UC Berkeley

The Internet holds tremendous promise for providing youth with sexual health knowledge at critical times in their lives. Adolescent health advocates, researchers, and practitioners have enthusiastically endorsed digital interventions for adolescent sexual health as a necessary component for sexuality education, including the development of sexuality education websites. Prior research has investigated the quality and accuracy of online sexual health interventions, and general adolescent attitudes towards the Internet as a source of health information. Yet our current evidence base lacks a clear understanding of how adolescents utilize the web for sexual health topics, if their process is consistent based on what kind of sexual health information they need, and what leads adolescents to trust and utilize certain online resources over others.

Through this dissertation, I aim to refine our understanding of how the Internet may be an essential resource for sexual health knowledge for adolescents. To accomplish this, I designed the following studies to capture in situ adolescent user experiences for searching and evaluating sexual health information in the digital environment.

In the first paper, “Late adolescent user experiences with online sexual health resources: A qualitative study,” I report findings from a computer-based qualitative study with 30 interviews and web behavior observations with individuals in late adolescence. Four phases of interaction with the Internet for sexual health information are discussed: (1) approach; (2) selection; (3) assessment; and (4) corroboration. Together these four phases comprise a framework for understanding adolescent behavioral process for using the web for sexual health knowledge. In addition, I report on seven corresponding themes that fit within this framework, including implicit trust placed in top search results for sexual health queries and a preference among adolescents for storytelling to learn about sexual identity. Implications and recommendations for sexuality education website developers are discussed.

In the second paper, “Risks and rewards of sexual health information seeking online: Late adolescent user views of online privacy and personalization,” I report a subset of findings from the first study focused on adolescent views of privacy when interacting with online sexual health interventions. Five emergent themes are discussed: (1) Adolescents believe searching for sexual health information online is normal, but fear of stigma for searching for sexual disease information persists in the online environment. (2) Online appointment making features for clinical services are popular and perceived to have high benefits and low risk to the user. (3) Adolescents are willing to disclose their age and gender on intervention sites to receive tailored information, but are not likely to disclose more personal data like email addresses or full names. (4) The event of a sexual health emergency warrants sharing your location, but otherwise this is viewed as a violation of privacy. (5) Online privacy is generally compromised by “big brother” tracking groups for which average users have no control. Implications for understanding the boundaries of online privacy for adolescents are discussed.

In the final paper, “Constructing a theory-driven model for adolescents’ judgment and trust in online sexual health information: A systematic literature review,” I systematically review research pertaining to adolescent development, dual process theories of information processing, and online trust and web credibility for relevance to adolescents using the Internet for sexual health learning. I present results of 22 quantitative, qualitative, and theoretical studies captured in the review and thoroughly discuss their applicability for adolescent web users. This paper concludes by presenting a new conceptual model for adolescent judgments and trust in online sexual health information and discusses implications and future research applications of the model.

As a whole, this dissertation highlights the need for future research on adolescents’ use of digital tools for sexuality education to be grounded in innovative, interdisciplinary research strategies.