Understanding young singaporeans gathering and credibility assessments of online sexual health information 1a

UNDERSTANDING YOUNG SINGAPOREANS’ GATHERING AND CREDIBILITY ASSESSMENTS OF ONLINE SEXUAL HEALTH INFORMATION SITI NURHARNANI BINTE NAHAR BSocSc.Hons., National University of Singapore

UNDERSTANDING YOUNG SINGAPOREANS’

GATHERING AND CREDIBILITY ASSESSMENTS

OF ONLINE SEXUAL HEALTH INFORMATION

SITI NURHARNANI BINTE NAHAR

BSocSc.(Hons.), National University of Singapore

A THESIS SUBMITTED FOR THE DEGREE OF MASTER OF ARTS

COMMUNICATIONS AND NEW MEDIA PROGRAMME

NATIONAL UNIVERSITY OF SINGAPORE

2010

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To Ayah & Ibu,

my fellow TAs, administration and technical support ladies for being there during my occasional ranting.

I would also like to take this opportunity to thank new friends - my respondents and the Health Promotion Board for making this completion possible My respondents were not only willing to share their experiences with me; they also took the extra mile and roped in more participants And to the Health Promotion Board, I am appreciative of their assistance and support

Most importantly, I am thankful to God for giving me strength and endurance, my parents, and brother for their love, support and occasional waivers from household chores And, I would like to give special mention to

Ck who was my bastion of support with his unwavering belief, constant supply

of resources, wake-up calls, and keeping me sane

1.2.2 Profile of the Singaporean Youth

1.2.3 Sex Education in Singapore

3.2 Strengths of the Self-Confrontation Interview 47

3.4 Sampling, Selection Criteria and Actual Respondent Profiles 49

4.1.2 Convenience and speed

4.1.3 Other concomitant factors

65

66

68

70 4.2 Knowledge Structure

4.2.1 Search string permutations

4.2.2 Navigation within websites

4.2.3 Keying of web addresses

5.1 Key Findings and Recommendation to Increase Media Literacy 112

Appendix 1.1 Overview of Singapore Education Landscape

Appendix 1.2 Figures and tables extracted from IDA Annual Survey

on Infocomm usage in households and by individuals Appendix 2.1 Blurbs of 2001 to 2010 studies related to young people,

Singapore, sexual health and/or Internet Appendix 3.1 Age-group statistics according to ethnic group

Appendix 3.2 Detailed Profiles of Respondents

Appendix 3.3 Coding

Appendix 3.4 Interview Guide

Table 3.1a Variables for Maximum Variation Sampling

Table 3.1b Sampling based on gender, ethnicity and institution type

Table 3.2a Profiles of Respondents

Table 3.2b Detailed Profiles of Respondents

Table 3.3 Pre-interview questionnaire

Table 3.4 Sample of Instruction and Task List

Table 4.1 Different permutations of search strings

Table 4.2 Respondents and time spend on Internet daily

Table 4.3 Different types of websites and websites visited

Figure 1.1 Sex + Body column in Teen magazine

Figure 1.2 Question & Answer in Teen Confidential column

Figure 3.1 Overall Sampling of Study

Figure 3.2 Second screen capture which allows for matching pauses and audio Figure 4.1 Images from Google

Figure 4.2 Video from YouTube

Figure 4.3 List of protection methods grouped

Figure 4.4 List of protection methods grouped by gender

Figure 4.5 Examples of search aids

Figures 4.6 Spelling mistakes

Figure 4.7 Ali was attracted to the graphics

Figure 4.8 Ads presented within content

Figure 4.9 Ads presented within content

Figure 4.10 Pages that were possibly read instead browsed by respondents

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Abstract

There is little literature which explains how young people seek and assess online sexual health information Also, there is still a gap in understanding the part that media literacy plays when young people sieve through the myriad sources for credible information With the plethora of information online and the rise of user-generated content, this comprehension

of their manner of assessment serves to be increasingly pertinent Given this milieu, the main focus of this paper is to understand the influences and thought processes of young people in seeking sexual health information

