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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Sarah N. Keller
Heather LaBelle
Assistant Professor
Master’s Candidate
Dept. of Communication
Health Communication
Emerson College
Dept. of Communication
120 Boylston St.
Emerson College
Boston, MA 02116
[email protected]
(617) 824-8857
[email protected]
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Background – US data
• About 1 in 4 sexually active youth will be infected
with an STD by age 24 (Cates & McPheeters, 1997)
• 3 million new cases of Chlamydia in the U.S. every
year (Cates 1999)
• 40% of Chlamydia cases are in the 15 to 19 year old
age group (Cates 1999)
• 120,000 cases of Hepatitis B occur every year in the
U.S. (Cates 1999)
• 49% of high school students report having sexual
intercourse
• 58% of sexually active students reported using a
condom during last sexual experience (1999 YRBS)
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Background – Massachusetts
(MDYRS 2000)
• 1/5 of AIDS cases are among people in their 20s
or younger
• 44% of high school students have had sex
• 57% used condoms during last sexual encounter
• 17% used no form of birth control
• Condom use dropped by grade level, but sexual
activity increased
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Background – US Internet data
• 140 million people use the Internet (Richardson, 2000)
• 52 million use the Internet for health information
(Richardson, 2000)
• 46% of 12 to 17 year olds have gone online in the past
month (CyberAtlas, 2000)
• 44% learn about sexual issues from the Internet (Kaiser
Family Foundation, 2001)
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Background
Phase I
Methods
Results
Why use the Internet?
•
•
•
•
•
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
•
•
•
Offers anonymity
Specific message tailoring
Relays information on demand
Can facilitate decision-making skills and risk
assessment
Provide online peer support through message
boards, chat rooms, and e-mail
Ability to promote self-efficacy
Inaccurate or inappropriate information
Lack of Internet access
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Internet access
• Income gap (Cole, Suman et al., 2000).
– 81 to 88% of families with incomes over $50,000
are using the Internet
– 41% of families with incomes less than $14,000
use the Internet
• With each passing year, this gap is narrowing
(U.S. Bureau of Census, 2001)
– Between December 1998 and September 2001
Internet use among people who earn less than
$15,000 per year increased at an annual growth
rate of 25%.
– Internet use among people earning more than
$75,000 per year or more increased at an 11%
annual growth rate.
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Other Studies
Home
•
Background
•
Phase I
•
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
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At least two articles have reviewed online HIV/AIDS resources
(Brettle, 1997; Mallory, 1997)
One case study looked at www.iwannaknow.org (Keller, Gilbert et
al., 2001)
Another examined websites that covered a range of STDS and
HIV information (Smith, Gertz et al., 2000)
Research on how people use the Internet for sexual information is
sparse; and most studies do not focus specifically on teen
audiences (Bull et al., 2001; Reeves, 2001)
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Other Studies
• Few studies of effects of Internet use on
adolescents’ sexual health
• Studies document that sexual content exists, and
that it is frequently explicit (Smith et al., 2000)
• Few studies examine effectiveness of Internet for
any health objective (AHCPR, 1997)
• No studies to date have scientifically evaluated the
impact of STD prevention sites on adolescent health
outcomes
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Interactive health
communication studies
• Some patients prefer online counseling to face-toface interaction (Alemi, Alemagno et al., 1996)
• People may be more likely to be truthful to a
computer than a clinician in reporting HIV-risk
factors (Locke et al., 1992; Erdman, Klein et al.,
1985)
• One study of 1,690 males ages 15-19 found that
adolescents were three times more likely to report
risky behavior when using audio computerassisted self-interviewing (audio-CASI)
technology compared to more traditional selfadministered questionnaires (Turner, Ku et al.,
1998)
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Pilot Methods (Phase 1)
• 6 search engines using 12 key words
• Screened first 100 search results for web sites that
were educational, contained information about both
HIV and other STDs, and were specifically targeted
towards teenagers
• The remaining sites in our sample of 1,378 were
categorized by type (for example) :
-26% (n=359) “umbrella sites” (359), defined as
lists of links to other sites
-25% (n=350) “other” (e.g., sex education
without STD information; discussion forums;
pharmaceutical sites; etc.)
-20% (n=276) news articles or press releases
-8% (n=110) advocacy sites
• Only 36 web sites met inclusion criteria
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Survey Measure Development
(Phase 1)
• Building on a content analysis conducted in
conjunction with the American Social Health
Association, coding tools were developed to assess
usability characteristics (e.g., criteria for credibility)
and sexual health content
– Categories for measurement of sexual health content
were based on The Guidelines for Comprehensive
Sexuality Education, Kindergarten- 12th Grade
– Categories for usability were obtained from national
standards for web evaluation and assessment from
the American Library Association (Alexander &
Tate, 1999).
• Researchers in this project converted the guidelines
to serve as standards for Web-based sexuality
education curricula.
