15 October 2012

Searching for a “Plan B”: young adults’ strategies for finding information about emergency contraception online

Eszter Hargittai of Northwestern University discusses her study, co-authored with Heather Young and published in the journal Policy and Internet, suggesting that despite the availability of quality health information on the Web, many young people are unable to find accurate information about important health matters online. Hargittai, E. and Young, H. (2012) Searching for a “Plan B”: Young Adults' Strategies for Finding Information about Emergency Contraception Online. Policy and Internet 4 (2).

People increasingly turn to the Internet for health information, with 80 percent of U.S. Internet users (59 percent of adults) having used the Web for this purpose. However, because there is so much health content online, users may find it difficult to find reliable content quickly. Research has also shown that websites hosting information about the most controversial topics – including Emergency Contraceptive Pills, ECPs – contain a great number of inaccuracies. While the Internet is a potentially valuable source of information about sexual health topics for young adults, difficulty in searching and evaluating credibility may prevent them from finding useful information in time.

Emergency contraception has long been heralded as a “second chance” for women to prevent pregnancy after unprotected intercourse. However, the commercial promotion and use of ECPs has been a highly contentious issue in the United States, a fact that has had a significant impact on legislative action and accessibility. Due to their limited window of effectiveness and given that people do not tend to obtain them until the moment when they are needed urgently, it is essential for people to be able to find accurate information about ECPs as quickly as possible.

Our study investigated empirically how over 200 young college students (18-19 years old) at two college campuses in the Midwestern United States searched for and evaluated information about emergency contraception. They were given the hypothetical scenario: “You are at home in the middle of summer. A friend calls you frantically on a Friday at midnight. The condom broke while she was with her boyfriend. What can she do to prevent pregnancy? Remember, neither of you is on campus. She lives in South Bend, Indiana.” All of the students had considerable experience with using the Internet.

Worryingly, a third of the participants, after looking for information online, were unable to conclude that the friend should seek out ECPs. Less than half gave what we consider the ideal response: to have the friend purchase ECPs over the counter at a pharmacy. Some participants suggested such solutions as “wait it out,” “adoption,” “visit a gynecologist” (in the incorrect location), and purchasing another condom. Three percent of respondents came to no conclusion at all.

While adolescents often claim to be confident in searching for information online, they are often unsystematic in their search and few students made a concerted effort to verify information they found during their search. The presence of a dot-org domain name was sometimes cited as a measure of credibility: “Cause it’s like a government issued kind of website,” noted one participant. While it’s encouraging that students are aware of different top-level domain names, it’s alarming that their knowledge of what they signify can be wrong: dot-org sites are not sanctioned any more than are dot-com sites and thus should not be considered a signal of credibility.

Another student assumed that “the main website” for the morning after pill was morningafterpill.org, which happens to be sponsored by the American Life League, a pro-life organization. The website includes articles with titles such as “Emergency Contraception: the Truth, the Whole Truth, and Nothing but the Truth,” as well as advocacy by medical professionals matching the perspectives of the American Life League. This demonstrates the way in which people and organizations with a particular agenda can publicize any type of information – in this case erroneous health information – to the public.

Overall, the findings suggest that despite information theoretically available on the Web about emergency contraception, even young adults with considerable online experiences may not be able to find it in a time of need. Many respondents were uncertain of how to begin looking for information; some did not immediately consider the Internet as a primary source for it. An important policy implication of this study is that it is problematic to assume that just because content exists online, it is easily within the reach of all users. In particular, it is a mistake to think that just because young people grew up with digital media, they are universally savvy with finding and evaluating Web content.

Given the importance of finding credible and accurate health-related content, it is important to understand the strategies people use to find information so that obstacles can be addressed – rather than taking such know-how for granted, educational institutions should think about incorporating related content into their curricula. Additionally, related services should be available at establishments such as public libraries available to those not enrolled in school.

In some cases particular search terms determined whether people found the right information: providers of content about emergency contraception need to be aware of this. The study also raises questions about search engine practices. While search engine companies seem to take pride in letting their algorithms sort out the ranking of search results, is it ideal or responsible to leave content important to people’s health in the hands of automated processes that are open to manipulation?

Algorithms themselves are not neutral – they include lots of decisions taken by their creators – yet the idea of “algorithm literacy” is not a topic taken up in educational curricula or public conversations.

Note: This article gives the views of the authors, and not the position of the Policy and Internet Blog, nor of the Oxford Internet Institute.