This section is a systematic literature review on applications of Internet based computer-mediated technology within youth sexual health intervention. To lend credibility to this research project, all articles will be peer-reviewed. In the vain of Randolph and Viswanath and their extensive, and arguably the most definitive, review of media use in public health Lessons Learned from Public Health Mass Media Campaigns: Marketing Health in a Crowded Media World (2004) (Randolph & Viswanath, 2004), I shall engage in a rigorous and complementary review of applications of IBCM youth sexual health education and sexual health promotional tools. In this literature review I will: Describe the field of youth sexual health and sexual health intervention; defines Internet based computer-mediated technology; describe how IBCM technology has been used to undergo and/or improve public health generally and youth sexual health specifically; identify what evidence we have to support the application of IBCM interventions in youth sexual health promotion; explain what is necessary for an IBCM intervention to successfully alter youth sexual health behaviors and improve their health outcomes; find out to what extent can we learn from the successes and failures of previous IBCM interventions; and lastly, unearth how we apply this knowledge to future youth sexual health interventions.
Youth Sexual Health
Youth are considered a high-risk group and priority in sexual health promotion and prevention. Youth here, and commonly throughout the study of sexuality, is defined as fourteen to twenty-four years of age. Sexually transmitted infection (STI) and Human immunodeficiency virus (HIV) remain a problem among youth in the United States (Rangel, Gavin, Reed, Fowler, & Lee, 2006). HIV prevalence is especially high in youth of minority groups, and epidemics of sexually transmitted HIV are gaining hold in these vulnerable populations (Eaton, et al., 2008). STIs such as chlamydia, gonorrhoea and syphilis are still prevalent in sexual and racial minority populations especially among youth (Eaton, et al., 2008).
Socio-demographic youth groups are at further disproportionate risk of poor sexual health when disenfranchised. This is true for both gay bisexual and transgender (GBT), and Heterosexual youth groups (Solorio, Milburn, Weiss, & Batterham, 2006; Tyler, 2008; Van Leeuwen, et al., 2006). Youth may not broach concerns regarding sexual health in healthcare encounters because of pressure on health service facilities, patientsÃ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ and even physiciansÃ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ reservations about raising complex and potentially sensitive topics (Gadomski, Bennett, Young, & Wissow, 2003; Merzel, et al., 2004)
In person and school based interventions are the most commonly used sexual health educational intervention strategies use to promote youth sexual health (Paul-Ebhohimhen, Poobalan, & van Teijlingen, 2008). These interventions have limited geographic reach, are usually relegated to parentally consented youth, and most often miss disenfranchised youth. Moreover, sexual health interventions can often be complex in both scope and execution. There are often a number of components to sexual health prevention programs, which often interact with one another to illicit a different response or address a specific concern, simultaneously at varying levels, toward a central goal (Agha & Van Rossem, 2004; Paul-Ebhohimhen, et al., 2008). Research of health interventions to promote youth sexual health and increase sexual health knowledge have consistently shown that simply providing information to youth does not significant elicit positive behavior change (Catalano, Gavin, & Markham, 2010; Gavin, Catalano, David-Ferdon, Gloppen, & Markham, 2010).
Moreover, the components necessary to execute a successful intervention, or educe positive behavior change, have yet to be outline and systematized in a way that would suggest potential for universality (Catalano, et al., 2010). Theory supported interventions are often reported to have higher rates of efficacy(Fishbein & Ajzen, 2005; Hagman, Clifford, & Noel, 2007), as are interventions that are customized to address the specific concerns and needs of the target population (Fisher, Cornman, Norton, & Fisher, 2006). Leveraging theory, particularly those in the social and psychological sciences, and those specific to sexuality and social behavior, has show repeated promise in strengthening the final outcome of a well developed intervention. Also important in youth sexual health promotion seems to be skills to help youth modify and improve their self-perception, often in an effort to increase self-efficacy (Ellis, Rothbart, & Posner, 2004).
Internet Based Computer-Mediated (IBCM) Interventions
The Internet and related Internet accessing technologies (i.e. cellular and computer) are more commonly providing access to sexual health information (Della, Eroglu, Bernhardt, Edgerton, & Nall, 2008; Parker & Thorson, 2008). Youth are already taking advantage of the Internet as a health information resource (Pew Research Center, 2009; Skinner, Biscope, Poland, & Goldberg, 2003). Computers are still the most effective way to access the Internet. Unfortunately most youth groups that are at a disproportionately higher risk for contracting HIV/STIs, such as marginalized minority groups, disenfranchised youth, GBT youth, and the socio-economically disadvantaged youth, also are less likely to have access to advanced Internet technology such as a computer (Everett, 2008; Pew Research Center, 2009).
