Swedish Agency for Health Technology Assessment and Assessment of Social Services
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Adolescents experience of accessibility to online health information
The youth counselling centres in Sweden (Ungdomsmottagningen) give advice and health information on topics like reproductive health and relationships, psychological health and legal rights to visitors in the age span of 12–25 years. The centres usually stay open on weekdays and visits are free of charge. Access online is possible via homepages from the regional clinics as well as a shared page with information in different languages. The question comes from officials in the healthcare region of Gothenburg who wants to increase the access to the youth guidance centre. They also want to reach out more to young persons with different disabilities (physical and cognitive), youth with transgender experience and youth who are exposed to honour-based violence and control.
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Question
What do research say about adolescent’s experience of accessibility to online health information?
Identified literature
| Included studies | Population/intervention | Outcome |
| Freeman et al 2018 [1] | ||
| 34 | 13–18 years | Whether and how adolescents search for online health information, and the extent to which adolescents appraise online health information. |
| Authors' conclusion: Adolescents are aware of the varying quality of online health information. Strategies used by individuals for searching and appraising online health information differ in their sophistication. It is important to develop resources to enhance search and appraisal skills and to collaborate with adolescents to ensure that such resources are appropriate for them. • Use of Search Engines: One of the most striking themes across the literature concerned the widespread use of algorithm-based search engines by adolescents. • Barriers to Searching: Various barriers to searching emerged throughout the papers. One of the more significant barriers described by participants was the challenge of navigating vast quantities of often irrelevant or inconsistent online health information. • Absence of Searching: Numerous studies revealed that online health information searching is not a frequent activity undertaken by adolescents. Although adolescents demonstrated an awareness that the information was available, they were often not sufficiently motivated to actively search for it. or they viewed the Internet as a vehicle for entertainment rather than a source of health information. • Evaluation Based on First Impression of Web Site: Adolescents demonstrated a preference for Web sites that were well-organized with online health information that was concise and clear. Participants reported a preference for Web sites that seemed to be in some way professional, using a professional tone, with language that was understandable and age appropriate. • Evaluation of Web Site Content: Adolescents reported cross-referencing and validating health information with other online and offline sources. When faced with conflicting information, participants described trusting the information provided by the majority of Web sites and thus corroboration was viewed as an indicator of the credibility of the online content. • Absence of a Sophisticated Appraisal Strategy: Many papers found that adolescents used no clear appraisal strategy when assessing the credibility of online health information. Instead, some participants reported using their instinctive responses to information. |
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| Park et al 2018 [2] | ||
| 19 | <24 years | The objective of this systematic literature review was to examine the phenomenon of children and adolescents’ health-related internet use and to identify gaps in the research. |
| Authors' conclusion: This study’s findings provide important information on how youth seek information and related support systems for their health care on the internet. The conceptual and methodological limitations of the identified studies, such as the lack of a theoretical background and unrepresentative samples, are discussed, and gaps within the studies are identified for future research. • The most common means for accessing the internet were personal computers or laptops (65%), followed by cell phones or other mobile internet-enabled devices (42%), with many reporting using both. • The topics that young people search for online includes information on daily health-related issues, physical well-being, sexual health, mental health social problems, and culturally and religiously sensitive topics. • Youths often use the internet to connect and create supportive communities on particular health issues, expressing interest in diverse online activities related to health, including messaging and connecting with others, networking, and receiving information. Intriguingly, 61.2% preferred an online support group to offline in-person groups. • Gender, age, and in-school status are associated factors for the frequency of health-related internet use. Girls tend to use the internet more often for help seeking online. Youth of both sexes aged 16 to 17 years reported the internet to be their primary source for information. • Overall, children and adolescents’ perception of health-related internet use is positive. • Regarding the perceived importance and usefulness of the internet, 90% of the participants in one study responded that having access to health-related resources on the Web is important, but only 8% of those in another study stated that their preferred source of information was the internet. When adolescents are asked specifically about their sexual health–related use, 48.1% reported that they are relieved or comforted by the information online. Online privacy was a key issue for youth, with 87.7% stressing the importance of online privacy, which was particularly important for those with a specific health problem such as mental health issues. Looking for sexual health information online was also closely linked to privacy issues as many youth felt reluctant to speak with an HCP about sensitive issues surrounding sexuality and instead use the internet to avoid embarrassment and overcome privacy issues. On the other hand, lesbian, gay, bisexual, and transgender (LGBT) youth identified fear as an obstacle to online sexual health behaviors because of the perceived stigma resulting from being “caught”. • Another strong concern among youth who use the internet was the accuracy of the information. |
