Elsevier

Journal of Adolescent Health

Volume 37, Issue 3, September 2005, Pages 243.e1-243.e7
Journal of Adolescent Health

Original article
The Internet: A window on adolescent health literacy

https://doi.org/10.1016/j.jadohealth.2004.08.023Get rights and content

Abstract

Purpose

Adolescents are well served by the Internet through school access, but they will only derive maximum benefit from this information resource if they are able to search for, evaluate, and use its online information effectively. Internet use, however, requires significant literacy skills, and little is known about the health literacy of adolescents. The aim of this paper is to describe functional, critical, and interactive health literacy challenges experienced by adolescent students when using the Internet for online health information.

Methods

Twenty-six focus groups with 157 adolescent students, aged 11–19, conducted within a convenience sample of middle and high schools in diverse geographical and socioeconomic settings in the United Kingdom (UK) and United States of America (US) between May 2001 and May 2002.

Results

Many students cited difficulties in accessing health information online. Functional health literacy challenges included, for example, spelling medical terms correctly and being able to construct questions describing symptoms accurately. Critical challenges included discerning relevance of information retrieved by search engines and knowing which sites to trust. Interactive challenges included the appropriate application of health information to address personal health concerns within their local neighborhood.

Conclusions

Exploring the challenges faced when adolescents search for online health information indicates deficiencies regarding health literacy skills. Difficulties regarding functional, critical, and interactive skills were all present. The Internet may offer opportunities for identifying such deficiencies and building better health literacy skills among adolescents, as part of health curriculum interventions to improve the population’s future health.

Section snippets

Beyond the digital divide

Commentators have rightly concerned themselves with the “digital divide”, where issues of physical access to the Internet could aggravate already unacceptable health inequalities [1]. Inevitably, many of the first purchasers of home computers and Internet services were in higher social groupings, either by virtue of wealth or educational ability. Classic diffusion of innovation theory dictates that other groups in the population copy “early adopters” over time [6]. Adolescents as a population

Health literacy: More than reading and writing

The recent report from the Institute of Medicine (IOM), “Health Literacy: A Prescription to End Confusion”, confirms the importance of promoting health literacy in individuals as it estimates that 90 million people in the US cannot understand complex texts [10]. Strategies proposed by the IOM include incorporating health-related tasks into lesson plans in schools, recognizing that teaching young people will be a good investment for future population health. The American Medical Association

Health literacy and adolescents: Missing an opportunity?

Most studies that have measured health literacy and its impact on health status or use of health services have not included adolescents: studies involved mainly hospital patients, those with long-term conditions and older people [22]. One study addressing the relationship between health literacy and gonorrhea related care did include a wide cross-section of a US local population (aged 12 to 55 years) [23], but age-related differences were not examined in the analysis.

Many adolescents are still

The Internet as a “window” on health literacy

When an individual uses the Internet to find health information, it is an excellent illustration of the demands placed upon their health literacy to find, evaluate, and apply information in order to achieve a positive health outcome. The user has to locate Web sites that meet their need, often by using sophisticated search strategies. Ideally, they should then critically evaluate the information to determine its credibility. If they perceive that they have found useful information, they then

Methods

The wider study was undertaken to examine adolescents’ perceptions and experiences of using the Internet for health information. We conducted a series of 26 single-gender focus groups from a convenience sample of middle and high schools known by the cross-national research team to reflect diversity of public/private funding, socioeconomic background, and ethnicity (Table 1). Data collection took place between May 2001 and May 2002. The overall age range was broad, but the members of each group

Results

The focus groups included a total of 157 adolescents (ages 11–19 years), with a range of 3–9 participants per group. All the data presented here are self-reported by the students.

