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Pengembangan Skala Cyberchondria Versi Pendek
Abstract
Studi ini bertujuan mengembangkan dan memvalidasi versi pendek Cyberchondria Severity Scale (CSS).Cyberchondria adalah perilaku pencarian informasi kesehatan di internet yang berlebihan. Uji Exploratory Factor Analysis (EFA) digunakan untuk mengidentifikasi struktur faktor skala cyberchondria. Hasil uji asumsi awal menunjukkan skala layak untuk dianalisis faktor (KMO > 0,5;
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Background
Self‐administered questionnaires are widely used to collect data in epidemiological research, but non‐response reduces the effective sample size and can introduce bias. Finding ways to increase response to postal and electronic questionnaires would improve the quality of epidemiological research.
Objectives
To identify effective strategies to increase response to postal and electronic questionnaires.
Search methods
We searched 14 electronic databases up to December 2021 and manually searched the reference lists of relevant trials and reviews. We contacted the authors of all trials or reviews to ask about unpublished trials; where necessary, we also contacted authors to confirm the methods of allocation used and to clarify results presented.
Selection criteria
Randomised trials of methods to increase response to postal or electronic questionnaires. We assessed the eligibility of each trial using pre‐defined criteria.
Data collection and analysis
We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios (OR) and 95% confidence intervals (CI) in a random‐effects model. We assessed evidence for selection bias using Egger's weighted regression method and Begg's rank correlation test and funnel plot. We assessed heterogeneity amongst trial odds ratios using a Chi² test and quantified the degree of inconsistency between trial results using the I² statistic.
Main results
Postal
We found 670 eligible trials that evaluated over 100 different strategies of increasing response to postal questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies.
The odds of response almost doubled when: using monetary incentives (odds ratio (OR) 1.86; 95% confidence interval (CI) 1.73 to 1.99; heterogeneity I² = 85%); using a telephone reminder (OR 1.96; 95% CI 1.03 to 3.74); and when clinical outcome questions were placed last (OR 2.05; 95% CI 1.00 to 4.24).
The odds of response increased by about half when: using a shorter questionnaire (OR 1.58; 95% CI 1.40 to 1.78); contacting participants before sending questionnaires (OR 1.36; 95% CI 1.23 to 1.51; I² = 87%); incentives were given with questionnaires (i.e. unconditional) rather than when given only after participants had returned their questionnaire (i.e. conditional on response) (OR 1.53; 95% CI 1.35 to 1.74); using personalised SMS reminders (OR 1.53; 95% CI 0.97 to 2.42); using a special (recorded) delivery service (OR 1.68; 95% CI 1.36 to 2.08; I² = 87%); using electronic reminders (OR 1.60; 95% CI 1.10 to 2.33); using intensive follow‐up (OR 1.69; 95% CI 0.93 to 3.06); using a more interesting/salient questionnaire (OR 1.73; 95% CI 1.12 to 2.66); and when mentioning an obligation to respond (OR 1.61; 95% CI 1.16 to 2.22). The odds of response also increased with: non‐monetary incentives (OR 1.16; 95% CI 1.11 to 1.21; I² = 80%); a larger monetary incentive (OR 1.24; 95% CI 1.15 to 1.33); a larger non‐monetary incentive (OR 1.15; 95% CI 1.00 to 1.33); when a pen was included (OR 1.44; 95% CI 1.38 to 1.50); using personalised materials (OR 1.15; 95% CI 1.09 to 1.21; I² = 57%); using a single‐sided rather than a double‐sided questionnaire (OR 1.13; 95% CI 1.02 to 1.25); using stamped return envelopes rather than franked return envelopes (OR 1.23; 95% CI 1.13 to 1.33; I² = 69%), assuring confidentiality (OR 1.33; 95% CI 1.24 to 1.42); using first‐class outward mailing (OR 1.11; 95% CI 1.02 to 1.21); and when questionnaires originated from a university (OR 1.32; 95% CI 1.13 to 1.54).
The odds of response were reduced when the questionnaire included questions of a sensitive nature (OR 0.94; 95% CI 0.88 to 1.00).
Electronic
We found 88 eligible trials that evaluated over 30 different ways of increasing response to electronic questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response tripled when: using a brief letter rather than a detailed letter (OR 3.26; 95% CI 1.79 to 5.94); and when a picture was included in an email (OR 3.05; 95% CI 1.84 to 5.06; I² = 19%).