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| Population | Study design | Outcome |
| Ellis et al 2013 [3] | ||
| 486 males (aged 16 to 24) and 17 focus groups involving 118 males (aged 16 to 24). | Mixed methods study | This mixed-methods study was designed to explore young Australian men’s attitudes and behaviour in relation to mental health and technology use to inform the development of online mental health services for young men. |
| Authors' conclusion: The key challenge for online mental health services is to design interventions specifically for young men that are action-based, focus on shifting behaviour and stigma, and are not simply about increasing mental health knowledge. Furthermore, such interventions should be user-driven, informed by young men’s views and everyday technology practices, and leverage the influence of peers. • The focus group data suggested that young men would be less likely to seek professional help for themselves, citing a preference for self-help and action-oriented strategies instead. • Most survey participants reported that they have sought help for a problem online and were satisfied with the help they received. |
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| Flanders et al 2017 [4] | ||
| 18 sexual minority women between the ages of 16–29 | Exploratory qualitative study on focus groups | This exploratory qualitative study employed a series of focus groups to understand more about what types of Online resources young sexual minority women access, their motivations for using those resources, and what types of sexual health information they need. |
| Authors' conclusion: These findings help begin to fill the gap on knowledge of young sexual minority women’s sexual health information seeking practices, which can be used for the development of effective online sexual health information resources targeting young sexual minority women. • Results indicate that participants used a wide range of online resources, such as apps, websites, blogs, and YouTube. • The type of resource accessed often depended upon the information needed. • Participants reported preferring online resources due to experiences or expectations of heteronormativity from their sexual health service providers, convenience and accessibility, the capacity to remain anonymous, and the lack of relevant sexual health information offline. |
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| Frost et al 2016 [5] | ||
| N=457 | Age range: 14–25 Mixed-methods exploratory analysis |
To investigate the perspectives of young people who self-injure regarding online services, with the aim of informing online service delivery. |
| Authors' conclusion: Young people expressed clear preferences regarding online services for self-injury, supporting the importance of consumer consultation in development of online services. • Seven themes emerged in relation to preferences for future online help-seeking: information, guidance, reduced isolation, online culture, facilitation of help-seeking, access, and privacy. • Direct contact with a professional via instant messaging was the most highly endorsed form of online support. |
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| Gilbert et al 2005 [6] | ||
| N=1242 | Age range: 13–17 Online survey |
A pilot study was conducted to measure audience and information-seeking characteristics of the www.iwannaknow.org Web site. (A teen STD prevention Web site.) |
| Authors' conclusion: Methods and findings will assist researchers, Web site developers, and health educators to refine these evaluation methods, develop effective Web sites, and tailor STD prevention messages by age group and gender. The Internet is a cost-effective method for educating teens and those who care for or work with teens about STD risks and prevention, however, more research is needed to assess the behavioral effects of online interventions. • The content analyses and the usability tests were useful for revising the site content and aesthetics and preparing the online survey. • Most accessed the Internet from home. • The most frequent topic of interest was sexual expression, followed by teen sexuality, virginity, relationships, contraception, and then STD information and these varied by age and gender. |
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References
- Freeman JL, Caldwel PHY, Bennett PA, Scott KM. How adolescents search for and appraise online health information: A systematic review. J Pediatr 2018;195:244-55.
- Park E, Kwon M. Health-related internet use by children and adolescents: Systematic review. J Med Internet Res 2018;20:e120.
- Ellis LA, Collin P, Hurley PJ, Davenport TA, Burns JM, Hickie IB. Young men's attitudes and behaviour in relation to mental health and technology: implications for the development of online mental health services. BMC Psychiatry 2013;13:119.
- Flanders CE, Pragg L, Dobinson C, Logie C. Young sexual minority women's use of the internet and other digital technologies for sexual health information seeking. Canadian Journal of Human Sexuality 2017;26:17-25.
- Frost, M, Casey L, Rando N. Self-injury, help-seeking, and the internet: Informing online service provision for young people. Crisis 2016;37:68-76.Gilbert LK, Temby JRE, Rogers SE. Evaluating a teen STD prevention Web site. Journal of Adolescent Health 2005;37:236-42.
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Project group
Alexandra Snellman, Sally Saad, Sara Fundell, Åsa Fagerström and Miriam Entesarian Matsson at SBU.
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