In December 2008, the study recruited 36 Singaporeans between the ages of 17 and 21 to participate in a self-confrontation interview study, using Camtasia studio Although the interview sessions indicate that young people are equipped with basic media literacy skills, there is still a gap in youths’ information seeking Also, often, youths become absorbed in only gathering information that they do not stop to evaluate them Therefore, youths still need

to be equipped with strong knowledge structures, to be in control of their locus

in looking for information, and to continually upgrade their skills through frequent use In order to aid these youths, the school curriculum needs to move from the trend of functional media literacy to that of critical literacy

Keywords: Internet; information-seeking, media literacy; health literacy;

electronic health information; sexual health information; young people

between 17 and 21; Singapore

Chapter 1

Significance and Background

Information

Chapter One

Significance and Background Information

Traditionally, books, newspapers, magazines, television, radio, family, and friends were the main sources of information for the masses In the information age today, the Internet has dominated that role – rivalling the

aforementioned old media and bringing about tremendous change in the way

people obtain information The current youth population has not been spared from this change, and the Internet plays a big part in their lives Today, a youth is more likely to look for information using a search engine rather than visiting the library (Palfrey & Gasser, 2008) The Internet allows them to be involved in these activities under different parameters, via anonymity and simultaneity (de Kerckhove, 1995) Youths preferentially use the web as an information resource because compared to traditional media, the Internet maintains a 24–hour presence, allows for private browsing while still receiving current information, and boasts fast search capabilities (Pierce, 2007; Stern & Willis, 2007; Suzuki & Calzo, 2004)

As for Singaporean youths, recent newspaper articles suggest that one use of the Internet is to retrieve information on sex-related topics They also use blogs to pen their sexual adventures, share sex tips on various forums, and engage in cyber-sex using various online communication applications such as Instant Messaging (Shuli, 2008; Teo, 2008; Toh, 2007) This is a trend that requires greater attention because in the absence of sufficient and accurate sex information, youths have been found to depend greatly on the media for such information and guidance (Strasburger, 2005; Weimann, 2000)

As for the content available on the Internet, studies show an increased delivery of sexual and reproductive health promotion information, and this is due to sexuality and reproductive health education efforts They aim to provide individuals with information, motivation, and behavioural skills that will enable individuals to avoid sexual and reproductive health problems and achieve well-being in this area (Barak & Fisher, 2001; 2003; Fisher & Fisher, 1992; 1999) There are also websites which are commercially-driven, and other websites which are uploaded by private individuals

Despite the motives behind these efforts, the plethora of information online has resulted in a cause for concern about quality of the information online Participatory Web gives rise to a complication, which relates to information quality One of the big changes wrought by the use of the Internet

is the way in which individuals can easily create and consume information and knowledge With a lack of universal standards for posting information, online information may be easily modified, plagiarised, misrepresented, or even created under false pretences (Fritch & Cromwell, 2002; Johnson & Kaye, 2002; Metzger, Flanagin, Eyal, Lemus, & McCann, 2003; Rieh, 2002) Information quality issues are neither Internet-specific nor new to the digital age, however, the availability of user-generated content has made it more difficult to distinguish accurate and inaccurate information However, there are concerns about the challenges that youths are facing, having to grow up surrounded by numerous information sources that allow anyone become an author or an editor (Palfrey & Gasser, 2008; Metzger, 2007)

In relation to the Singapore context, this lack of gate-keeping is worrying as 91% of Singaporeans who receive information from the Internet

have taken action in response to the information gathered (Siow et al., 2003) Also, 45% of Singaporean Internet surfers of health content consider online health information trustworthy if the information is from a professional source

or if the website displays the source, while 10% trust the information if it concurs with the doctor’s advice (Siow et al., 2003)

Currently there is a gap in literature pertaining to youths’ assessment of health information online; with only several studies conducting research in this area (eg Metzger, 2007; Rieh & Hilligoss, 2008) Firstly, this is because

extant research has primarily been about information searching where

researchers examine the kind of information respondents acquire and learn (Chelton & Cool, 2007; Chelton & Cool, 2004 as cited in Chelton & Cool,

