Use of the internet as a source of health information by Spanish adolescents

  • Jaime Jiménez-Pernett1, 3,

    Affiliated with

    • Antontio Olry de Labry-Lima1, 2, 3,

      Affiliated with

      • Clara Bermúdez-Tamayo1, 3Email author,

        Affiliated with

        • Jose Francisco García-Gutiérrez1, 2, 3 and

          Affiliated with

          • Maria del Carmen Salcedo-Sánchez2, 3

            Affiliated with

            BMC Medical Informatics and Decision Making201010:6

            DOI: 10.1186/1472-6947-10-6

            Received: 12 May 2009

            Accepted: 29 January 2010

            Published: 29 January 2010

            Abstract

            Background

            The Internet is a fundamental part of the daily life of adolescents, they consider it as a safe and confidential source of information on health matters. The aims is to describe the experience of Spanish adolescents searching for health information on the Internet.

            Methods

            A cross-sectional study of 811 school-age adolescents in Granada was carried out. An adapted and piloted questionnaire was used which was controlled by trained personnel. Sociodemographic and health variables were included together with those concerning the conditions governing access to and use of information and communication technologies (ICT).

            Results

            811 adolescents were surveyed (99.38% response rate), mean age was 17 years old. Of these, 88% used the Internet; 57.5% used it on a daily or weekly basis and 38.7% used it occasionally. Nearly half the sample group (55.7%) stated that they used the Internet to search for health-related information. The main problems reported in the search for e-health were the ignorance of good web pages (54.8%) and the lack of confidence or search skills (23.2%).

            Conclusions

            In conclusion, it seems plausible to claim that websites designed and managed by health services should have a predominant position among interventions specifically addressed to young people.

            Background

            The Internet is increasingly becoming part of our lives, its use being centred on the younger age-group (90.3% of citizens between 15 and 24 and 78.3% between 25 and 34 years of age are Internet users) [1].

            The Internet is a fundamental part of the daily life of adolescents; they maintain permanent contact with their friends, form friendships with people who share their interests and hobbies and widen their knowledge [2, 3]. As a consequence, this phenomenon has turned the Internet into one of the main means of communication between adolescents and is the reason why the younger age-group must be trained in the correct use of the Internet in relation to health information [4]. There are many reasons why the young are prompted to use the Internet, mainly because it is fast and easy and because it provides a great deal of information [5].

            This is a particularly important aspect owing to the fact that adolescents find it hard to access traditional health services; the Internet also provides them with a confidential and safe source of health information [6]. The environment in which patients consume medical and health information has changed dramatically during the past decade. Rapid diffusion of Internet technology within the public sphere has placed an unprecedented amount of health information within reach of general consumers [7, 8]. For adolescents, the internet is an integral part of their world, making e-Healthcare not only a reasonable extension of technology but an expectation [9].

            In view of all this, this survey aims to describe the experience of adolescents in Andalusia (Spain) searching for health information on the Internet.

            Methods

            A cross-sectional survey was carried out on adolescents in their post-compulsory schooling (or 11th and 12th grades in North America) in Andalusian high schools (Spain).

            A calculation of sample size for a prevalence of 50%, with a 5% accuracy level and 95% confidence level was carried out, resulting in a total of 700 adolescents; in order to avoid any possible losses, calculation of the sample size was increased by 15%. The sample was selected by equiprobability single-stage cluster sampling. From among 42 secondary education schools providing post-compulsory schooling in Granada (Spain), nine were selected by simple random sampling, subsequently all the pupils attending the selected school were included.

            Variables

            1) Sociodemographic and health variables : age, sex, perceived health and the number of visits to the doctor over the previous year. 2) Variables related to the conditions governing the access to and use of information and communication technologies (ICT) : Use of the Internet, frequency of use, main use of the Internet (games, travel, shopping, e-Learning, others), who the results are aimed at, opinion of the Internet as a good source of health information and the use of other sources of health information. Three multi-answer questions were formulated in order to obtain the greatest amount of information available to identify Internet access points, sources for health information searches and health subjects searched.

