June 28, 2012 — Summary of "Searching for a 'Plan B': Young Adults' Strategies for Finding Information about Emergency Contraception Online," Hargittai/Young, Policy & Internet, 2012.
People increasingly use the Internet as a source of health information, but locating accurate, helpful and credible content is not always a straightforward process, according to Eszter Hargittai and Heather Young of Northwestern University. They noted that for young adults who desire to avoid pregnancy, emergency contraception is a particularly relevant topic on which accurate information is needed in a short period of time, given that the effectiveness of emergency contraception pills (ECPs) diminishes over time.
Hargittai and Young wrote that while much research has been done on access to ECPs, little has focused on finding relevant information online. They developed a study to assess how young adults locate information on the topic through Web searches.
Researchers used in-person interviews and observations to study 210 first-year students ages 18 or older at two Midwestern college campuses -- one public and one private -- during the spring and fall of 2007 and the winter of 2008. Participants were paid $40 to meet one-on-one with a researcher and use an Internet-connected computer to respond to this 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."
At the time of the study, ECPs had just been made available without a prescription to adults ages 18 and older in the U.S., "so visiting a pharmacy to purchase ECPs [over-the-counter] was the ideal solution to the task," the researchers noted. They wrote that the timing of the scenario was purposely structured so that students could avoid simply telling the friend to go to campus health services and would have trouble easily reaching a health professional. Further, the town used in the scenario does not have a Planned Parenthood to discourage students from simply searching for one of the organization's clinics.
The researchers considered an answer "successful" if the solution involved suggesting that the friend take ECPs, regardless of how the participant suggested the friend obtain them. An "ideal" answer involved recommending purchasing ECPs at a pharmacy. An "unsuccessful" answer did not mention ECPs.
Sixty-six percent of participants came up with a successful answer, while 34% were unsuccessful. Forty percent gave an ideal response. About 26% of the students -- 40% of the successful group -- suggested getting ECPs elsewhere than a pharmacy. Nineteen percent said their friend should seek medical care but did not suggest anything beyond that, while 3% gave no answer.
The remaining responses, each given by one student, included "adoption," "ascorbic acid," purchasing another condom, "RU-486," taking a pregnancy test, visiting a gynecologist, "wait it out" and "wash genitals."
The researchers found that participants' prior knowledge and experiences regarding ECPs shaped their approach to the task. Several students cited personal experiences with a similar situation, and students who were studying health-related majors or had worked in health care settings often made statements indicating they had knowledge of ECPs. For example, a female nursing student who worked at a pharmacy knew immediately that the friend needed Plan B and searched online for a pharmacy that had it.
The strategy participants used when beginning the task shaped the rest of their online search. The majority of participants -- 88% -- began by using a search engine, while others went directly to topic-related sites, such as Planned Parenthood (2%) or WebMD (4%). The researchers noted that students who were unaware of the existence of ECPs to prevent pregnancy after unprotected intercourse sometimes assumed that there was nothing the friend could do to avoid pregnancy, and their search terms reflected this belief. Moreover, many students began their search by querying terms in the scenario, such as "prevent pregnancy," which was the most common initial query but typically led students to overly general information that was insufficient for explaining what to do after a broken condom.
The use of .org at the end of Web addresses "was frequently relied upon by respondents as a measure of credibility," despite the fact that these sites are not regulated any more than .com sites, the researchers wrote. Plannedparenthood.org, ppin.org (Planned Parenthood of Indiana) and morningafterpill.org -- a site sponsored by the American Life League that includes erroneous health information -- were the most popular ECP-related sites accessed.
Fewer than half of participants were able to give the ideal answer, "despite the wealth of information available on the Web on the topic," the researchers wrote, adding that the finding "is even less encouraging if we consider that several of the people who arrived at the ideal solution had prior knowledge about ECPs." Further, few students made an effort to verify the information they found.
From a policy standpoint, "it is problematic to assume that just because content exists online, it is easily within the reach of all users," the researchers stated, adding that "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."
Noting that the particular search terms used influenced whether participants found the appropriate information, the researchers suggested that providers of ECPs incorporate additional search terms, such as "pregnancy prevention," into their search-engine optimization strategies. The researchers also called for educating Internet users "about how the Web works and how to approach content they find online through a critical lens."
Debra Ness, publisher & president, National Partnership
Andrea Friedman, associate editor & director of reproductive health programs, National Partnership
Marya Torrez, associate editor & senior reproductive health policy counsel, National Partnership
Melissa Safford, associate editor & policy advocate for reproductive health, National Partnership
Perry Sacks, assistant editor & health program associate, National Partnership
Cindy Romero, assistant editor & communications assistant, National Partnership
Justyn Ware, editor
Amanda Wolfe, editor-in-chief
Heather Drost, Hanna Jaquith, Marcelle Maginnis, Ashley Marchand and Michelle Stuckey, staff writers
Tucker Ball, director of new media, National Partnership