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Given the increasing availability of the internet, it has become a common source of health information. However, the effect of this increased access on health needs to be further studied.
This study aimed to investigate the correlation between online health information–seeking behavior and general health dimensions in a sample of high school students in Iran.
A cross-sectional study was conducted in 2019. A total of 295 female students participated in the study. The data were collected using two validated questionnaires: the e-Health Impact Questionnaire and the 36-Item Short Form Health Survey. The collected data were analyzed through descriptive statistics and Pearson correlation coefficients using SPSS version 23 (IBM Corp).
The participants moderately used online information in their health-related decisions, and they thought that the internet helped people in health-related decision making. They also thought that the internet could be used to share health experiences with others. Participants had moderate confidence in online health information and stated that the information provided by health websites was moderately understandable and reliable and moderately encouraged and motivated them to play an active role in their health promotion. Nevertheless, the results showed that online health information–seeking experience had no significant correlation with health-related quality of life.
This study provides insights into the effect of using internet information on the health of adolescents. It has important implications for researchers and policy makers to build appropriate policies to maximize the benefit of internet access for health.
Adolescence refers to the age range of 10 to 19 years [
In general, people choose different ways to find answers to their questions and doubts about health. Health information–seeking behavior refers to seeking and receiving information to reduce uncertainty and doubts and ensure health status [
Similar to most fields, health information seeking has changed from traditional practices such as referring to books and magazines and even direct expert advice to new methods such as the use of the internet and social networks. Online resources play an important role in providing health information, and young people are increasingly using online information in various domains. In their systematic review, Park and Kwon (2018) showed that adolescents used the internet widely in different countries [
According to another systematic review, 81% (21/26) of the studies indicated that more than 50% of their samples used the internet to obtain health information [
Johnson et al (2015) found that youth with lower mental quality of life used the internet more to gain health information [
According to the 2016 census in Iran, adolescents make up 8% of the country’s population of 12 million, half of whom are girls [
This cross-sectional questionnaire study was conducted in 2019. A total of 295 female high school students in Ardekan city, Yazd province, who had access to the internet and the experience of health information seeking participated in the study. All participants provided informed consent to participate in the study and were assured that their personal information would be kept confidential. The parents of the students were made aware of the participation of their children in the study and had the opportunity to not let their children participate in the study. The school principal and students’ teachers approved the study. All the study procedures were conducted in accordance with the ethical standards of the Declaration of Helsinki. In addition, the ethics committee of Shahid Sadoughi University of Medical Sciences approved the study (approval code: IR.SSU.SPH.REC.1399.023). Questionnaires were completed in class, and any students who were absent on the testing days had the opportunity to participate in the study on the following days. All the data were gathered using two validated questionnaires: the e-Health Impact Questionnaire (eHIQ) and the 36-Item Short Form Health Survey (SF-36).
The eHIQ was used to measure the online health information–seeking behavior of participants. The eHIQ, developed by Kelly et al in 2015 as an instrument to measure the potential consequences of using websites containing different types of material across a range of health conditions, is a 2-part instrument with 37 items. eHIQ-Part 1 consists of 11 items related to general views of using the internet in relation to health. These 11 items have been grouped into 2 subscales named “Attitudes towards online health information” (5 items) and “Attitudes towards sharing health experiences online” (6 items). eHIQ-Part 2 consists of 26 items related to the consequences of using specific health-related online sources. The 26 items have also been grouped into 3 subscales: “Confidence and identification” (9 items), “Information and presentation” (8 items), and “Understanding and motivation” (9 items). In our study, the participants were asked to respond to the 26 items of eHIQ-Part 2 regarding the online sources from which they have sought information in recent months. In addition, the participants were asked to score all items from both parts on a 5-point scale ranging from 1 (“never”) to 5 (“always”). We used a standard “forward-backward” procedure to translate the eHIQ from English into Persian. To demonstrate the content validity, we used the content validity ratio to quantify the extent of the experts’ agreement. The reliability of the translated version of the eHIQ was confirmed using the Cronbach alpha coefficient, which was calculated as 0.89 for the total scale and 0.81, 0.87, 0.94, 0.83, and 0.91 for “Attitudes towards online health information,” “Attitudes towards sharing health experiences online,” “Confidence and identification,” “Information and presentation,” and “Understanding and motivation,” respectively.
