission period, symptom management after the operation had the highest score. After discharge, prevention of recurrence had the highest score. The results of this research indicate that an educational program should be focused on the medical and symptom management information based on their treatment stages.

Recently, information and education provided through Internet has been actively used to provide emotional support for the patients and their families, as well as helping them in their decision of choosing a health care provider [5Krishna S, Balas EA, Spencer DC, Griffin JZ, Boren SA. Clinical trials of interactive computerized patient education: implications for family practice J Fam Pract 1997; 45: 25-33.]. The most helpful aspect of the Internet is that the user can seek information at the most convenient time and place for them. Through education via Internet, patients can gain significant medical knowledge, self-care and bio-clinical goals can change positively, and the quality of life improved [6Jung YY. The development of a Internet-based computer assisted instruction program and analysis of its educational effects on patients with coronary artery disease, Doctoral dissertation Seoul,Korea: College of Nursing Seoul National University 2004.].

Although some studies [7Kraut R, Patterson M, Lundmark V, Kiesler S, Mukopadhyay T, Scherlis W. Internet paradox: A social technology that reduces social involvement and psychological well-being? Am Psychol 1998; 53: 1017-31., 8Morahan-Martin J, Schumacher P. Incidence and correlates of pathological Internet use among college students Comput Hum Behav 2000; 16: 13-29.] indicate a negative impact of Internet use, such as decreased rates of family communication, decreased social contact, and greater loneliness, other studies demonstrate that Internet use offers greater social support. Its positive impact was demonstrated in the studies focused on the need of specific types of individuals, for example, parents of children with developmental disabilities [9Mickelson KD. Seeking social support: Parents in electronic support groups In: Kiesler S, Ed. Culture of the Internet. Mahwah, NJ: Erlbaum 1997; pp. 157-78.], individuals with isability [10Finn J. An exploration of helping processes in an online self-help group focusing on issues of disability Health Soc Work 1999; 24: 220-31.], caregivers of Alzheimer's disease patients [11White MH, Dorman SM. Online support for caregivers: Analysis of an Internet Alzheimer mailgroup Comput Nurs 2000; 18: 168-76.], widows experiencing bereavement [12Bacon ES, Condon EH, Fernsler JI. Young widows' experience with an Internet self-help group J Psychosoc Nurs Ment Health Serv 1992; 38: 24-33.], and elderly individuals residing in assisted and independent living facilities [13Cody MJ, Dunn D, Hoppin S, Wendt P. Silver surfers: Training and evaluating Internet use among older adult learners Health Commun 1999; 48: 269-86.].

The effect of Internet use was also demonstrated in cancer patients with various diagnosis [14Fernsler JI, Manchester LJ. Evaluation of a computer-based cancer support network Cancer Pract 1997; 5: 46-51., 15Klemm P, Hurst M, Dearholt SL, Trone SR. Cyber solace: Gender differences on Internet cancer support groups Comput Nurs 1999; 17: 65-72.], and breast cancer patients in particular [16Fogel J, Albert SM, Schnabel F, Ditkoff BA, Neugut AI. Internet use and social support in women with breast cancer Health Psychol 2002; 21: 398-404., 17Sharf BF. Communicating breast cancer on-line: Support and empowerment on the Internet Women Health 1997; 26: 65-84.] Fogel et al. [18Fogel J, Albert SM, Schnabel F, Ditkoff BA, Neugut AI. Use of the Internet by women with breast cancer J Med Internet Res 2002; 4: e9.] indicated that 42% of breast cancer patients use the Internet as a source of information in the United States.

A recent survey in Korea reported the number of Internet user as almost 2.7 million, accounting for 64.1% of the population in 2003 [19]. Among them the number of women was about 1.3 million. The age distribution was highest in their 30s and 40s, and most of them (71.6%) used the Internet to search for information. The mean number of hours spent on the Internet, per week was 12.2 hours. However, well organized Internet sites about health care, breast health in particular, have not been developed to a great extent in Korea. Thus we strongly believe that web-based educational program would be very effective and efficient in supporting WBC in Korea.

