What Do Young Adults Expect When They Go Online? Lessons for Development of an STD/HIV and Pregnancy Prevention Website


We used participatory research to develop a theoretically based online STD/HIV and pregnancy prevention intervention that would be entertaining and captivating for 15–25 year olds while delivering key messages about condom use. We conducted six focus groups with 15–25 year olds attending reproductive health clinics and completed a content analysis with focus group data. Youth had expectations that websites contain features such as graphics and flash technology. They would participate in research online if their confidentiality was assured and if they could receive an instant incentive. Limited access to high-end bandwidth capability requires use of compressed graphics and music to reach diverse audiences. Youth suggested approaches to frame role-model delivered messages about HIV/STD and pregnancy risk, condom attitudes, norms and self-efficacy for negotiation. These data allowed for development of a dynamic, interactive and relatively low bandwidth site that retains fidelity to key theoretical constructs in STD/HIV and pregnancy prevention.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Centers for Disease Control and Prevention. Compendium of HIV prevention interventions with evidence of effectiveness. URL: http://www.cdc.gov/hiv/stats/hasr1402/2002SurveillanceReport. pdf [accessed 2004 Feb 23].

  2. 2.

    Centers for Disease Control and Prevention. HIV/AIDS year-end 1999 edition surveillance report. 2000;11(2). 1999.

  3. 3.

    Ventura, S., Matthews, T., and Hamilton B., Teenage births in the United States: State trends, 1991–2000, an update. Natl. Vital Stat. Rep. Jun. 15; 52(23):1–9, 2004.

    Google Scholar 

  4. 4.

    A. C. Nielson Survey, A. C. Nielsen Survey finds nearly two-thirds of U.S. population age 12 or older are online. URL: http://www.acnielsen.com/news/american/us/2000/20000508.htm [accessed 2004 Feb 23].

  5. 5.

    Mandl, K. D., Feit, S., Pena, B. M. G., and Kohane, I. S., Growth and determinants of access in patient e-mail and Internet use. Arch. Pediatr. Adolesc. Med. 154:508–511, 2000.

    Google Scholar 

  6. 6.

    Rideout V., Generation Rx.com: How young people use the Internet for health information. Mark Health Serv. Spring 22(1):26–30, 2002.

    Google Scholar 

  7. 7.

    Witte, J. C., Amoroso, L. M., and Howard, P. E. N., Research methodology: Method and Representation in Internet-based survey tools–mobility, community and cultural identity in Survey 2000. Soc. Sci. Comp. Rev. 18(2):179–195, 2000.

    Article  Google Scholar 

  8. 8.

    National Telecommunications and Information Administration (NTIA). Falling through the Net, toward digital inclusion. URL: http://www.ntia.doc.gov/ [accessed 2004 Feb 24].

  9. 9.

    Pew Internet and American Life Report. The online health care revolution: How the Web helps Americans take better care of themselves. URL: http://www.pewinternet. org/pdfs/PIP_Health_Report.pdf [accessed 2004 Feb 18].

  10. 10.

    Cyber Dialogue. Cyber dialogue: CyberCitizen Health 2000. URL: http://www.cyberdialogue.com/pdfs/promotional/cch/cch-2000-brochure.pdf [accessed 2004 Feb 4].

  11. 11.

    Bryant, D. K., Fox, A. S., Spigland, I., Childers, E., Motyl, M., and Rosenfeld, W. D., Comparison of rapid diagnostic methodologies for Chlamydia and gonorrhea in an urban adolescent population: A pilot study. J. Adolesc. Health 16(4):324–327, 1995.

    Article  Google Scholar 

  12. 12.

    Krishna, S., Balas, E., Spencer, D., Griffin, J., and Boren S., Clinical trilas of interactive computerized patient education: Implications for family practice. J. Fam. Pract. 45(1):25–33, 1997.

    Google Scholar 

  13. 13.

    Revere, D., and Dunbar, P. J., Review of computer-generated outpatient health behavior interventions: Clinical encounters “in absentia.” J. Am. Med. Inform. Assoc. 8(1):62–79, 2001.

    Google Scholar 

  14. 14.

    Gustafson, D. H., Hawkins, R., Boberg, E., et al., Impact of a patient-centered, computer-based health information/support system. Am. J. Prev. Med. 16(1):1–9, 1999.