2007) It is only in recent years that studies have shifted towards information

seeking in a bid to explain how respondents look for information (Chelton &

Cool, 2007; Chelton & Cool, 2004 as cited in Chelton & Cool, 2007) Next, despite the growing body of literature on the Internet and healthcare, with the exception of research on college students, there are few empirical studies of youths' usage of the Internet for health information, and even fewer concerning sexuality issues (Gray & Klein, 2006) There is also limited research on how youths learn about sexuality from the media (Strasburger, Wilson, & Jordon, 2009) The literature gap in youths’ usage of sexual health information exists as the sensitivity of the issue has resulted in such literature being skewed towards situating adults and college students as the subjects of research In the case of Singapore, prior studies of the situation have found that 27% of young Singaporeans aged 13 to 19 and 37% of those aged 20 to

29 use the Internet to look for health information (Siow et al., 2003) Of such

Internet surfers aged 13 to 55, 25% choose the Internet as the second top preferred source (Siow et al., 2003) Notwithstanding the value of Siow’s study, there is still a lack of qualitative and quantitative academic research on Singaporean youths’ usage of the Internet to search for sexual information

This thesis seeks to fill the aforementioned gaps and to contribute to research on Internet studies pertaining to youths Given that a high percentage of Singaporeans take action from the health information which they gather, the findings from this paper will be significant as it will enable better understanding of youths’ concerns in seeking sexual health information With this understanding, steps can then be taken to better tailor future literacy programs

1.1 Objectives of Study

The thesis seeks to examine young Singaporeans’ thought processes,

and cater to their competency levels to understand the selection of online information in their exploration of sexual health topics It concerns itself with youths’ evaluations of the multitude of information online by studying the factors that influence their information search It also will explore how youths assess the credibility of online sexual health information

The thesis will focus specifically on young people between 17 and 21 years old It mainly seeks to capture information seeking among youths who have just completed their education in secondary schools to those attending universities There are several reasons why this age-group is chosen Firstly,

it is interesting to study the digital natives who assert that they are web experts (Livingstone, 2007) Next, a high percentage has Internet access -

83% of Singaporeans aged between 15 and 30 access the Internet at any location (IDA, 2007) Also, this age group is significant as it is a developmental phase manifested by identity formation, increased independence, peer influence, sexual coming-of-age and risk-taking behaviour (Donovan & Jesser, 1985; Strasburger, Wilson, & Jordon, 2009) Moreover, there is little research done on this age group as a result of inherent problems in doing research on youths’ knowledge, attitudes and behaviour toward sexual media content and sexuality (Gray & Klein, 2006; Wartella, Scantlin, Kotler, & Donnerstein, 2000) Previously, the main barrier was youths’ concerns about confidentiality Therefore, past studies on youths were mainly conducted on university students For this reason, this paper aims to fill the literature gap by examining a slightly younger age group

1.2 Background Information

In this section, the paper will define young people, provide their background information, as well as present their behavioural traits In considering youths’ information seeking behaviour, it is also imperative that

we understand what it means to be a Singapore youth Therefore, the paper will present a profile of young Singaporeans An understanding of their educational, technological, social, familial, sexual backgrounds will better contextualise our understanding of their media engagement

1.2.1 Defining Youths

In this paper, young people, young adults, and youths will be used

interchangeably as they are common terms used to denote the group of

people who are caught between childhood and adulthood The United Nations

1985 General Assembly defines the term youth as “those persons falling

between the ages of 15 and 24 years inclusive” (United Nations, 2007) Youth

is a “demographic concept that has both biological and sociological aspects (Atal, 2005, p.10).” However, sociologically it is a category, not a group; and a category may consist of several groups This is because although categorically, this concept is represented by certain biological attributes, with the roles and expectations associated with it differing from culture to culture (Atal, 2005) During this period, relationships and peer culture also take on important roles in explaining youths’ choices (Wolfe, Jafee & Crooks., 2006)

In addition, the media plays an integral part in young people’s communication, general knowledge, comprehension of the world and relation to other people (Kenway & Bullen, 2001)