            Instruments

            The information was gathered using a structured questionnaire with 22 items. This self-administered questionnaire was adapted and piloted [10]. from a Kaiser Family Foundation study [4]. Their instrument was designed and analyzed by staff of the organization, in consultation with International Communications Research.

            Procedure

            Prior to gathering the information, a pilot test was carried out on a sample of 50 adolescents in order to determine the proper functioning of the questionnaire; the data collected was not included in the analyses carried out [10].

            First, the research protocol had to be approved by the Research and Ethics Committee of the Progress and Health Foundation of the Andalusian Regional Ministry of Health. Subsequently, contact was made with those in charge of each school and after obtaining approval of the heads and teaching staff of schools, the adolescents were asked to take part in the survey. Informed consent on the part of students was verbally requested.

            The questionnaires were controlled by personnel specifically trained for this survey who had good communication skills. In addition, no information was collected that could facilitate the identification of respondents.

            Statistical analysis

            A descriptive analysis of the sample group was carried out using the standard frequencies, percentages for qualitative variables and means and deviations for quantitative variables. Eventually, a bivariate analysis was carried out by means of the chi-square test. The analysis was carried out using the statistical programme SPSS 11.5.

            Results

            A total of 811 adolescents were studied, 46% of them were men, 17 years old was the average age of sample (none of the youngsters refused to take part in the survey). An average of 2 visits to the doctor were made over the previous year and 9.3% reported an average, bad or very bad self-perceived state of health compared with 26.3% who considered their health to be very good.

            As far as the access and use of information and communication technology variables are concerned, 88% used the Internet, 57.5% used it on a daily or weekly basis and 38.7% used it occasionally. Only 7.8% of the adolescents thought that more information would improve their health.

            Nearly half the sample (55.7%) stated that they used the Internet to search for health information, 19.4% used it on a daily or weekly basis compared with 25.7% who used it occasionally during the year/not at all. The main problems reported when searching for e-health was a lack of knowledge of good web pages (54.8%) and a lack of confidence or search skills (23.2%). Among those who used the Internet, 82% stated that it helped them obtain more health information and 54.9% answered that the Internet helped them obtain better health information (Table 1).
            Table 1

            Summary of the main variables (n = 811).

              

            N (%)

            Gender

            Male

            373 (46%),

             

            Female

            438 (54,1%)

            Perceived health

            Very good

            213 (26.3%)

             

            Good

            521 (64.4%)

             

            Not so good-Bad/very bad

            75 (9.3%)

            General use of the Internet

            No

            97 (12%)

             

            Yes

            713 (88%)

            Frequency of use of the Internet

            Daily/A few times a week

            410 (57.5%)

             

            A few times a month

            276 (38.7%)

             

            A few times a year-Never

            27 (3.8%)

            Do you search for health information on the Internet?

            No

            359 (44.3%)

             

            Yes

            451 (55.7%)

            Frequency of health information searches on the Internet

            Daily/A few times a week

            88 (19.4%)

             

            A few times a month

            249 (54.8%)

             

            A few times a year - Never

            117 (25.7%)

            Do you think your QOL would improve if you had more health information?

            No

            63(7.8%)

             

            Yes

            580(72%)

             

            Do not know

            162(20.1%)

            Problems when looking for health information on the Internet (choose one)

            Do not know good sites

            239 (54.8%)

             

            Lack of search skills

            101 (23.2%)

             

            No Internet at home

            24 (5.5%)

             

            Not interested in the subject

            15 (3.4%)

             

            No confidence/no search/Other

            57 (13.1%)

            What sources do you use to find health information? (mark all)

            Family and friends

            456 (56.4%)

             

            Magazines, newspapers

            357 (44.2%)

             

            Books/medical encyclopaedias

            179 (22.2%)

             

            Television

            348 (43.1%)

             

            Radio

            29 (3.6%)

             

            Internet

            424 (52.5%)

             

            Doctors, nurses

            488 (60.4%)

             

            Chemists

            177 (21.9%)

             

            None

            54 (6.7%)

            Why do you search health information on the Internet (choose one)

            Easy

            158 (36.9%)

             

            Lots of information

            93 (21.7%)

             

            Fast information

            63 (14.7%)