The odds of response almost doubled when: using monetary incentives (OR 1.88; 95% CI 1.31 to 2.71; I² = 79%); and using a more interesting topic (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by half when: using non‐monetary incentives (OR 1.60; 95% CI 1.25 to 2.05); using shorter e‐questionnaires (OR 1.51; 95% CI 1.06 to 2.16; I² = 94%); and using a more interesting e‐questionnaire (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by a third when: offering survey results as an incentive (OR 1.36; 95% CI 1.16 to 1.59); using a white background (OR 1.31; 95% CI 1.10 to 1.56); and when stressing the benefits to society of response (OR 1.38; 95% CI 1.07 to 1.78; I² = 41%).
The odds of response also increased with: personalised e‐questionnaires (OR 1.24; 95% CI 1.17 to 1.32; I² = 41%); using a simple header (OR 1.23; 95% CI 1.03 to 1.48); giving a deadline (OR 1.18; 95% CI 1.03 to 1.34); and by giving a longer time estimate for completion (OR 1.25; 95% CI 0.96 to 1.64).
The odds of response were reduced when: "Survey" was mentioned in the e‐mail subject (OR 0.81; 95% CI 0.67 to 0.97); when the email or the e‐questionnaire was from a male investigator, or it included a male signature (OR 0.55; 95% CI 0.38 to 0.80); and by using university sponsorship (OR 0.84; 95%CI 0.69 to 1.01).
The odds of response using a postal questionnaire were over twice those using an e‐questionnaire (OR 2.33; 95% CI 2.25 to 2.42; I² = 98%). Response also increased when: providing a choice of response mode (electronic or postal) rather than electronic only (OR 1.76 95% CI 1.67 to 1.85; I² = 97%); and when administering the e‐questionnaire by computer rather than by smartphone (OR 1.62 95% CI 1.36 to 1.94).
Authors' conclusions
Researchers using postal and electronic questionnaires can increase response using the strategies shown to be effective in this Cochrane review.
Background
Cyberchondria (CYB) has been described relatively recently as a behaviour characterized by excessive online searching for medical information that is associated with increasing levels of health anxiety. Although CYB has received some attention from researchers, there is no consensus about many of its aspects.
Aims
We describe one of the first reported cases of a treatment-seeking patient with CYB. We review the published literature on the definition of CYB, its assessment, epidemiology, cost and burden, psychological models and mechanisms associated with CYB, relationships between CYB and mental disorders and prevention and treatment strategies.
Methods
Systematic review of all peer-reviewed papers published within the PubMed, PsycINFO, and Cochrane Library databases.
Results
61 articles were selected. Nearly all the studies were descriptive and cross-sectional recruiting sample mainly from the general/university student population and collecting self-report data via online surveys. Data on epidemiology, clinical features, course, comorbidity and therapeutic interventions were scarce. CYB showed a self-reported association with health anxiety, hypochondriasis and obsessive-compulsive disorder (OCD) as well as other forms of problematic usage of the internet (PUI) The psychological mechanisms associated with CYB include low self-esteem, anxiety sensitivity, intolerance of uncertainty, pain catastrophizing and certain meta-cognitive beliefs.
Conclusion
A working definition of CYB includes excessive online health searches that are compulsive and may serve the purpose of seeking reassurance, whilst leading to a worsening of anxiety or distress and further negative consequences. CYB represents a clinically relevant transdiagnostic compulsive behavioural syndrome, closely related to PUI and usually presenting in association with health anxiety, hypochondriasis and/or OCD. CYB is clearly in need of further study and we identify key areas for future research.
Cyberchondria is a relatively new term addressing health anxiety associated with online information. Research data is scarce, as most instruments measuring anxiety do not consider online behavior an important factor. Medical students are arguably assumed to have frequent health anxieties, i.e. “medical student syndrome.” Moreover, they are exposed to large amounts of information. We aimed to measure the level of cyberchondria severity of first-year medical students. First-year medical students of the regular program at Universitas Gadjah Mada completed self-reported instruments (the Cyberchondria Severity Scale (CSS) and the Beck Anxiety Inventory (BAI)). Cut off was determined using ROC analysis to find the best score that corresponded to BAI cut off of16. Data were analyzed using chi square and t-tests to analyze any differences between gender. Respondents were 162 students, 54 males and 108 females, with mean age 18.18 year old +- 0.696. Based on ROC analysis, cut off of 75.5 corresponded with BAI scoreof 16. Mean CSS score was 70.73 +-16.292. There was no significant difference of CSS scores between genders. Based on the analysis of individual items, compared to malestudents, female students more frequently searched for physical symptoms on the Internet, and afterwards, consulted the results with a General Practitioner (GP), discussed with a GP, or went to other specialists; and thus, more frequently required reassurance after online search. In contrast, male students more frequently had difficulty relaxing after searching online for physical symptoms. We concluded that there was no difference of overall cyberchondria severity score, but there were slight but significant differences of online behavior between genders.
