The Internet, in contrast to in-person interactions with health providers, allows anonymous and nonpunitive ease of access. Adolescents have long sought honest, direct answers to important but embarrassing questions about health; emerging technologies provide a venue to obtain relevant information without geographic, time, financial, and personal barriers. This article is a case study of TeenHealthFX.com . Those interested in how youth access online health information can learn of the positive and negative aspects of delivering messages through the Internet. This article discusses the process involved in creating and maintaining TeenHealthFX and the challenges of providing online health information to adolescents via new technology.
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Reasons for going online include communication and entertainment, but adolescent users also turn to this resource for health information.
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Health Web sites can offer youth a way to easily access sensitive health information, explore topics anonymously, and receive direct, candid answers from health professionals.
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TeenHealthFX is a health information Web site that was created in 1999 by the Atlantic Health System Goryeb Children’s Hospital, Morristown Medical Center, and Overlook Medical Center.
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Although funding and maintenance of such a Web site can be substantial, the rewards to the young people who use it, the professionals who operate it, and the community that it serves are great.
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Those considering development of a technology-based intervention to reach young people can learn from the case history of TeenHealthFX.
Although there are concerns in using emerging technology for health information and behavioral advice, the Internet, in contrast to in-person interactions with health providers, allows ease of access in an anonymous and nonpunitive way. Across generations, adolescents have sought honest, direct answers to important but embarrassing questions about health; emerging technologies provide a much-needed venue to obtain relevant information without geographic, time, financial, and personal barriers.
This article is a case study, offering the story of TeenHealthFX. From discussion of this specific Web site, those interested in how youth access online health information can learn of the positive and negative aspects of delivering health messages through the Internet. Beyond describing the process involved in creating and maintaining TeenHealthFX, this article discusses the challenges of providing online health information to adolescents via new technology.
TeenHealthFX’ s beginning
TeenHealthFX is a project of the Atlantic Health System Goryeb Children’s Hospital, Morristown Medical Center, and Overlook Medical Center. The planning for this hospital–community collaborative initiative began in 1998 and was created with the assistance, advice, and support from the Morristown Health Department, County College of Morris, Morris School District, Child and Family Resources, New Jersey Department of Education, Morristown Medical Center Advisory Board, Community Health Department, and the Adolescent/Young Adult Center for Health at the Atlantic Health System’s Goryeb Children’s Hospital.
Every 3 years, community and board members of the Morristown Medical Center convene to establish their goals, driven by a community needs assessment. In 1998, this assessment revealed that adolescents lacked easy access to good and reliable health information. Despite a local and comprehensive adolescent medicine program, only a small proportion of local youth were having their health information concerns addressed. Given that most local youth were not accessing care and the emerging must-have status of the Internet, the community proposed that a Web site for adolescents and young adults be created. In early 1999, the Atlantic Health System Community Health Committee made up of Morris County community leaders and hospital employees gave $67,500 to initiate this effort.
TeenHealthFX’s stated mission is to provide adolescent Internet users with an online resource for general and specific questions about physical and emotional health. As conceived, the Web site was also a tool to improve young people’s health literacy and train them to navigate a challenging health care system. Additionally, the Web site was to assist youth living in the region (Northern New Jersey) with information about how to obtain local medical, mental health, and support services. An underlying goal of TeenHealthFX was and is to empower adolescents to improve their health through individual responsibility.
It is common for adolescents to believe that their health questions, behaviors, and physical changes are abnormal and even bizarre. Because youth may be too embarrassed to seek important health care and advice, resources must be confidential. Although candid, direct, and factual information is valued, it may not be readily available to young people through local services, many of which are already overburdened. Additionally, youth benefit from learning that what they consider a “unique” question or problem is also asked and/or faced by others. Although a Web site neither cannot nor should not replace one-on-one clinical advice, the developers of TeenHealthFX thought that it could serve as an ideal starting place to deliver essential, albeit sometimes uncomfortable, information.
Original design and modifications
After receiving initial funding, a coordinator was hired and a design committee was formed. Although resourceful and enthusiastic, those involved, like others joining the dot-com surge of the late 1990s, had limited direct experience in Web site design or management. The initial team consisted of the coordinator, adolescent medicine professionals, community leaders, and, most importantly, teenagers who also served on the newly formed Teen Advisory Committee (TAC). An outside Web site development firm was contracted to create the Web site. It took approximately 6 months to craft the Web site’s first version.