             

            Confidential search

            45 (10.5%)

             

            See different opinions

            34 (7.9%)

             

            Free information

            24 (5.6%)

             

            Other

            11 (2.6%)

              

            Median (DS)

            Age (in years)

             

            17 (1.01)

            Visits to the doctor during the previous year

             

            2 (3.92)

            As far as the multi-answer variables are concerned (Table 2), the three most popular sources for obtaining information on health were: family and friends (56.4%), doctors and nurses (21.9%) and the Internet (60.4%). The adolescents reported accessing the Internet mainly from their homes (93.5%), followed by school centres (28.4%) and cybercafés (14%). They mainly used the Internet for leisure pursuits, music and games (90%), school work (87%) and chats and forums (79.7%). And 97.6% of respondents obtained their health information through a search engine (mainly Google), followed by newspapers (50.1%) and out-links in the websites they visited (45.5%). Regarding the intended users of the information, 95.6% of the subjects stated that the information was for personal use. The main reasons for searching health information on the Internet were: easy of use (36.9%), lots of information (21.7%) and speed (14.7%). The main health topics looked up on the Internet were: Self-image, beauty and wellness (56.5%), fitness and physical activity (53%) and piercing and tattoos (44.6%) (Table 3).
            Table 2

            Summary of the main variables (n = 811).

              

            N (%)

            Where do you usually access the Internet? (Multiple choice)

            Home

            666 (93,5%)

             

            School

            202 (28,4%)

             

            Cultural or leisure centres

            23 (3,2%)

             

            Cybercafé

            100 (14%)

             

            Mobile phone

            26 (3,7%)

             

            Other places

            52 (7,3%)

            What do you usually use the Internet for? (Multiple choice)

            Leisure, music, games

            642 (90%)

             

            School work

            620 (87%)

             

            Searching for information

            564 (79,1%)

             

            Shopping

            47 (6,6%)

             

            Courses

            32 (4,5%)

             

            E-mail

            519 (72,8%)

             

            Chat (e.g. messenger), forums

            568 (79,7%)

             

            Others

            49 (6,9%)

            Why do you look for health information in the internet? (Multiple choice)

            It is free

            24 (5,6%)

             

            It is quick

            63 (14,7%)

             

            It is confidential

            45 (10,5%)

             

            It is easy

            158 (36,9%)

             

            There are a lot of information

            93 (21,7%)

             

            To have different opinions

            34 (7,9%)

             

            Others

            11 (2,6%)

            ¿How do you look for health information? (Multiple choice)

            Internet searcher

            444 (97,6%)

             

            Family/friends

            167 (36,7%)

             

            Physicians

            39 (8,6%)

             

            News paper, media

            228 (50,1%)

             

            Links of websites

            207 (45,5%)

             

            Others

            17 (3,7%)

            ¿Whom do you look health information for? (Multiple choice)

            Yourself

            434 (95,6%)

             

            Family

            182 (40%)

             

            Classmates or friends

            142 (31,2%)

             

            Others

            28 (6,2%)

            Table 3

            Twelve main health topics looked up on the Internet (n = 451*).

            Health topic

            N(%)

            Body image, beauty and wellness

            255 (56,5%)

            Fitness and physical activity

            239 (53%)

            Piercing and tattoos

            201 (44,6%)

            Contraception

            185 (41%)

            Nutrition and diet

            184 (40,8%)

            Sexual behavior

            183 (40,6%)

            Drugs

            165 (36,6%)

            Sexually Transmitted Diseases

            147 (32,6%)

            Skin conditions

            144 (31,9%)

            Tobacco and alcohol

            119 (26,4%)

            Eating disorders

            103 (22,8%)

            Physical development

            80 (17,7%)

            * Respondents that have searched for health information on the Internet

            The bivariant analysis showed that those adolescents who used the Internet on a daily basis were most likely to search for health information (OR: 1.49; IC95% 2.02-1.01). Concerning the information sources, those who searched for health information on the Internet demonstrated, with a significant statistical difference, a greater probability of consulting doctors (60.8% vs. 51.1%), magazines (49.9% vs. 37.7%), books (27.9% vs. 14.9%) and, in contrast, a lesser degree of probability of consulting none (1.6% vs. 13.6%).