Keyword: cyberchondria, gender differences, online behaviors, Internet effects, health education
Questionnaires are a widely used research method in human resource management (HRM), and multi-item psychometric scales are the most widely used measures in questionnaires. These scales each have multiple items to measure a construct in a reliable and valid manner. However, using this method effectively involves complex procedures that are frequently misunderstood or unknown. Although there are existing methodological texts addressing this topic, few are exhaustive and they often omit essential practical information. The current article therefore aims to provide a detailed and comprehensive guide to the use of multi-item psychometric scales for HRM research and practice, including their structure, development, use, administration, and data preparation.
http://dx.doi.org/10.1002/hrm.21852
In this study, the number of factors obtained from parallel analysis, a method used for determining the number of factors in exploratory factor analysis, was compared to that of the factors obtained from eigenvalue and scree plot—two traditional methods for determining the number of factors—in terms of consistency. Parallel analysis is based on random data generation, which is parallel to the actual data set, using the Monte Carlo Simulation Technique to determine the number of factors and the comparison of eigenvalues of those two data sets. In the study, the actual data employed for factor analysis was gathered from a total of 190 primary school teachers using the Organizational Trust Scale to explore a teacher’s views about organizational trust in primary schools within the scope of another study. The Organizational Trust Scale comprises 22 items under the three factors of “Trust in Leaders,” “Trust in Colleagues,” and “Trust in Shareholders.” A simulative data set with a sample size of 190 and 22 items was simulated in addition to the actual data through an SPSS syntax. The two data sets underwent parallel analysis with the iteration number of 1000. The number of factors was found to be three. This was consistent with the number of factors obtained in the development process of the scale. The number of factors was restricted to three and exploratory factor analysis was re-performed on the actual data. It was concluded that the item-factor distributions obtained as a result of the analyses were consistent with those obtained in the scale development study. Hence, parallel analysis was found to provide consistent results with the construct obtained in the scale development study.
The purpose of this study is to investigate the impact of estimation techniques and sample sizes on model fit indices in structural equation models constructed according to the number of exogenous latent variables under multivariate normality. The performances of fit indices are compared by considering effects of related factors. The Ratio Chi-square Test Statistic to Degree of Freedom, Root Mean Square Error of Approximation, and Comparative Fit Index are the least affected indices by estimation technique and sample size under multivariate normality, especially with large sample size.
Cyberchondria is a form of anxiety characterised by excessive online health research. It may lead to increased levels of psychological distress, worry, and unnecessary medical expenses. The aim of the present study was to develop a psychometrically sound measure of this dimension. A sample of undergraduate students (N = 208; 64% female) completed a pilot version of the Cyberchondria Severity Scale (CSS) along with the short form version of the Depression, Anxiety and Stress Scale (DASS-21). Exploratory factor analysis identified a correlated five factor structure that were labelled ‘Compulsion’, ‘Distress’, ‘Excessiveness’, ‘Reassurance Seeking’ and ‘Mistrust of Medical Professional’. The CSS demonstrated good psychometric properties; the subscales had high internal consistency, along with good concurrent and convergent validity. The CSS may prove useful in a wide variety of future research activities. It may also facilitate the development and validation of interventions for cyberchondria.
Looking for information about symptoms and illnesses on the Internet is common and often serves useful purposes. However, a number of people who are overly distressed or anxious about their health perform excessive or repeated health-related searches on the Internet, only to become more distressed or frightened - a pattern defined here as cyberchondria. This behavior, which can also be construed as a form of reassurance seeking and occurs as a manifestation of health anxiety and hypochondriasis, is the focus of this article. The antecedents of cyberchondria, factors that maintain it and its consequences are examined conceptually and in light of the relatively little research that has been performed so far. Managing cyberchondria poses a challenge, and several approaches as part of the treatment of health anxiety and hypochondriasis are described. The article makes suggestions for further research on cyberchondria.