Discussion

This study provides useful insights into how the challenges faced by adolescents who search for health information online might be linked to poor health literacy skills. The dynamics and open nature of focus group discussions result in a more diverse, insightful, and rich output than other more structured techniques allow. There are limitations, however, because the sample is not representative of the US and UK adolescent populations. It is based on self-reports of perceptions and experiences,

Conclusions

To maximize their benefit from online health information, adolescents need to develop good health literacy skills. Our study revealed that adolescents are relatively sophisticated Internet users: nonetheless, they have gaps in their ability to find, evaluate, and apply online health information. Strategies have usually been developed through trial and error, with little guidance from adults either at home or at school. The students themselves did not always perceive these needs, but their

Acknowledgments

The authors thank the students, staff, and schools who participated in this study, and the research colleagues who helped with data collection at the Universities of Rochester and Manchester (Melissa Matos Auerbach, Rachel Mullen, Ellen Schafheutle, and Elizabeth Seston). This study has been 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,

References (29)

  • D.L.G. Borzekowski et al.

    Adolescents, the Internet, and healthIssues of access and content

    J Appl Dev Psychol

    (2001)
  • S.C. Kalichman et al.

    Health literacy and health-related knowledge among persons living with HIV/AIDS

    Am J Prev Med

    (2000)
  • M. Brodie et al.

    Health information, the Internet, and the digital divide

    Health Aff

    (2000)
  • V. Rideout

    Generation Rx.comHow Young People Use the Internet for Health Information

    (2001)
  • D.L. Hansen et al.

    Adolescents searching for health information on the InternetAn observational study

    J Med Internet Res

    (2003)
  • H. Skinner et al.

    How adolescents use technology for health informationImplications for health professionals from focus group studies

    J Med Internet Res

    (2003)
  • E.M. Rogers

    Diffusion of Innovations

    (1995)
  • Internet Access in US Public Schools and Classrooms1994–2000

    (2001)
  • Statistics of EducationSurvey of Information and Communications Technology in Schools 2001

    (2001)
  • D.L.G. Borzekowski et al.

    Adolescent cybersurfing for health informationa new resource that crosses barriers

    Arch Ped Adolesc Med

    (2001)
  • Health LiteracyA Prescription to End Confusion

    (2004)
  • Health literacyReport of the Council on Scientific Affairs

    JAMA

    (1999)
  • D. Schillinger et al.

    Association of health literacy with diabetes outcomes

    JAMA

    (2002)
  • D.W. Baker et al.

    The health care experience of patients with low literacy

    Arch Fam Med

    (1996)
  • Cited by (137)

    • Differential impact of web habits and active navigation on adolescents’ online learning

      2022, Computers in Human Behavior Reports
      Citation Excerpt :

      Notably, our findings show that the majority of participants endorsed the reliability of nonprofit NGO websites, such as the National Association for Cancer Research, which in our case also represented the best source of information needed to succeed on the learning tasks. This finding is consistent with the many studies showing that adolescents deem NGO or IGO websites (i.e., the National Health Service in the United Kingdom: Gray, Klein, Noyce, Sesselberg, & Cantrill, 2005, or the Mayo Clinic in the United States: Malbon, Ojong, & Nucci-Sack, 2012) as the most reliable for health-related information (Gray, Klein, Cantrill, & Noyce, 2002; R. K. Jones & Biddlecom, 2011a, 2011b). In this respect, more than the half of our participants indicated they attributed trust and reliability to web sources based on the quality of the information provided, such as its clarity (Selkie, Benson, & Moreno, 2011) and the degree to which it provided scientific evidence.

    • ICT diffusion and health outcome: Effects and transmission channels

      2022, Telematics and Informatics
      Citation Excerpt :

      Compared with non-Internet users, Internet users smoke about one cigarette less per day. The results are consistent with a growing body of literature that emphasizes the importance of Internet use in maintaining HL (e.g., Jiang and Beaudoin, 2016; Kobayashi et al., 2015; Gray et al., 2005). Therefore, the micro-mechanism analysis suggests that ICT diffusion contributes to the improved public health outcome via cultivating people’s HL.

    • User Experience Research and Usability of Health Information Technology

      2024, User Experience Research and Usability of Health Information Technology
    View all citing articles on Scopus
    View full text