TeenHealthFX went live in September 1999. Fig. 1 presents an image of the first home page. The launch occurred at a neighborhood high school and local television news stations and newspapers featured stories about the Web site.
Without drawing on a specific communication theory, the design incorporated a user-friendly approach consistently involving static components of information and navigation bars on the page’s top and left sides. Dynamic text or images appeared center right on the page (where the picture of the Wizard is on the home page). The top navigation bar included the TeenHealthFX logo, which was a link back to the home page. Below the TeenHealthFX logo, users could access the Emergency Help Now!, Links, About Us, Ask FX, and Rate Us sections using navigation buttons, and these buttons appeared throughout the Web site. The side toolbar featured navigation buttons for different subject categories. The original Web site’s sections included
Ask FX: An area where visitors could post questions any time they wished to.
FX Answers: An area where visitors could find previously posted questions and answers. Visitors could search through categorized subject areas.
FX Links: A section that linked visitors to Web sites not associated with Morristown Medical Center but deemed by the research team and other health educators good medical and health resources. (External links are added to TeenHealthFX.com regularly in the Links section and in most of the questions in the FX Answers section of the site. Before any external links are included on the site, a trained educator thoroughly reviews them for relevance to the current question/answer or section of TeenHealthFX, accuracy of information in a teen-friendly format, good reputation of site authors, and that the external link is consistent with the philosophy of TeenHealthFX. In June 2006, the links on TeenHealthFX were re-reviewed and revised with several additions and deletions.)
Chat: A chat room moderated by medical professionals and health educators. This feature was canceled in May 2002, primarily because it was labor intensive and not cost efficient.
Emergency Help Now: A section that provided visitors with phone numbers for immediate medical and mental health services. Additionally, this section was a disclaimer page stating that TeenHealthFX was neither a crisis intervention Web site nor a substitute for medical care.
Despite growing use and appreciation, a common criticism was that the initial design was too juvenile. Focus groups and Web site surveys offered information from adolescents, who perceived TeenHealthFX’s information as relevant and helpful but thought that the overall look was childish and colors used (gray and white) were corporate and plain looking. Responding to these concerns, a revision was done in conjunction with the design committee and a new Web site development company.
A redesigned TeenHealthFX was launched in September 2000 ( Fig. 2 ). This Web site used bright colors (yellows, blues, and pinks) on a darkened (black and navy blue mix) background. Throughout the redesigned site, photographs of adolescents were featured. New sections were added, including
Teen Tips: A section created by the TAC that offered articles, tips, and feedback on common issues of concern to teenagers; some topics were mundane (eg, 9 Ways to Speed Up your Morning Ritual), whereas others were serious (eg, how to deal with traumatic events).
SearchFX: An internal search using a keyword search to find relevant pages within the Web site.
The SearchFX feature was added for two reasons. First, it aided visitors in their search for answers to commonly asked questions. Second, it reduced the burden on the TeenHealthFX staff; it became impractical to answer every submitted question. Adolescents would be both reassured to see that they were not alone with their concerns as well as pleased to find immediate answers. The highlighted search engine button on the home page encouraged visitors to search first before submitting questions.
In late 2003, the Atlantic Health System had an external agency audit TeenHealthFX, with the primary goal of uncovering ways to increase traffic flow not only to TeenHealthFX but also to the hospital’s home page. This audit prompted another redesign. An established Web design and marketing firm (which was becoming easier to find) created the current version of TeenHealthFX. This version, which features a newspaper look with bright colors (orange and greens) and more photographs of real adolescents, went live in April 2004 ( Fig. 3 ). In addition to the sections found in previous designs, the revised TeenHealthFX added the following sections:
Facts: Quick and easy to understand health facts. New facts appear each time a visitor logs on.
Hot Topics: A short paragraph, written by the TeenHealthFX professional staff, on current subjects, modified monthly.
Happenings: A page and links referencing local community programs and opportunities, available through the Atlantic Health System.
Quizzes: A short multiple-choice quiz on a relevant health subject. Approximately 7 different quizzes are cycled, so that visitors may view new quizzes each time they visit the home page. Correct responses are available once a visitor completes the quiz.
Resource of the Month: Added in 2007, this section reviews books and other Web sites for adolescents.
Where Do You Stand: In 2007–2009, current and controversial issues were posted and adolescents encouraged to contribute their thoughts and feelings.