The World Wide Web provides an abundant source of medical information. This information can assist people who are not healthcare professionals to better understand health and disease, and to provide them with feasible explanations for symptoms. However, the Web has the potential to increase the anxieties of people who have little or no medical training, especially when Web search is employed as a diagnostic procedure. We use the term cyberchondria to refer to the unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web. We performed a large-scale, longitudinal, log-based study of how people search for medical information online, supported by a large-scale survey of 515 individuals' health-related search experiences. We focused on the extent to which common, likely innocuous symptoms can escalate into the review of content on serious, rare conditions that are linked to the common symptoms. Our results show that Web search engines have the potential to escalate medical concerns. We show that escalation is influenced by the amount and distribution of medical content viewed by users, the presence of escalatory terminology in pages visited, and a user's predisposition to escalate versus to seek more reasonable explanations for ailments. We also demonstrate the persistence of post-session anxiety following escalations and the effect that such anxieties can have on interrupting user's activities across multiple sessions. Our findings underscore the potential costs and challenges of cyberchondria and suggest actionable design implications that hold opportunity for improving the search and navigation experience for people turning to the Web to interpret common symptoms.
Many people turn to the Web for self-diagnosis and healthcare assessment based on limited knowledge of signs, symptoms, and disorders. Studies of search and browsing for healthcare information have shown that reviewing Web content can lead to escalations from concerns about common, typically benign symptoms to searches on rare and frightening disorders. We explore the potential for the Web to induce costly and potentially unnecessary engagements with health professionals. We present findings on the transition of search on common symptoms to the pursuit of in-world healthcare resources such as nearby physicians and healthcare facilities. We build models that predict the transition from searches on initial common symptoms to queries pursuing local medical expertise, using evidence about a user's stream of queries, the content on reviewed pages, and long-term medical search behaviors. Our findings have implications for reducing costly and unnecessary healthcare resource utilization through refinements of ranking algorithms and search interfaces.
The rapid expansion of the Internet has increased the ease with which the public can obtain medical information. Most research on the utility of the Internet for health purposes has evaluated the quality of the information itself or examined its impact on clinical populations. Little is known about the consequences of its use by the general population.
Is use of the Internet by the general population for health purposes associated with a subsequent change in psychological well-being and health? Are the effects different for healthy versus ill individuals? Does the impact of using the Internet for health purposes differ from the impact of other types of Internet use?
Data come from a national US panel survey of 740 individuals conducted from 2000 to 2002. Across three surveys, respondents described their use of the Internet for different purposes, indicated whether they had any of 13 serious illnesses (or were taking care of someone with a serious illness), and reported their depression. In the initial and final surveys they also reported on their physical health. Lagged dependent variable regression analysis was used to predict changes in depression and general health reported on a later survey from frequency of different types of Internet use at an earlier period, holding constant prior depression and general health, respectively. Statistical interactions tested whether uses of the Internet predicted depression and general health differently for people who initially differed on their general health, chronic illness, and caregiver status.
Health-related Internet use was associated with small but reliable increases in depression (ie, increasing use of the Internet for health purposes from 3 to 5 days per week to once a day was associated with .11 standard deviations more symptoms of depression, P = .002). In contrast, using the Internet for communication with friends and family was associated with small but reliable decreases in depression (ie, increasing use of the Internet for communication with friends and family purposes from 3 to 5 days per week to once a day was associated with .07 standard deviations fewer symptoms of depression, P = .007). There were no significant effects of respondents' initial health status (P = .234) or role as a caregiver (P = .911) on the association between health-related Internet use and depression. Neither type of use was associated with changes in general health (P = .705 for social uses and P = .494 for health uses).
Using the Internet for health purposes was associated with increased depression. The increase may be due to increased rumination, unnecessary alarm, or over-attention to health problems. Additionally, those with unmeasured problems or those more prone to health anxiety may self-select online health resources. In contrast, using the Internet to communicate with friends and family was associated with declines in depression. This finding is comparable to other studies showing that social support is beneficial for well-being and lends support to the idea that the Internet is a way to strengthen and maintain social ties.