    Article  Google Scholar 

  15. 15.

    Ritterband, L. M., Gonder-Fredrick, L. A., Cox, D. J., Clifton, A. D., West, R. W., and Borowitz, S. M., Internet intervetions: In reveiw, in use, and into the future. Prof. Psychol. Res. Pr. 34:527–534, 2003.

    Article  Google Scholar 

  16. 16.

    Tate, D. F., Wing, R. R., and Winette, R. A., Using Internet technology to deliver a behavioral weight loss program. JAMA 285(9):1172–1177, 2001.

    Article  Google Scholar 

  17. 17.

    Palinkas, L. A., Russell, J., Downs, M. A., and Petterson, J. S., Ethnic differences in stress, coping, and depressive symptoms after the Exxon Valdez oil spill. J. Nerv. Ment. Dis. 180(5):287–295, 1992.

    Article  Google Scholar 

  18. 18.

    Lange, A., van de Ven J-P., Schrieken, B. A. L., Bredeweg, B., and Emmelkamp, P. M. G., Internet-mediated, protocol-driven treatment of psychological dysfunction. J. Telemed. Telecare. 6:15–21, 1992.

    Article  Google Scholar 

  19. 19.

    Barrera, M. Jr., Glasgow, R. E., McKay, H. G., Boles, S. M., and Feil, E. G., Do Internet-based support interventions change perceptions of social support?: An experimental trial of approaches for supporting diabetes self-management. Am. J. Community. Psychol. Oct. 30(5):637–654, 2002.

    Article  Google Scholar 

  20. 20.

    Turner, C. F., Ku, L., Rogers, S. M., Lindberg, L. D., Pleck, J. H., and Sonerstein, F. L., Adolescent sexual behavior,drug use, and violence: Increased reporting with computer survey technology. Science 280:867–873, 1998.

    Article  Google Scholar 

  21. 21.

    Gustafson, D. H., Robinson, T. N., Ansley, D., Adler, L., and Brennan, P. F., Consumers and evaluation of interactive health communication applications. The Science Panel on Interactive Communication and Health. Am. J. Prev. Med. 16(1):23–29, 1999.

    Article  Google Scholar 

  22. 22.

    Albarracin, D., Fishbein, M., Johnson, B. T., and Muellerleile, P. A., Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychol. Bull. 127(1):142–161, 2001.

    Article  Google Scholar 

  23. 23.

    Albarracin, D., McNatt, P. S., Klein, C. T., Ho, R. M., Mitchell, A. L., and Kumkale, G. T., Persuasive communications to change actions: an analysis of behavioral and cognitive impact in HIV prevention. Health Psychol. 22(2):166–177, 2003.

    Article  Google Scholar 

  24. 24.

    National Institute of Mental Health Multisite HIV Prevention Trial Group, The NIMH Multisite HIV prevention trial: Reducing HIV sexual risk behavior. Science 280:1889–1894, 1998.

    Article  Google Scholar 

  25. 25.

    Bull, S., Lloyd, L., McFarlane, M., and Rietmeijer, K., Men who have sex with men and women (MSM/W): Their use of Internet and related HIV/STD risk. Unpublished Manuscript 2004.

  26. 26.

    Azjen, I., The theory of planned behavior. Organ. Behav. Hum. Decis. Process 50:179–211, 1991.

    Article  Google Scholar 

  27. 27.

    Bandura, A., Self-efficacy: The Exercise of Control. W.H. Freeman, New York, 1997.

    Google Scholar 

  28. 28.

    Centers for Disease Control and Prevention, Community-level HIV intervention in five cities: Final outcome data from the CDC AIDS Community Demonstration Projects. Am. J. Public Health Mar. 89(3):336–345, 1999.

    Google Scholar 

  29. 29.

    Rogers, E. M., Diffusion of Innovations, 4th edn. Free Press, New York, 1995.

    Google Scholar 

  30. 30.

    Rogers, E. M., Vaughan, P. W., Swalehe, R. M., Rao, N., Svenkerud, P., and Sood S., Effects of an entertainment-education radio soap opera on family planning behavior in Tanzania. Stud. Fam. Plann. Sep. 30(3):193–211, 1999.

    Article  Google Scholar 

  31. 31.