In coping with transition into adulthood, youths inevitably experiment in risky behaviours Risky behaviours, relating to substance use, sexual activity and extreme sports activities occur when youths with limited or no experience engage in behaviours in anticipation of benefits without comprehending the immediate or long-term consequences of their actions (Irwin & Millstein,

1992) Conducting risky activities may be a function of adolescent

egocentrism – these youths think that they are unique and that misfortunes

will happen to someone else, not them (Strasburger, Wilson & Jordon, 2009)

1.2.2 Profile of the Singaporean Youth

Termed as “the parents, decision-makers, business people and leaders

of tomorrow [n.p.]” (National Youth Council, 2006), young people in Singapore

are invaluable to a nation that depends on human capital as its main resource As at the end of June 2007, young Singaporeans between the ages

of 15 and 24 constituted 475,000 out of the country’s 3.58 million citizens (Singapore Department of Statistics, 2008) Youths in Singapore are well-learned, highly connected to the Internet, and participate in offline and online activities These associations to Singaporean youths will be elaborated in the following sections

Firstly, on the issue of education, Singapore passed the Compulsory Education Act in 2000, and it states that “a child of compulsory school age is one who is above the age of 6 years and who has not yet attained the age of

15 years” (Ministry of Education, 2008) An overview of the 2010 Singapore education landscape is available in Appendix 1.1 The overview illustrates that students in Singapore would have obtained a satisfactory level of education

Next, being “the most wired nation” with a household broadband penetration rate of 99.9% as of December 2008, the use of the Internet in Singapore is close to saturation (Tan, 2009) The Ministry of Education (MOE) promotes ICT use in schools by providing network infrastructure, hardware, and curricular support In schools, using ICT is integrated into 30% of curriculum period through its use in lessons, online learning portals, and educational games (Koh, 2007) Therefore, with regards to youths’ media consumption, this means that it is fairly common for Singaporean students, even at primary schools, to research, prepare, and even submit homework using the Internet In fact, the 2008 annual survey on households’ infocommunications usage shows that among Singaporean youths aged 15 to

24, 99% have access to computers at any location and 98% are Internet

users (IDA, 2009) 78% of the youths use the Internet at least once a day (IDA, 2009) Their top three uses of the Internet are for communication,

leisure activities and getting information (IDA, 2009) Getting information is

one of the top three Internet activities carried out by youths between ages 15

to 29 years old (IDA, 2007) Research from the World Internet Project (2009) findings indicate that 73% of Internet users in Singapore aged 18 and older

consider the Internet to be an important / very important source for information, and 79% use the Internet several times a day / daily / weekly to

get information for school related work The full figures and tables are available at Appendices 1.2a, b, c and d Hence, with the basic IT knowledge learnt from schools, and daily Internet usage, the youths would have sufficient media literacy to gather information online

Similar to youths in other countries, youths in Singapore dabble in many activities during this transition period These activities may include those which put them at risk In Singapore, at-risk youths refer to “those who have been subject to a combination of interrelated biological, psychological, and social factors that result in greater likelihood for the development of delinquency, substance abuse, or other related anti-social and self-destructive behaviours” (Inter-Ministry Committee on Youth Crime, 2002, p 5) In particular, the next paragraphs look at risks related to sex as youths who engage in risky sexual behaviour may be vulnerable to sexually transmitted diseases, unwanted pregnancies, and dangers of unsafe abortions (United Nations World Youth Report, 2007)

With regards to legal statutes relating to sex, the minimum legal age for (a) engaging in sexual intercourse and (b) watching movies categorised as