A self-rated measure of health anxiety should be sensitive across the full range of intensity (from mild concern to frank hypochondriasis) and should differentiate people suffering from health anxiety from those who have actual physical illness but who are not excessively concerned about their health. It should also encompass the full range of clinical symptoms characteristic of clinical hypochondriasis. The development and validation of such a scale is described.
Three studies were conducted. First, the questionnaire was validated by comparing the responses of patients suffering from hypochondriasis with those suffering from hypochondriasis and panic disorder, panic disorder, social phobia and non-patient controls. Secondly, a state version of the questionnaire was administered to patients undergoing cognitive-behavioural treatment or wait-list in order to examine the measure's sensitivity to change. In the third study, a shortened version was developed and validated in similar types of sample, and in a range of samples of people seeking medical help for physical illness.
The scale was found to be reliable and to have a high internal consistency. Hypochondriacal patients scored significantly higher than anxiety disorder patients, including both social phobic patients and panic disorder patients as well as normal controls. In the second study, a 'state' version of the scale was found to be sensitive to treatment effects, and to correlate very highly with a clinician rating based on an interview of present clinical state. A development and refinement of the scale (intended to reflect more fully the range of symptoms of and reactions to hypochondriasis) was found to be reliable and valid. A very short (14 item) version of the scale was found to have comparable properties to the full length scale.
The HAI is a reliable and valid measure of health anxiety. It is likely to be useful as a brief screening instrument, as there is a short form which correlates highly with the longer version.
Purpose: Cyberchondria describes excessive or repeated online health-related information seeking associated with an increased level of health anxiety. Given the nascent nature of the concept of cyberchondria, this systematic review attempts to summarize the current landscape of cyberchondria research.
Design/methodology/approach: Based on a comprehensive search and systematic filtering process, 40 articles were included in the final sample.
Findings: Characteristics of these articles, measures of cyberchondria and factors related to cyberchondria were reported. This review found that the measures of cyberchondria are still in the developmental stages and thus require further validation in future studies. In addition, while studies have examined various factors associated with cyberchondria, the detailed processes involved in the development of cyberchondria require further conceptualization.
Originality/value: The contributions of this review are threefold: first, it presented a comprehensive overview of studies on cyberchondria by addressing their key characteristics such as country of study, sample size and research method. Second, this review analyzed major assessment tools of cyberchondria to offer useful guidance on future investigations on cyberchondria. Third, it identified important antecedents and consequences of cyberchondria in previous research, which contributes to theoretical understanding of how cyberchondria develops.
The current study aimed to obtain health anxious students’ perspectives on their reasons for using the Internet to obtain health information, and the nature and effects of such usage. Data were gathered using semi-structured interviews with 20 postgraduate and undergraduate students identified as highly health anxious, and were examined using thematic analysis. Results suggested that themes were organized by different stages of the search process. Reasons for searching included curiosity, anxiety/worry about undiagnosed symptoms, and remedy-seeking. Both positive (e.g. reassurance) and negative (e.g. uncertainty) outcomes were reported. Findings from the current study suggest that the Internet constitutes an important resource for obtaining health information by health anxious individuals, with the potential to both reduce and exacerbate health anxiety.
Searching for health information online has become increasingly common, yet few studies have examined potential negative emotional effects of online health information search. We present results from an experiment manipulating the presentation of search results for common symptoms, which shows that the frequency and placement of serious illness mentions within results can influence perceptions of symptom severity and susceptibility of having the serious illness, respectively. The increase in severity and susceptibility can then lead to higher levels of negative emotional outcomes experienced--including feeling overwhelmed and frightened. Interestingly, health literacy can help reduce perceived symptom severity, and high online health experience actually increases the likelihood that individuals use a frequency-based heuristic. Technological implications and directions for future research are discussed.