The purpose of this study was to analyze the acceptance level of an Internet website designed to help those with breast cancer. Recently, through the increased in popularity of Internet websites and its information sharing network and emotional support, there have been many new Internet patient communities with lively activity. Along with the increase in usage of blogs, mini-homepage, online clubs and communities, there have been an increased need for consumer’s participation and common sharing. This sheds light on how important it is to take the health information consumer’s needs into account when developing Internet health information website.

When Internet first became popular it was widely thought that majority of Internet users were male demographic who work in offices or have professional careers. However, data shows that women, especially in their 30s and 40s, use Internet more frequently specifically in terms of searching for Internet health related information [20Ryeu SW, Ha YJ. Usage of health information on the Internet Health and Wellness Policy Forum 2004; 11: 71-87.]. To extrapolate this trend, we can predict that the usage of Internet website for breast cancer patient will only increase with time. In this study we showed that women in their 40s, who have higher income and have been using the Internet for more than 3 years, were the most satisfied by the website. This is because highly educated, high income demographics tend to rely more highly on Internet and use it more frequently, and also this group has higher expectation of quality regarding Internet health information. The recent development of Internet including the more user-friendly web 2.0’s debut has added to the previous functions, resulting in higher reflection of health information consumer’s needs and consideration of functional upgrades.

The study showed that the subjects evaluated the websites beneficially, but agrees that there can be more done in terms of the amount of content. Online patient communities that focus on a specific disease tend to demand the most in-depth information available. There are many websites that have general health information on the web, however in terms of the depth, they do not satisfy the demands of health information consumer. Hence, even those online patient communities that are well received need to keep up their quality control and provide contents that are rich in both quantity and quality.

According to one study [2Hur HK. Information needs of women with breast cancer Korean J Acad Adult Nurs 2000; 12: 286-95.], there has been frequent usage of Internet health information abroad. However due to language barrier and socio-economical reasons, Koreans living abroad have harder time approaching the medical systems in their residential countries and also if the health information website is in English, it makes it even harder for the Korean speakers which resulted in higher usage of health information website in Korean. Hence, since Internet allows information sharing between all countries, this also allows the Korean immigrants overseas to access the Internet health information websites that are developed within Korea. This shows the usefulness of Korean version of foreign websites and also the websites developed for this study specifically. As the issues around web-based education are not unique to Korean patients, the findings and clinical implication of developing and utilizing the health information websites will be applicable to the users globally. As this website is a sister site to the well-known Breast Cancer website provided in English, it could be extended to the global users by developing the English version of the flash educational materials and posting and linking them to the site.

To conclude, it is highly imperative for the development of educational websites that are sensitive to the needs of health information consumers and especially the online patient communities that are specific to certain conditions.

This study aimed to evaluate the effectiveness of the web based educational program by developing a website for breast cancer patients and analyzing the function of educational program and contents by surveying the women with breast cancer and 147 people replied.

1. Each category of Usefulness of information section showed high scores. The highest scoring subcategory was ‘Useful information in decision making related to breast cancer patients’ (3.33±0.51). Out of total 64 points, it showed a relative even distribution of 49.14 (±6.05) points.
2. Whether the demographic characteristics influence the educational effectiveness of Web-based educational program was verified. The result showed that all other factors except for the frequency of Internet usage have no relevance, and higher the frequency of Internet usage, the higher the effectiveness of the system scored.
3. The factors that influence the satisfaction of web-based educational program are age, religion, whether the subjects perform breast self-examination, income, stage of disease at diagnosis, source of health information, and the duration of Internet usage. The R² value of this model was 0.296 (F=6.15, P<0.0001).
4. The factors that influence the usefulness of web-based educational program are religion, period since diagnosis, source of information, frequency of Internet usage, recurrence of breast cancer, and family history (R² = 0.270, F=5.45, P<0.0001).

Through this study, there will be many useful improvements in terms of richness of resources and useful functions in the web-based educational program geared towards breast cancer patient in the future. For example, to improve the satisfaction of the users could be accomplished by developing customized contents by age groups and adopting features that are used more conveniently by age specific cognitive and motor skills. The authors would like to have the follow-up research to test whether women who have used the website are better off by measuring whether they are better informed long-term, or assessing whether they check themselves more effectively and so on. The research design would be post-treatment and long-term outcomes evaluation.