Restricted Artistic R(A) are 16 and 21 years of age respectively (National Youth Council, 2006) However, past studies show that (a) the average age that Singaporeans initiate sexual activities is between 14 to 15 years, (b) the first sex encounter is 18.9 years, and (c) a Singaporean youth has an average

of 5.8 sex partners (Durex, 2005; Fei Yue, 2002, as cited in A to Z Guide on Singapore Youth) 30% know their friends are having sex, 40% have half or less than half of their friends believe in abstinence from pre-marital sex, 60% have several, if not many friends, who hold permissive values towards pre-marital sex (Fei Yue, 2002, as cited in A to Z Guide on Singapore Youth) For

the 52% of youths who view pre-marital sex as being acceptable, being

curious, satisfy desire, and love are the three cited reasons for having

pre-marital sexual intercourse (Fei Yue, 2002, as cited in A to Z Guide on Singapore Youth) Despite the relatively high number of youths who are for pre-marital sex, 48% Singaporean youths view pre-marital sex as unacceptable even when two people love each other (Fei Yue, 2002, as cited

in A to Z Guide on Singapore Youth) Most students, especially females, say that they are able to resist pressures or temptations when they encounter situations where they are pressured or tempted to having sex (Fei Yue, 2002,

as cited in A to Z Guide on Singapore Youth) These pro-abstinence youths explain the top reasons with which they uphold their stand: (a) getting HIV/AIDS and other sexually-transmitted diseases, (b) becoming pregnant and (c) losing self-respect (Durex, 2004)

In recent years, there has been increasing public concern in Singapore over “teenage pregnancies, abortions, HIV infection, abandonment of babies

by teenage parents, [and] sexual abuse of children” (Ministry of Education,

2000) Teenage pregnancies and the higher rates of STIs indicate that some youths are sexually active and are having unprotected sex (Ministry of Education, 2009) With regards to safe sex practices, 74% of young Singaporeans display relatively high awareness of them by indicating that the condom is the most effective method of preventing sexually transmitted diseases (Chuah, 2007) However, only 36% say that they use contraceptives all the time Statistics show an increase in the number of HIV infected Singaporeans between ages 10 to 19 and 20 to 29 years old from 2006 to

2008 (Ministry of Health, 2009) Specifically among teens, the number cases

of sexually transmitted infections have increased by 250 per cent from 2002 to

2008 and the number of HIV cases has grown from 1 in 2002 to 9 in 2007 (Ministry of Education, 2009) Such statistics suggest that a small but significant minority of Singaporean youths are not well informed about sex, contraception and sexually transmitted diseases

Lastly, with regards to personal influence, inexperienced youths require support and advice in making decisions The National Youth Council reports that there are “moderately strong relationships between youth and their families”, since young Singaporeans generally indicate a positive perception

of support from their family For advice on important decisions, youths turn to their mothers (75%), followed by their friends (65%), fathers (57%) and siblings (39%) (National Youth Survey, 2002 as cited in A to Z Guide on Singapore Youth) Youths seldom confide their problems to teachers (National Youth Survey, 2002 as cited in A to Z Guide on Singapore Youth) Despite the fact that parents are deemed important by youths, more youths turn to their peers for social support; 79% and 70% indicate that they will turn

to their friends and mothers respectively for emotional support (National Youth Survey, 2002 as cited in A to Z Guide on Singapore Youth) This is because only few young people have family members paying attention to their problems and noticing their achievements (National Youth Survey, 2002 as cited in A to Z Guide on Singapore Youth) Therefore, in the event that youths have concerns, 25% indicate that they would choose to act on the concerns themselves, and 28% would ask friends for assistance (National Youth Survey, 2002 as cited in A to Z Guide on Singapore Youth)

In the next section, the chapter will provide a short introduction on the sex education landscape and present the sex-related information that is made available to Singaporean youths if they choose to seek them

1.2.3 Sex Education in Singapore

Sex education was initiated in the late nineteenth and early twentieth century by the social hygiene movements in the United States Early education centred on information about venereal diseases and its prevention (Irvine, 1995) Past literature showed various models of school-based sex education programs and curricula The two broad types are comprehensive programs and abstinence-only programs In the first school of thought, the conservative models of sex education maintained that for adolescents, refraining from sex is the only safe and moral choice (Gilbert, 2004) This program is largely influenced by religious groups; for instance the Christian Right group likened talking about sex in the classroom to emotional molestation (Irvine, 2002) where the language is said to provoke and infect the listeners The model equates talking about sex with a form of violation on