The purpose of this study was to determine how pregnant women in the Midwestern United States use the internet for health information during pregnancy including information related to physical activity and nutrition, and to determine the impact of the internet on women's confidence in making decisions about physical activity participation and eating behaviors during pregnancy. This was a descriptive, exploratory study using a convenient, non-probabilistic sample. Women were recruited through handouts provided in person, fliers posted at venues, or local websites that cater to women who are pregnant or up to 1 year post-partum. Overall, 293 women (28.5 years ± 4.9) completed the survey online (Survey Monkey) or in-print. Data were analyzed using descriptive statistics, paired t tests, and analyses of covariance. Almost all women used the internet for health information during their pregnancy. Half of women used the internet for information related to physical activity during their pregnancy and some increased their physical activity as a result. Women reported an increase in their confidence for making decisions related to physical activity during pregnancy after using the internet for physical activity information. Women that reported increases in physical activity during pregnancy, had greater increases in confidence for making decisions from using the internet compared to women who decreased or did not change their physical activity. Findings related to nutrition were similar to physical activity. However, there were no significant differences in increases in confidence between those who did or did not change the foods they ate. This study provides health promotional professionals useful information to consider when designing future physical activity and/or nutrition interventions for pregnant women.
given that real data often fail to satisfy the underlying scaling and normality assumptions, there has been growing interest in determining the robustness of structural equation modeling techniques to violations of scaling the normality assumptions and in developing alternative remedial strategies when these assumptions are seriously violated / these topics are the focus of the present chapter
overview of normal theory estimation / effects and detection of nonnormality / remedies for multivariate nonnormality (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examined the relationship between health anxiety and searching for health information online, a phenomenon dubbed 'cyberchondria'. The majority of those with 'high' (n=46) and 'low' (n=36) levels of health anxiety reported seeking health information online. However, those with higher levels of health anxiety sought online health information more frequently, spent longer searching, and found searching more distressing and anxiety provoking. Furthermore, more responses in the high than low health anxiety group related to searching for information on diagnosed and undiagnosed medical conditions, descriptions of others' experiences of illnesses and using message boards/support groups, although the largest proportion of responses in both groups was accounted for by seeking information on symptoms. Linear regression (n=167) revealed significant relationships between health anxiety and the frequency, duration and distress and anxiety associated with searching for health information online. This preliminary data suggests that searching for health information online may exacerbate health anxiety.
The ratio of subjects to variables (N/p), as a rule to calculate the sample size required in internal validity studies on measurement scales, has been recommended without any strict theoretical or empirical basis being provided. The purpose of the present study was to develop a tool to determine sample size for these studies in the field of psychiatry. First, a literature review was carried out to identify the distinctive features of psychiatric scales. Then, two simulation methods were developed to generate data according to: (1) the model for factor structure derived from the literature review and (2) a real dataset. This enabled the study of the quality of solutions obtained from principal component analysis or Exploratory Factor Analysis (EFA) on various sample sizes. Lastly, the influence of sample size on the precision of Cronbach's alpha coefficient was examined. The N/p ratio rule is not upheld by this study: short scales do not allow smaller sample size. As a rule of thumb, if one's aim is to reveal the factor structure, a minimum of 300 subjects is generally acceptable but should be increased when the number of factors within the scale is large, when EFA is used and when the number of items is small.
Sumario: This dictionary gives nontechnical definitions of statistical and methodological terms used in the social and behavioral sciences. Special attention is paid to terms that most often prevent educated general readers from understanding journal articles and books in sociology, psychology, and political science and in applied fields that build on those disciplines, such as education, policy studies, and administrative science. It does not, for the most part, directly explain how to do research or how to compute the statistics briefly described
The internet is one of a range of health information sources available to adolescents. It is recognised that young people have difficulties accessing traditional health services; in theory, the internet offers them confidential and convenient access to an unprecedented level of information about a diverse range of subjects. This could redress adolescents' state of relative health 'information poverty', compared to adults. This paper seeks to explore United Kingdom (UK) and United States (US) adolescents' perceptions and experiences of using the internet to find information about health and medicines, in the context of the other health information sources that are available to them. The study involved a series of 26 single-gender focus groups with 157 English-speaking students aged 11-19 years from the UK and the US. Many students reported that the internet was their primary general information source. Information sources were defined during analysis in terms of previous experience of the source, saliency of the available information, and credibility of the source (defined in terms of expertise, trustworthiness and empathy). Most focus group participants had extensive personal experience with the internet and some information providers therein (notably search engines). Internet health information was regarded generally as salient. Its saliency was increased through active searching and personalisation. Perceived credibility of the internet varied because expertise and trustworthiness were sometimes difficult to determine, and empathy could be facilitated through online communities but the individual could control disclosure. The internet combines positive features of traditional lay and professional, personal and impersonal sources. Although it is unlikely to supplant the role of trusted peers and adults, the internet has found an important place among adolescents' repertory of health information sources.
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