Health information-seeking behaviour in adolescence: the place of the internet
Introduction
This paper reviews adolescents’ health information-seeking behaviour, with specific regard to the sources that they use, and explores data describing the role of the internet in this context. The contribution of online health information will be reviewed in the context of the existing literature regarding adolescent health information-seeking behaviour. We describe a study of adolescents’ use and perceptions of the internet as a health information source, and review major themes from these data regarding previous experience, saliency and credibility of the information and the source.
Adolescents are interested in finding information about a range of health topics, such as exercise/diet, sexual health and alcohol/drug misuse. They form one of the most active groups of internet users, notably (although not exclusively) through initiatives to promote use of this technology in schools. This study seeks to add insights to the literature regarding adolescents’ experiences and perceptions of online health information seeking. It is important not to isolate the internet from the wider network of information sources that are accessible to individuals in their everyday life. This paper considers the link between issues unique to the internet, and those relevant to all health information sources. By considering the factors that influence adolescents’ use of traditional information sources, we can begin to reflect on how the internet might compare with these sources, and its perceived usefulness to young people.
Information about health and medicines is gathered over time through a complex network of sources (e.g. O’Keefe, Hartwig Boyd, & Brown, 1998; Rogers, Hassell, & Nicolaas, 1999; Gray, Cantrill, & Noyce, 2002). Information may be actively sought or passively absorbed. Health information sources have been categorised according to whether they are ‘professional’ or ‘lay’ (Gore & Madhavan, 1993), and ‘personal’ (involving a two-way exchange) or ‘impersonal’ (Elliott-Binns (1973), Elliott-Binns (1986)). Different sources can be examined in terms of three issues that are known to affect the perception and recall of information:
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previous experience of the symptom/condition, and of the source (Calnan & Williams, 1996);
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saliency of information to the individual (Schneider & Laurion, 1993);
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credibility of the source, which has been explored in previous health research as a function of three dimensions—expertise, trustworthiness and empathy (Gore & Madhavan, 1993).
Lay personal information sources feature strongly in the everyday lives of adolescents. Studies of general health information sources indicate that parents are key informants for adolescents (e.g. Dickinson, 1978; Gould & Mazzeo, 1982; van den Berg & Parry, 1983; Chambers, Reid, McGrath, & Finley, 1997; Schoen et al., 1997; Ackard & Neumark-Sztainer, 2001). Peers are also widely cited (e.g. Thornburg, 1981), and become more important for older adolescents (e.g. Gould & Mazzeo, 1982). Gender differences have been noted in some studies regarding male and female propensity to consult parents about sexual health information: Thornburg (1981) found, for example, that young women were more likely to consult their mothers whilst young men would favour peers.
In contrast, adolescents are known to have difficulty forming therapeutic relationships with professional health care providers, and accessing health services (e.g. Klein, Wilson, McNulty, Kapphahn, & Scott Collins, 1999; Jacobson, Richardson, Parry-Langdon, & Donovan, 2001). Doctors and nurses, however, are often cited as information sources about a range of conditions (e.g. Ackard & Neumark-Sztainer, 2001). A study of young people with long-term conditions indicated that they might choose different sources for different types of information (Beresford & Sloper, 2003). Thus, they might seek medical facts from health professionals, but psycho-social information from friends or someone else with the same condition.
Lay impersonal sources of information include mass media and health reference material derived from lay sources. Traditional mass media are characterised by the one-way flow of information from the producer to the recipient, and the resultant lack of feedback between them (Thompson, 1992). Many studies of adolescent illicit drug information sources have found that mass media played a key role (e.g. Sheppard, 1980; Mirzaee, Kingery, Pruitt, Heuberger, & Hurley, 1991). A recent study of smoking information sources among US African American students showed that television was most often cited as a source (Kurtz, Kurtz, Johnson, & Cooper, 2001). The authors noted, however, that students who cited lay personal contacts had higher knowledge, attitude and preventive effort scores than others. Little previous research exists concerning adolescents’ use and perceptions of professional health books and leaflets. Unlike mass media, access to these materials is often restricted to doctors’ surgeries and other health outlets, such as pharmacies.
It is necessary to consider how the use of the internet is placed in the broader context of health information resources. Moreover, reflecting on the current use of these sources, we can start to explore comparative advantages and disadvantages of the internet.
More recent studies of adolescent health information sources have included the internet (e.g. Schoen et al., 1997), and the body of literature regarding the use of this specific medium by adolescents is increasing rapidly (e.g. Brodie et al., 2000; Borzekowski & Rickert, 2001; Rideout, 2001; Gould, Munfakh, Lubell, Kleinman, & Parker, 2002; Hansen, Derry, Resnick, & Richardson, 2003; Hanauer, Dibble, Fortin, & Col, 2004). Relevant literature exploring previous experience, saliency and credibility, with regard to internet use, is summarised below.