            Discussion

            Moreover, this survey opens a small window through which we can begin to study the opinion that Spanish adolescents hold of the Internet and how they relate to it. Thus it is demonstrated that the young mainly use the Internet for leisure pursuits, to search for information and to communicate with their peers.

            The percentage of adolescents looking for health information on the Internet reflected in this study is within the range described in existing literature (40%-73.4%) [4, 1116]. This result is considerably remarkable since most research articles related to this topic have been conducted on adolescents who were native speakers of English and there are no articles on Spanish adolescents.

            Literature on the topic reflects, similarly to this study, that there is a statistically significant difference between adolescents who browse the Internet more intensively and those who do it less frequently, the former being more likely to search for information on health matters than the latter [1517].. Moreover, health topics most frequently searched by respondents correspond with those identified in previous studies: body image, exercise and fitness, diets and nutrition, sexual information and sexually transmitted diseases [9, 11, 18, 19].

            This study has several limitations which should be taken into account in order to analyse the results. Firstly, although the aim of this survey was not to determine or acknowledge any gaps or shortcomings in IT training or computer literacy, the existence of these could bias the results shown. On the other hand, a cluster sample was performed, which makes it impossible to know beforehand the number of questionnaires, however, in Spain there are a limited number of students per classroom (nearly 30).

            One significant result was that when asked which pages they used most to obtain health information all the adolescents surveyed replied that they accessed the information through Google-type search engines. It seems to show clearly that these mechanisms prevail mainly because they are easy, accessible, fast and contain a great deal of information [20].. Nevertheless, it is significant that these kind of web sites works by means of algorithms and some web pages are more likely to be among those recommended than others. This is especially important because these pages are usually sponsored by the private sector, which could influence young people [21], and because of the quality differences reported in their content [22]. Training adolescents in the correct use of the online information sources is a key element in optimizing interaction with the web [23].

            Conclusions

            From the point of view of public health, these results represent an opportunity for health services. Hence, it is necessary to design websites more adequate for adolescents needs that may provide them with reliable and confidential information. In this regard, literature depicts that children and teenagers tend to believe that "if you can find it online then it must be true" [24]. In conclusion, it seems plausible to claim that websites designed and managed by health services should have a predominant position among interventions specifically addressed to young people.

            Declarations

            Acknowledgements

            Project subsidised by the Ministry of Health for the Andalusian Regional Government (Exp. 134/2005).

            Authors’ Affiliations

            (1)
            Andalusian School of Public Health
            (2)
            CIBER en Epidemiología y Salud Pública (CIBERESP)
            (3)
            Alto Guadalquivir Hospital

