UK and US adolescents perceived internet health information to be salient but of questionable credibility
Q How do adolescents in the US and UK use and perceive the internet as a source of health information?
7 secondary schools and sixth form colleges in the UK and 3 public and 2 private middle/high schools in the US.
157 English speaking students (11–19 y) in 26 focus groups (15 in the UK and 11 in the US).
Data were collected from 30–60 minute focus group discussions that explored perceptions of accessing and using online health information. Discussions were audiotaped and transcribed verbatim. Emergent themes regarding previous experience, saliency, and credibility of the information and source were identified iteratively.
Experience using the internet. Most adolescents had actively sought health information online and said that the internet gave them access to information beyond their normal life experience. Students said that the internet was an important source of information that fit comfortably into the context of their lives (eg, “My computer’s right next to my TV so I just do both at the same time!”). Use of the internet as a combined communication, entertainment, and information medium was reflected in a range of comments relating to typical use. Many students reported searching for information about personal health and wellness through diet and exercise. For example, a young woman stated that “I went on the internet a while ago, because I started some yoga…I always forget, when I get home, what exercises I did. So I went on to see where to find some exercises…and that led to other exercises.” Similar examples of young men searching for fitness information were found. The convenience of accessing online self care information rather than visiting a health professional was cited as motivation for using the internet (eg, “I wanted to know how to get rid of a wart on my toe without the doctor—so I looked on the internet and it told me stuff like how to get rid of plantar warts”). Positive experiences led to favourable perceptions of the internet as a medium for obtaining health and wellness information.
Saliency of internet information. The internet enabled students to find a wide range of information quickly and conveniently. However, lack of specificity sometimes led to frustration. For example, “Like on search engines…If you’re looking up…sports or something…sometimes it never brings that sport…It could have a million different things. It’s annoying.” In an internet navigation exercise, several groups of UK students perceived lower relevancy of non-UK information (eg, pollen counts in the US). Students also reported passive exposure to an array of health information over the internet such as advertisements for condoms, medicines such as Viagra, and weight loss products. The personalisation of resources on the internet facilitated by feedback loops and online surveys increased the saliency of information for users.
Credibility of the internet. Some participants felt that the expertise and use of the internet had limits as a health information source. For example, one US woman felt that people with more serious diseases such as cancer might not use the internet, but that it might be appropriate for dealing with minor “cosmetic” ailments such as bad cuticles. Most themes regarding comparison of the internet with other sources related to the advantage of the internet over seeing a health professional or reading a book. Examples of advantages of the internet over books included currency of the data and ability of the user to examine a subject from different perspectives. However, some favoured the use of books, either because they trusted books more as credible sources or because they perceived that it was faster to access information from a book. Many groups commented on the importance of getting accurate health information. Information from websites associated with academic institutions rather than those created by individuals were considered to be more credible. Other issues about the internet included concerns about the possibility that it could lead to misdiagnosis and unwarranted anxiety about personal health, its poor image as portrayed by news media, and trustworthiness of online medicine retailers (no student reported ever buying a medicine online). Only 1 participant anonymously visited a chatroom to discuss a sensitive skin condition.
Adolescents in the US and UK had extensive personal experience with the internet, including search engines and specific information websites. Although the health information gleaned was generally regarded as salient, its credibility was sometimes questioned.
- Deborah Finfgeld-Connett, APRN, PhD, BC
The study by Gray et al offers insights into how, why, and to what extent adolescents use the internet to access health related resources. The results shed light on the saliency of web based information and students’ healthy scepticism about the credibility of some websites.
Single sex focus groups and cross-national data collection sites are clear strengths of this investigation.
Based on findings of this exploratory investigation, tentative recommendations for practice can be inferred. Web based health references appear to be resources that are readily accessible and acceptable to teenagers. For this reason, healthcare providers are encouraged to make the most of this age appropriate health promotion device. Nurses are urged to become familiar with reputable websites that might be of interest to adolescents and be ready to share these resources with their patients. Sites of particular interest to this age group might relate to alcohol and drug abuse, contraception, and eating disorders. If nurses are unable to refer teens to specific websites, they can urge adolescents to conduct their own online searches, keeping in mind ways to identify authoritative sites that offer age appropriate and culturally specific information (eg, professionally accredited portals such as http://www.nhs.uk/youngpeople/). When suitable websites are lacking, nurses may want to establish their own web based resources.
Despite optimistic predictions about the usefulness of web based resources for teenagers, limitations exist. Technology needed to access the internet may be lacking in some communities, such as impoverished or rural locations. Moreover, even when reliable technology is available, individuals may lack the personal resources to obtain it. Finally, nurses are urged to pursue research investigations that examine the effectiveness of web based resources in promoting healthy lifestyles.
For correspondence: Dr N J Gray, School of Pharmacy, University of Nottingham, Nottingham, UK.
Source of funding: Commonwealth Fund, New York, USA.