Previous experience: Data from the 1997 US Commonwealth Fund Survey of the Health of Adolescent Girls, a nationally representative survey of both male and female students from grades 5 to 12, showed significant internet health use (Schoen et al., 1997). Boys were significantly more likely than girls to use the internet for health information (15.6% vs. 9.4%, p<0.01). Surveys of adolescent internet use for health information confirm that many young people are grasping this opportunity (e.g. Brodie et al., 2000; Borzekowski & Rickert, 2001; Goold, Ward, & Carlin, 2003; Hanauer et al., 2004). “Generation Rx”,1 a survey of youth internet use, reported that 90% of its 15–24-year-old participants had ever been online, and that 75% of these “online youth” had sought health information (Rideout, 2001). This was roughly the same proportion as those who had ever played games or downloaded music online. Health subjects reported to be of most interest matched the key issues outlined above in previous information studies, namely sexual health and drug/alcohol abuse. When participants reported their actual use, however, the top three subjects were specific diseases (such as cancer and diabetes), sexual health and weight loss/gain. Respondents were also asked how they had used the information after their internet search: the majority reported that it helped to start a conversation with lay and professional personal contacts. A significant minority reported taking action based on the information, such as visiting a health professional or changing their behaviour.
Weiser (2001) undertook studies with separate groups of college students and internet users to model the major functions of internet use. He proposed that there were two main functions for which the technology was used: socio-affective regulation (SAR) and goods-and-information acquisition (GIA). This can be applied to the use of the internet for health issues by young people: SAR might be related to online community support from peers and professionals (lay and professional personal sources), and GIA by young people would relate to the seeking of information and health products online (from lay and professional impersonal sources).
Saliency: Hansen et al. (2003) observed adolescent searches for information related to pre-set tasks, and found that their success varied. The greatest challenges related to a task to find information about a local health service, but the sheer volume of possible sites retrieved by most search engines also caused difficulty that was often resolved by confining their interest to the first few results. Some adolescents in this study also noted the difficulty in retrieving relevant information, but others felt that the internet offered advantages over other sources in the facility on some sites to personalise information. Another recent study has reported that internet health information users regard the medium positively as a source, but many were unable to locate satisfactory information for a specific query (Zeng et al., 2004). Skinner, Biscope, Poland, & Goldberg (2003) found that adolescents who use the internet for health information felt that high-quality information did exist, but that they were insufficiently skilled to find it.
Credibility: There seems to be much anxiety among health professionals and policy makers about the potential for the internet to mis-inform patients (e.g. Arunachalam, 1998; Bonati, Impicciatore, & Pandolfini, 1998). This is manifested by numerous academic papers regarding the quality of web-based information about subjects as diverse as depression and the treatment of fever in children (e.g. Griffiths & Christensen, 2000; Fallis & Fricke, 2002). In the few studies that have explored users’ perceptions of the credibility of sources that transmit information through the internet, the concepts of expertise and trustworthiness have been closely linked. Peterson, Aslani, & Williams (2003) found that internet users’ perceptions of the credibility of health information varied: some viewed the pharmaceutical industry as authoritative, others preferred independent sources such as educational institutions and government departments.
Some of this literature relates to adolescents, but there is a need for more exploration of these specific issues in this demographic group. The present study explored adolescents’ perceptions and use of the internet for health and medicines information. During the wide-ranging discussion, insights were revealed into these characteristics of the internet, contextualised within their general use of online information, and compared with other health information sources.
This paper seeks to explore UK and US adolescents’ perceptions and experiences of online health information regarding previous experience of use, saliency of the information, and credibility of the medium. A cross-national perspective was sought to better understand universal versus culturally mediated attitudes within English-speaking countries.
Section snippets
Methods
This study was undertaken to examine adolescents’ perceptions and experiences of using the internet for health information. As this work was necessarily descriptive and exploratory, a series of focus groups was convened with adolescents (aged 11–19 years) from a convenience sample of UK secondary and US middle/high schools. It was hoped that when participants shared their experiences of internet use, we would find both consensus and challenges within the dynamic, interactive environment of the
Results and discussion
It was notable that most themes indicated consensus across different demographic groups and across countries. Native UK and US English speakers seem to be immersed in a common online culture, facilitated by common material available through search engines that have a presence in both countries. Significant differences will, however, be described. The results are presented according to previous experience of the source, the saliency of internet health information, and its credibility.
Conclusions
This is one of the first studies to explore adolescents’ experiences and perceptions of using the internet for health information using qualitative methods. We cannot generalise the findings of this study to specific populations, but we can comment on the strong overarching themes within the cross-national sample of young people in two countries that share both language and, increasingly, many cultural practices and icons. Many of the themes within the groups were not linked to specific
Acknowledgements
The authors would like to thank the students, schools and colleagues who made this study possible. We are also grateful for the comments of Dr. Paul Bissell and Dr. Kath Ryan during drafting. The study was supported by the Commonwealth Fund, a New York City-based private independent foundation. The views presented here are those of the authors and not necessarily those of the Commonwealth Fund, its directors, officers or staff.
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