the listener in which the students who hear an invasive vocabulary will catch

the disease of sexual desire Gilbert (2004) argues that this rhetoric of

protection serves to expand the silence surrounding sexuality in schools The second school of thought argues that sex topics should not be taboo because they are neither provocative nor encourage or promote sex or sexual identities (Gilbert, 2004) The main objective of this model is to be comprehensive by offering young people access to information on sex Therefore the difference lies in the fact that while conservative educators withhold information, comprehensive sex education supporters argue that access to information about sexuality will offer young people the tools to be able to refuse sex However, several authors criticise both models for the pathologisation of sexuality and the rejection of youths’ sexual rights (Britzman, 1998; Patton, 1996)

The content and delivery of sex education vary among different countries and education systems This is due to the sensitive nature of the subject matter which touches on fundamental values and religious beliefs Sex education in Singapore was initially a part of the cross-discipline curriculum It was covered in the Health Education lesson in Upper Primary levels; the Science, Civics and Moral Education, and Pastoral Care curriculum

in secondary schools and junior colleges Schools also invited external organisations such as the Ministry of Health, family service centres, the Singapore Planned Parenthood Association among others, to conduct talks and seminars for students In 1992, the Ministry of Education also developed

some general guidelines to teach human sexuality in secondary schools

However, it was only in 2000 that the framework for sex education was

developed and circulated to all schools The framework sets the objectives, main themes and principles for the design and delivery of sex education in schools The four main themes covered are (i) human development, (ii) interpersonal relationships, (iii) sexual health and behaviour, and, (iv) society and culture (MOE, 2007) Sex education in Singapore comprises four dimensions in shaping a person’s sexuality; physical, emotional, social and ethical The physical aspect refers to sexual maturation, physiology of sex and human reproduction The emotional aspect relates to sexual attitudes and feelings towards self and others The social aspect pertains to sexual norms and behaviour and legal, cultural and societal implications while the ethical aspect looks at the sexual values and moral systems (MOE, 2007)

Besides receiving sex education in schools, 52% of the Singaporean respondents indicate that parents/guardians should be the ones teaching sex education, followed by schools (32%) (Durex, 2005) 47% of the respondents suggest that the government should focus on sex education in schools, 21% educational initiatives, 14% contraception, and 11% via advertising campaigns (Durex, 2005) Other than dissemination of sex education in school, the study identifies the local media

as a source of sexual health dissemination For instance, print media such as local youth magazines and newspapers provide advice on sexuality issues

Figure 1.1 Sex + Body Column in Teen magazine

Figure 1.1 shows a Sex + Body column in the Teens magazine (Sex +

Body, Teens, 2006, p.110), which allows youths to ask questions

anonymously It is not stated whether experts are responding to the queries It provides contact numbers of counselling organisations in the article Figure 1.2 shows the response by a professional counsellor on sex issues faced by a

youth as an example of a weekly feature in the Gen Y section of the Sunday

Times under the Teen Confidential column (Teen Confidential, Sunday Times,

2007, p.43)

Figure 1.2 Question & Answer in Teen Confidential column

Currently there are no specific programs on local broadcast television which provide sexual health information for youths Nonetheless, a local

English-speaking current affairs program, Get Rea!, was aired with several

episodes relating to Singaporean teens’ experiences including teenage pregnancy premarital sex

Singapore’s Health Promotion Board (HPB) launched the HPB online in

2001 to disseminate health messages that are verified by healthcare professionals (Vijaya et al, 2006) HPB Online integrates multimedia into the published information – by using text, pictures, sounds and video clips (Vijaya

et al, 2006) HPB also sets up the Let’s talk about sex website for men,

women, couples and parents, which covers sexual issues and concerns such

as understanding one’s body, sexually transmitted infections, sexual relationships and imparting useful sexual information to youths (Let’s Talk about sex, 2009) The Youth Health Division of the Health Promotion Board plans a variety of health promotion initiatives that covers a range of pertinent health issues such as smoking control, mental wellness, STI/AIDS prevention, nutrition, physical activity promotion and obesity prevention The objectives are to create a health-promoting environment for the young and to equip them with the required knowledge and skills to lead healthy lifestyles (Wong & Chew, 2007)