            References

            1. Instituto Nacional de estadística: Survey on the Equipment and Use of ICT. [http://​www.​ine.​es/​]
            2. Punamäki RL, Wallenius M, Nygard CH, Saarni L, Rimpelä A: Use of information and communication technology (ICT) and perceived health in adolescence: The role of sleeping habits and waking-time tiredness. J Adolesc 2007, 30 (4) : 569–85.PubMedView Article
            3. Buckingham D: The electronic generation? Children and new media. In Handbook of new media: Social shaping and consequences of ICTs. Volume 7. Edited by: Lievrouw LA. Livingstone, London: Sage; 2002:7–89.
            4. Rideout V: Generation Rx: How young people use the Internet for Health information. [http://​www.​kff.​org/​entmedia/​loader.​cfm?​url=​/​commonspot/​security/​getfile.​cfm&​PageID=​13719] Kaiser Family Foundation Survey 2001. [Accessed: 2010–01–20]
            5. Kanuga M, Rosenfeld WD: Adolescent sexuality and the internet: the good, the bad, and the URL. J Pediatr Adolesc Gynecol 2004, 17: 117–124.PubMedView Article
            6. Gray NJ, Klein JD, Noyce PR, Sesselberg TS, Cantrill JA: Health information-seeking behaviour in adolescence: the place of the internet. Soc Sci Med 2005, 60: 1467–78.PubMedView Article
            7. Rice RE: The Internet and health communication: a framework of experiences. In The Internet and Health Communication: Experiences and Expectations. Thousand Oaks, Calif: Sage Publications; 2001:5–46.
            8. Hesse BW, Nelson DE, Kreps GL, Croyle RT, Arora N, Rimer BK: Trust and Sources of Health Information The Impact of the Internet and Its Implications for Health Care Providers: Findings From the First Health Information National Trends Survey. Arch Intern Med 2005, 165: 2618–2624.PubMedView Article
            9. Kell B: The strengths and limitations of the internet as a health information resource for adolescents. J Adolesc Health 2009, 4: s20.View Article
            10. Jiménez-Pernett J, Salcedo-Sánchez MC, García-Gutiérrez JF: Necesidades y expectativas de información sobre salud en Internet para adolescentes: Una prueba piloto. [http://​www.​revistaesalud.​com] Revista eSalud 2007., 3 (10) : [Electronic journal]. Accessed: 2010–01–20]
            11. Gould MS, Harris Munfakh JL, Lubell K, Kleinman M, Parker S: Seeking help from the Internet during adolescence. J Am Acad Child Psy 2002, 41: 1182.View Article
            12. Bleakley A, Merzel CR, VanDevanter NL, Messeri P: Computer access and internet use among urban youths. Am J Public Health 2004, 94: 744.PubMedView Article
            13. Gray NJ: The Internet: A window on adolescent health literacy. J Adolescent Health 2005, 37 (243) : e1-e7.
            14. Borzekowski DL, Rickert VI: Adolescents, the Internet, and health: issues of access and content. J App Dev Psychol 2001, 22: 49–59.View Article
            15. Ogan CL, Ozaka M, Groshek J: Embedding the Internet in the lives of college students. Online and Offline behaviour. Soc Sci Comput Rev 2008, 26: 170–177.View Article
            16. Hufken V, Deutschmann M, Baehring T, Scherbaum W: [Use of the internet for health care information: results from a national telephone survey]. Soz Praventivmed 2004, 49 (6) : 381–90.PubMedView Article
            17. Lenhart A, Madden M, Macgill AR, Smith A: Teens and social media. Pew Internet and American Life Project report, 2007 [online]. [http://​www.​pewinternet.​org]
            18. Skinner H, Biscope S, Poland B, Goldberg E: How adolescents use technology for health information: implications for health professionals from focus group studies. J Med Internet Res 2003, 5: e32.PubMedView Article
            19. Borzekowski DL, Fobil JN, Asante KO: Online Access by Adolescents in Accra: Ghanaian Teens' Use of the Internet for Health Information. Developmental Psychology 2006, 42: 450–458.PubMedView Article
            20. Boyer C, Geissbuhler A: Health and the Internet for all. Int J Med Inform 2006, 75: 1–3.PubMedView Article
            21. Miller EA, West DM: Characteristics associated with use of public and private web sites as sources of health care information. Med Care 2007, 45: 245–251.PubMedView Article
            22. Babio G, Bermúdez Tamayo C, García JF, Márquez S: Selección y evaluación de sitios web dirigidos a pacientes. [http://​www.​hvn.​es/​invest_​calid_​docencia/​bibliotecas/​publicaciones/​archivos/​doc_​52.​pdf] Andalusian Agency for Health Technology Assessment 2006. [Accessed: 2009–01–26]
            23. Truccolo I, Bianchet K, Dal Maso L, Cognetti G, De Paoli P: Internet as a health education tool by Italian high school students. [http://​www.​eahil.​net/​journal/​journal_​2009_​vol5_​n2.​pdf#page=​15] Journal of the European Association for Health Information and Libraries 2009., 5: [Electronic journal]
            24. Bremer J: The internet and children: advantages and disadvantages. Child Adolesc Psychiatr Clin N Am 2005, 14 (3) : 405–28. viiiPubMedView Article
            25. Pre-publication history

              1. The pre-publication history for this paper can be accessed here:http://​www.​biomedcentral.​com/​1472-6947/​10/​6/​prepub

            Copyright

            © Jiménez-Pernett et al. 2010

            This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.