The SF-36 is a popular instrument for assessing the health-related quality of life. The SF-36 has 36 items, which measure 8 subscales (ie, vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health). These 8 subscales of SF-36 are grouped into two distinct dimensions, namely a physical dimension represented by the physical component summary (PCS), which is the sum of physical functioning, bodily pain, general health perceptions, and physical role functioning, and a mental dimension represented by the mental component summary (MCS), which is the sum of vitality, emotional role functioning, social role functioning, and mental health. After completing the questionnaire, each scale is directly transformed into a 0-100 score on the assumption that each question carries equal weight. The lower the score, the greater the disability; the higher the score, the less the disability (ie, a score of 0 is equivalent to maximum disability and a score of 100 is equivalent to no disability). In this study, we used the Persian version of the SF-36, which had been validated by Montazeri et al (2005) [
Of the participants, 16 students were married, and the rest were single. All of them had access to the internet at their home and the experience of seeking health information in recent months before the study. Demographic characteristics of the participants are presented in
Demographic characteristics of the participants (N=295).
Variable | n (%) | ||
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Single | 279 (94.6) | |
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Married | 16 (5.4) | |
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Muslim | 279 (94.6) | |
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Not available | 16 (5.4) | |
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Fathers | 104 (35.3) |
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Mothers | 116 (39.3) |
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Fathers | 122 (41.4) |
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Mothers | 108 (36.6) |
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Fathers | 69 (23.4) |
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Mothers | 71 (24.1) |
The findings regarding information-seeking behavior of the participants are presented in
Mean scores for online health information–seeking behavior of the students.
Item | Mean score (SD) | |
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Attitudes towards online health information | 2.46 (0.80) | |
Attitudes towards sharing health experiences online | 2.77 (0.90) | |
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Confidence and identification | 2.52 (0.77) | |
Information and presentation | 2.90 (0.79) | |
Understanding and motivation | 2.90 (0.88) | |
eHIQ (total) | 2.71 (0.71) |
The descriptive results regarding the students' health statuses on the SF-36 subscales are presented in
SF-36 scores of the students.
Item | Mean score (SD) |
Physical functioning | 83.67 (15.00) |
Physical role functioning | 75.94 (26.65) |
Bodily pain | 71.84 (23.27) |
General health perception | 63.31 (19.53) |
Emotional role functioning | 56.01 (38.58) |
Vitality | 75.94 (26.65) |
Social role functioning | 70.25 (25.34) |
Mental health | 65.29 (22.54) |
Physical component summary | 72.90 (16.20) |
Mental component summary | 63.19 (22.26) |
The correlation coefficients of online health information–seeking behavior and its subscales with the main SF-36 subscales are presented in
Correlations of online health information–seeking subscales with health status.
Item | PCS | MCS | ||
r | r | |||
Attitudes towards online health information | 0.04 | .51 | 0.04 | .55 |
Attitudes towards sharing health experiences online | 0.05 | .42 | 0.04 | .50 |
Confidence and identification | 0.02 | .69 | 0.02 | .67 |
Information and presentation | 0.05 | .38 | 0.05 | .41 |
Understanding and motivation | 0.03 | .65 | 0.01 | .84 |
eHIQ (total) | 0.04 | .46 | 0.04 | .53 |
This study aimed to examine the correlation of online health information–seeking behavior with health-related quality of life in a sample of Iranian female students. Results showed that the participants used online information moderately in their health-related decisions and thought that the internet helped people in health-related decision making and could be used to share health experiences with others. Participants had a moderate amount of confidence in online health information. They stated that the information provided by health websites was moderately understandable and reliable, and it moderately encouraged them to play an active role in their health promotion.