In 2005, the Health Promotion Board launched the Youth Advolution for Health (YAH) program (Wong & Chew, 2007) YAH is a peer-led program, with an executive committee comprising of youth leaders from tertiary institutions which sets the directions and plans different initiatives for their peers The HPB plays an advisory role and supports the youths in the planning and implementation of their projects (Wong & Chew, 2007) Yah.sg includes a blog where youths can access and share their thoughts and views about various health issues (Youth Advolution for Health, 2009) Examples of youth projects are the Audible Hearts project and StompAIDS The former is a confidential online platform for young people to reveal and talk about common issues of growing up (e.g relationships with families and friends, school life, career choices) with their peers (AudibleHearts, 2007) The StompAIDS project aims to raise awareness of the causes, consequences and prevention

of HIV/AIDS as well as to dispel common misconceptions of the disease among youths (StompAIDS, 2007) HPB also develops youth-centric

Multimedia Services (MMS) downloads which carry health messages to encourage them to adopt positive health behaviours to be forwarded to peers (Wong & Chew, 2007)

While Singaporean youths may receive information on sex through official channels, a significant question to ask is, whether they do so Otherwise, are the Singaporean youths equipped to sieve through the myriad

of sexual health information online via the unofficial channels This is pertinent

as earlier statistics suggest that a significant minority of Singaporean youths still remain ignorant about sex, contraception and sexually transmitted diseases

1.3 Sequence of Presentation

This chapter has provided a general overview of the orientation, objectives and significance of this study It has also defined youths and identified their salient behavioural traits, reviewed sex education initiatives and its imperatives in Singapore, and presented a profile of Singaporean youths in terms of statistics, values and concerns To position the paper in the relevant academic context, Chapter Two will review the theoretical and empirical literature which frames this study Specifically, the chapter is concerned with examining literature on information seeking, credibility and literacy It will explain the analytical framework which will be applied Chapter Three will explain the methodology used in the study Chapter Four will provide an overview of the research findings It is assessed according to the coding frame designed for video recording and interview scripts It analyses the research findings and highlights the prominent choices made by youths in

their decision-making Chapter Five is the concluding chapter which will provide a detailed summary of the study, including a recapitulation of the research questions, findings and analysis It will reflect on the limitations of the study and how it could have been improved, thereby also suggesting directions for future research and development

1.4 Conclusion

Being citizens of the “most wired nation” (Tan, 2009), Singaporeans are highly connected to cyberspace With the plethora of information online and the rise of user-generated content, assessment on the credibility of information serves to be increasingly pertinent This thesis contributes to research on the Internet by examining how young Singaporeans between the ages of 17 and 21 use the Internet to seek information on sexual health This study reveals the different stages of influence and thought processes of youths’ seeking sexual health information, the challenges that youths face in seeking information and the importance of media literacy

Chapter 2Literature Review

Chapter Two – Literature Review

Chapter Two

Literature Review

Existing literature shows that youths turn to various channels for sexual health information Peers and social perceptions play more important roles in influencing youths’ decisions about safe sex practices, compared to clinicians

or authoritative information resources (Zwane, Mngadi & Nxumalo, 2004) Also, as the mass media – television, newspapers, magazines, radio, and the Internet – permeates the lives of youths, it is inevitably used to gather information and gradually plays an important role in imparting information

In particular, studies show that youths are “major users and early adopters of the Internet [p.519]” and that they use the Internet for a broad array of information, ranging from entertainment and shopping to academic and health-related topics respectively (Borzekowski, 2006) Accordingly, sexual health is one of the most common health topics that youths seek information online (Borzekowski & Rickert, 2001; Baxter, Egbert & Ho, 2008) However, the nature of the Internet has resulted in a world saturated with information; and this factor among others, has made information seeking difficult

This chapter will discuss in greater depth the nature of the Internet and describe the information seeking process It will explain why sieving through the myriad of online information has become an onerous task and the various problems that occur in youths’ information seeking online In view of the difficulty that young people face in seeking information using the Internet, it becomes pertinent for them to have media literacy The chapter will also review extant literature on information seeking online, paying special attention