However access is increasing even among marginalized populations (Pew Research Center, 2005, 2009); thus, the potential for the wide scale and rapid delivery of sexual health promoting tools to youth through internet technology increases in tandem. Unfortunately, little is known about the efficacy and effectiveness of Internet based computer-mediated interventions designed to promote sexual health. Most traditional evaluation techniques are only moderately effective at unearthing the effects, shortcomings, and potential of such a unique method of sexual health intervention delivery.
Currently unknown, it is imperative we understand what forms of Internet based computer-mediated youth sexual health interventions are most effective in addressing which specific sexual health issues and in what geographic settings.
IBCM, interactive interventions are more than just feasible, and have been effective in assisting people with chronic illness monitor and modify their behavior and has also increase adherence to medication and specific health regimens (i.e. diabetes) (Jonasson, Linne, Neovius, & Rossner, 2009; Lee, et al., 2009). Among adults, such IBCMs have lead to increased health literacy and knowledge, larger and more effective social support networks, noteworthy health behavior change, and very promising statistically significant clinical outcomes (Lau, Lau, Cheung, & Tsui, 2008; Mimiaga, et al., 2008). Youth health promoting potential for IBCM interventions have also been implemented in combating underage drinking and early alcoholism (LaBrie, et al., 2009), youth smoking cessation and prevention (Wang & Etter, 2004), and to promote nutrition and physical activity while combating early childhood obesity (Hung, et al., 2008; Maes, et al., 2008; Mauriello, Sherman, Driskell, & Prochaska, 2007).
There are also many advantages to IBCM interventions when dealing with sensitive or stigmatized topics. IBCM is often preferred over in person interventions because IBCM interventions can have a higher level of privacy, can be easily repeated, and administered at convenient times for the participant (Tomnay, Pitts, & Fairley, 2005). IBCM interventions can also be tailored to meet individual needs, offer individualized feedback, and can promote active learning through interactive elements (Bowen, Horvath, & Williams, 2007; Noar, Clark, Cole, & Lustria, 2006). Though most youth sexual health interventions and programs are not pre-evaluated by control trial before use (Haigh & Jones, 2005; McMorris, et al., 2009), qualitative evaluations of youth focused IBCM interventions in schools, neighborhoods, and healthcare settings indicate that users prefer the privacy, convenience, tailored design, and interactivity (McFarlane, Kachur, Klausner, Roland, & Cohen, 2005; Rietmeijer & McFarlane, 2009).
Need for IBCM Reviews
New Media technology such as the Internet offers great potential for youth sexual health promotion and HIV/STI prevention. There are no known systematic reviews of Internet based computer-mediated delivery for youth sexual health interventions. Though thorough reviews of youth sexual health interventions are available these reviews focus specifically on interventions that make use of in-person interaction and education by teachers, peers educators or healthcare providers (Paul-Ebhohimhen, et al., 2008; Turnbull, van Wersch, & van Schaik, 2008; Underhill, Montgomery, & Operario, 2008).
It is not known whether an Internet based computer-mediated intervention is simply another delivery system of the same youth sexual health education, or whether the Internet can provide a different locus with intrinsic experiences that operate and affect the end user in a different way than in person youth sexual health education. There may also be something intrinsically positive about in person interactions that protect for human error or lends itself to a more dynamic or adjustable intervention process. There is also the potential that Internet based interventions may cause harm. Thus, a systematic review is imperative to unearth trials of Internet based computer-mediated interventions, and to assess their efficacy and/or effectiveness.
The objectives of this literature review are to:
Determine the efficacy and/or effectiveness of Internet based computer-mediated interventions for youth sexual health promotion, while taking into consideration behavioral, cognitive, biological and economic outcomes.
Describe how IBCM technology has been used to undergo and/or improve public health generally and youth sexual health specifically.
Identify what evidence we have to support the application of IBCM interventions in youth sexual health promotion.
Explain what is necessary for an IBCM intervention to successfully alter youth sexual health behaviors and improve their health outcomes.
Find out to what extent can we learn from the successes and failures of previous IBCM interventions.
Unearth how we apply this knowledge to future youth sexual health interventions.