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Results (Phase I)
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Websites
STD/HIV
(%)
Communication
(%)
Usability
(%)
Average
Score
(%)
1. www.nnfr.org/adolsex/fact/adolsex_std.html
82
33
45
53
2. www.unspeakable.com/truth.html
63
24
55
47
3. www.siecus.org/teen/
23
33
82
46
4. www.chebucto.ns.ca/Health/TeenHealth/
77
0
50
43
5. www.coolnurse.com
50
0
73
42
6. www.cdc.gov/nchstp/dstd/dstdp.html
59
0
64
41
7. www.cfoc.org/3_teen/3_stdsteens.cfm
27
33
55
38
8. www.itsyoursexlife.com
41
38
45
37
9. www.umkc.edu/sites/hsw/teens/index2.html
41
24
27
31
10. www.aidspartnership.org/teens.shtml
59
0
27
29
11. www.std.terrashare.com
32
19
33
28
Average of top 10 sites
55
20
54
Average for all 36 sites
33
9
44
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Objective (Phase II)
• To find out which educational messages and
usability features of safe sex web sites are
important to teenagers
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Sample
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•
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Ages 13 to17
English language proficiency
Internet access
High Schools in Boston Area
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Sample
Boston’s Teenage Population
• 23% of the is African-American
• 13% is Hispanic
• 58% is Caucasian
Stratification approach
• We will choose only half of students from predominantly
Caucasian neighborhoods
(Andover high school is 91% white)
• The other half of the students we are recruiting from have
primarily African-American and Hispanic populations
– Cambridge Rindge and Latin students are 38% AfricanAmerican; 14% Hispanic; and 40% Caucasian
– Boston High School is 55% African –American; 24%
Hispanic; and 15% Caucasian
(Massachusetts Department of Education, 2002).
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Phase I
Methods
Results
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Methods
Discussion
Keller, LaBelle et al., 2004
Sample
• Within each school, we will work with health
education teachers and after-school program
coordinators to recruit and disseminate parental
consent forms to students, as well as to recruit
teachers who are willing to allow us to conduct
the survey in their classroom times.
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Methods
• Written questionnaire given to 500 teenagers
(ages 13 – 17) about what they look for in STD
websites
• Usability test given to a smaller group (n=20) of
teenagers to assess the usability and navigability
of certain websites
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Survey
If you went to the Internet for sex education, what topics would be most important to
you? Please rate each of the following items on a scale from 1-10, 10 = most
important and 1 = least important:
Content Areas
Background
Puberty
Phase I
Methods
Reproductive body parts
Sexual orientation
Preventing pregnancy
Results
Phase II
Methods
Discussion
Sexual decision-making
Communicating with a partner
Looking for help
Relationships
Sexual abstinence “saying no”
Masturbation
Sexually Transmitted Diseases* (STD) /HIV
Sexual abuse
Sex in the media
Keller, LaBelle et al., 2004
Importance (1-10)
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Background
Phase I
If you went online to find out specifically about Sexually Transmitted Diseases or HIV,
which of the following topics would be most important to you? Please rate each topic
on a scale from 1-10, 10 = most important and 1 = least important:
Topics about Sexually Transmitted Diseases (STDs)
More than one STD
HIV transmission by casual contact (e.g. hugging or shaking
hands)
HIV transmission through kissing
Talking about STDs with a partner
How to avoid STD/HIV
Methods
Results
Phase II
Condom effectiveness
When to go to a clinic
How to get counseling
Which STDs can be cured or treated
Support groups for HIV positive people
Methods
Discussion
STD/HIV Testing
Reinfection
What to do if infected
Getting support from friends & family
STD/HIV hotline information
Information about Hepatitis B
Helping others protect themselves
Keller, LaBelle et al., 2004
Importance (1-10)
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Background
Phase I
Methods
Results
Survey
Which of the following web site characteristics are most important to you? Please rate
each feature from 1-10, 10 = most important and 1 = least important:
Feature
Accuracy
Importance (1-10)
Is the information correct?
Authority
Is the information reliable?
Objectivity
Is the information unbiased?
Currency
Is the information up-to-date?
Phase II
Methods
Discussion
Readability
Is the information easy to read?
Navigability
It the website well organized?
Coverage
Keller, LaBelle et al., 2004
Are the topics well covered in the
website?
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Survey
•
Background
Phase I
Methods
•
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
•
Ask them to tell how much sexual health
information they have gotten from different sources
such as friends, parents, health classes in school,
doctors, newspapers, magazines, the Internet, and
TV shows
Ask how often they go online for information about
certain topics such as HIV or AIDS, other sexually
transmitted diseases, pregnancy and birth control,
smoking, weight loss and weight gain, violence, and
depression or mental illness
Ask them what search engine they used the last time
they looked for health information online and when
finding sexual health information what key word(s)
they are most likely to use
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Discussion
• Phase 1 findings:
– The study demonstrated the difficulty of finding
websites with teen-oriented sex education
– It also demonstrated the need for improved safe
sex negotiation education online
– And a confusion among sexual health educators
about what content to put online
– It also pointed to a need for better cataloguing
educational information online, perhaps sorted by
age-appropriateness and content.
• An online clearinghouse of reproductive health
information for teens might be useful (Smith,
Gertz et al., 2000).
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Discussion
• Phase I findings (cont’d)
– Sites geared towards adolescents that were analyzed
in Phase I used language that may have exceeded the
abilities of most adolescents (an average of 9.3)
– Sites that used adolescents’ input in generating
content were the most teen-friendly
– Health educators need to do a better job of presenting
online information in formats and styles appealing to
young people
• Information on websites needs to encompass all
aspects of STD.HIV information from information
about the disease, to where to get help, to how to
talk about with your partner, parents, counselors
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Discussion
• Phase II goals:
– To find out what key words teenagers use
– Generate valuable advice about the key words
adolescents use when searching for sexual health
information on the Internet
– Conduct workshops with participants to educate young
people on efficient search strategies and key word
selection for health issues
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Background
Phase I
Methods
Results
Phase II
Methods
Discussion
Keller, LaBelle et al., 2004
Discussion
• Phase II goals (cont’d)
– To find out which topic are most important to teenagers,
so they are not overloaded with information form
websites
– To give as much information as possible about how to
proceed when evaluating educational websites for
adolescents
– Outcomes of this study will be used to inform future
research involving user testing of STD/HIV education
websites
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