Use of the internet to access health information has increased in recent years for reasons such as accessibility, high volume of information disseminated, confidentiality, low cost, multimedia capabilities, and the ability to interact and gain support [
A US national survey has found that 75.0% (907/1209) of online teens search health information [
In Iran, as in other countries, using the internet for health-related purposes has increased in recent years. A survey of adolescents in Shiraz, Iran, has shown that the internet is among the top sources of the respondents' health information, with 88% (352/400) using the internet to find a kind of health information [
Overall, it seems that use of the internet as a source of health information is expanding; however, the review of the literature shows that searching for online health information is correlated with some variables such as age, gender, education level, skills and experience with internet use, health status, and availability and reliability of sources [
Adolescents often seek health information with different objectives and motives [
Due to the increasing use of the internet for health purposes, many studies have been conducted on online health information–seeking behavior in different demographic groups, including students. Most of these studies have examined the sources of health information used by different groups, attitudes towards health information seeking, aims and motivations, types of information sought, and factors related to health information–seeking behavior [
The findings showed that the majority of the participants had good or somewhat good general health status. Numerous studies have been conducted on the general health status of adolescents in Iran; most of them have reported approximately similar findings [
In addition, the descriptive findings of the study regarding online health information–seeking behavior showed that the participants had moderate scores on all subscales of eHIQ.
Regarding attitudes about online health information and sharing them, a similar study that aimed at explaining health information behavior of adolescents in Shiraz has reported that the participants’ general attitude toward health information retrieved from the internet is positive. The majority of the participants also trusted in the quality of information and were interested in retrieving health information from the internet twice [
This study was conducted among a non–English-speaking female sample in a developing religious community. The unique features of the research environment may affect the results. Several studies show that contextual factors may affect different aspects of information-seeking behavior. Dankasa (2017) found in a study that geographical location, culture, and religious status may influence the information-seeking behavior of the internet users [
Statistical tests also showed that different dimensions of online health information–seeking behavior had no significant correlations with health-related quality of life. On this subject, in a survey of 400 school-age adolescents in Shiraz, respondents stated that they believed that the retrieved online health information affected their health status positively [
Overall, it seems that although internet technology has provided a good opportunity to access health information, its practical impact on health status is still controversial. This can have many explanations. Challenges such as the lack of appropriate information, inadequate quality of information, poor health literacy of internet users, insufficient skills in searching for information, lack of trust in online health information sources, and concerns about security and confidentiality reduce the potential of the internet in serving the health of population [
Based on the findings of this study, interventions such as encouraging students to make more use of the internet as a source of health information; expanding their access to reliable online health sources; launching specific students’ health websites containing relevant, reliable, and understandable information by health authorities, especially in native language; improving the English language skills of students (since it could be a barrier for most of the participants in searching activities); improving students’ internet skills; and familiarizing them with search methods and specialized sources can be prioritized in order to maximize the potential of use of the internet in promoting the students’ health. It is also helpful to strengthen the online culture by using social marketing in the school environment. This study has several strengths. Few studies have been conducted in Iran to investigate the correlations between online health information–seeking behavior and the health status of students. In addition, there are few studies investigating the health information–seeking behavior of Persian language speakers. Therefore, the study has implications for research and practice. It contributes to research on health information–seeking behavior as it brings out the association of health information seeking with health outcomes that has not been given much attention in the literature. In addition, the study provides health and information professionals with information needed to make health information understandable, available, and accessible for students. The findings could also be used to develop appropriate interventions to enhance the students’ internet skills, so that they can make the best use of internet technology to promote their health. The study, however, has some limitations; first, it used a sample of female students, while some studies have reported gender-based differences in health information–seeking behavior that may affect the generalization of our findings to other population groups. Also, the study was done in a specific geographical, cultural, and religious context, which also makes it difficult to generalize the findings to different contexts. The results described have been extracted from research in a developing country, and it is likely that there are differences between countries.
Students have a variety of health issues and have an increased demand for health information [
Although students' access to online sources has increased substantially, they can only gain the most benefit from this information source by being able to effectively search for, evaluate, and use online information [
e-Health Impact Questionnaire
mental component summary
physical component summary
36-Item Short Form Health Survey
The authors acknowledge the participants, their parents, and their teachers.
None declared.