    O’Donnell, L., San Doval, A., Vornfett, R., and DeJong W., Reducing AIDS and other STDs among inner-city Hispanics: The use of qualitative research in the development of video-based patient education. AIDS Educ. Prev. 6(2):140–153, 1994.

    Google Scholar 

  32. 32.

    Lamptey, P. R., and Price, J. E., Social marketing sexually transmitted disease and HIV prevention: A consumer-centered approach to achieving behavior change. AIDS 12(Suppl 2):S1–S9, 1998.

    Google Scholar 

  33. 33.

    Van Rossem, R., and Meekers, D., An evaluation of the effectiveness of targeted social marketing to promote adolescent and young adult reproductive health in Cameroon. AIDS Educ. Prev. 12(5):383–404, 2000.

    Google Scholar 

  34. 34.

    Maibach, E., and Cotton D., Moving People to Behavior Change: A Staged Social Cognitive Approach. In: Maibach, E., and Parrott, L. (eds.), Designing Health Messages: Approaches from Communication Theory and Public Health Practice. Sage Publications, Thousand Oaks, CA, 1995.

    Google Scholar 

  35. 35.

    Bull, S. S., Cohen, J., Ortiz, C., and Evans T., The POWER Campaign for promotion of female and male condoms: Audience research and campaign development. Health Commun. 14(4):475–491, 2002.

    Article  Google Scholar 

  36. 36.

    Alstead, M., Campsmith, M., Halley, C. S., Hartfield, K., Goldbaum, G., and Wood, R. W., Developing, implementing and evaluating a condom promotion program targeting sexually active adolescents. AIDS Educ. Prev. 11(6):497–512, 1999.

    Google Scholar 

  37. 37.

    Bull, S. S., Lloyd, L., Rietmeijer, C., and McFarlane, M., Recruitment and retention of an online sample for an HIV prevention intervention targeting men who have sex with men: The Smart Sex Quest Project. AIDS Care Nov. 16(8):931–943, 2004.

    Article  Google Scholar 

  38. 38.

    Atlas-ti Scientific Software Development, Version. Berlin, 1999.

  39. 39.

    Strauss, A., and Corbin J., Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Sage Publications, Newbury Park, CA, 1990.

    Google Scholar 

  40. 40.

    Rogers, E., Communication Strategies for Family Planning. Free Press, New York, 1973.

    Google Scholar 

  41. 41.

    Bandura, A., Social Foundations of Thought and Action: A Social Cognitive Theory. Prentice Hall, Englewood Cliffs, NJ, 1986.

    Google Scholar 

  42. 42.

    Sogolow, E., Peersman, G., Semaan, S., Strouse, D., and Lyles, C. M., HIV/AIDS Prevention Research Synthesis Project Team. The HIV/AIDS Prevention Research Synthesis Project: scope, methods, and study classification results. J. Acquir. Immune. Defic. Syndr. Jul. 1 30(Suppl 1):S15–S29, 2002.

    Google Scholar 

  43. 43.

    Bull, S. S., Phibbs, S., Watson, S. T., and Ray J., Colorado Health Outcomes Program, Denver, USA. URL: www.keepitreal.info [accessed 2005 Feb 7].

  44. 44.

    Flicker, S., Goldberg, E., Read, S., Veinot, T., McClelland, A., Saulnier, P., and Skinner, H., HIV-positive youth’s perspectives on the Internet and e-health. J. Med. Internet. Res. Sep 29 6(3):e32, 2005.

    Google Scholar 

  45. 45.

    Body Health Resources Corporation, New York, USA. URL: http://www.thebody.com/index.shtml [accessed 2005 Feb 28].

  46. 46.

    Planned Parenthood Federation of America, New York, USA. URL: http://www.teenwire.com/index.asp [accessed 2005 Feb 28].

Download references


We wish to acknowledge the National Institute of Mental Health for providing the funds to conduct this research under grant number 5 R01 MH63690-02. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.

Author information



Corresponding author

Correspondence to Sheana Salyers Bull.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bull, S.S., Phibbs, S., Watson, S. et al. What Do Young Adults Expect When They Go Online? Lessons for Development of an STD/HIV and Pregnancy Prevention Website. J Med Syst 31, 149–158 (2007). https://doi.org/10.1007/s10916-006-9050-z

Download citation


  • HIV
  • Internet
  • Adolescent
  • Sexually transmitted diseases
  • Unintended pregnancy
  • Behavior change