Chapter Two – Literature Review

to the context of health and sexual health Finally, the chapter will introduce the study’s research questions which will seek to fill the gap in existing literature

2.1 Nature of the Internet

The Internet has become an important source for individuals to seek

information With its fast search capabilities and 24–hour availability, the Internet has become a useful alternative to traditional media (Stern & Willis, 2007; Suzuki & Calzo, 2004) The Internet is particularly popular as it contains content that “fulfil[s] nearly every want and need” of most youths (Stern & Willis, 2007)

Yes, the advent of the Internet has endowed us with vast information access at the click of the mouse Yet, at the same time, this convenience results in information overload and the emergence of several concomitant factors

Firstly, the problem of quality control occurs as it is easy for any individual to post information online This ease has resulted in an overwhelming amount of information online which makes it difficult to decide what information is valid and important In the past, the high cost of information production and dissemination limited content provision to those with sufficient authority and capital (Metzger, 2007) While previously the limited number of content providers resulted in lower quantity of content, the likelihood of their being quality information providers was higher

Next, the task to differentiate between various messages is no longer

an easy one with the blurring of different genres today For example, news

Chapter Two – Literature Review

shows use the entertainment formula, thereby providing less information and more entertainment while advertisements look more like information (Potter, 2004) In addition, information is often presented with greater brevity and in

‘sound bite’ form, and therefore there is a greater need to contextualize the information in order to understand it

Decoupling of information from online authors can be a difficult task as the nature of the Internet makes it possible for authors to remain anonymous Their intentions are also often unknown (Metzger, 2007; Potter, 2004)

Also, the idea of credibility and the web is recently getting more attention in academia because it is recognised that web credibility must be differentiated from other forms of credibility because its characteristics These include factors such as speed, multifarious attributes and links, need for referencing and organizational conventions which makes it impractical to be assessed conventionally, absence of gate keeping mechanism, the uncertainty of sources, and the lack of evaluation standards (Burbeles, 2001; Danielson, 2005; Taraborelli, 2008)

Therefore, despite the ease in gathering information, the aforementioned nature of the Internet has made it difficult for individuals to seek information online

2.2 Information Seeking

To understand the information seeking process and the role of media literacy in information seeking, the paper looks at works on information seeking and media literacy as underlying conceptual frameworks

Chapter Two – Literature Review

Past studies demonstrate the need to have literacy in processing the myriad of online information Individuals require various knowledge and competencies – textual understanding, visual and aural discernment, ICT skills, critical analysis and more This movement for literacy has gained more urgency as it has become increasingly difficult to determine the sources of the information (Martin, 2006) Literacy is also identified as a necessary remedy for the earlier-mentioned information overload problem (Potter, 2004) Specifically, media literacy can be defined as a “set of perspectives from which we expose ourselves to the media and interpret the meaning of the messages we encounter” (p 58, Potter, 2004) Riddell (2008) says that when equipped with media literacy, individuals are able to plough through the massive storehouses of information and to distinguish between true and false information This ability to differentiate between true and false information refers to the idea of credibility which is believability of some information and/or its source (Hovland, Janis, & Kelley, 1953)

Context is also central to information seeking (Case, 2002; 2007) Users’ concerns for information credibility therefore vary according to the perceived consequence of information use (Rieh & Hilligoss, 2008) Credibility is less pertinent for online entertainment information than for other kinds of online information (Flanagin & Metzger, 2000) Concerns increase when it involves personal information needs such as health and finances (Rieh & Hilligoss, 2008) For example, compared to product or travel search tasks, users are more concerned with credibility and authority for health-related information seeking (Rieh, 2002)

Chapter Two – Literature Review

In addition, in seeking information with specific concerns such as

health, having health literacy is important Health literacy refers to “the degree

to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions” (p 6, Ratzan & Parker, 2000) It is required when someone seeks information via various media to know more about an illness affecting them or their family members From the gathering of information, they start asking questions relating to the content they encounter, as well as its validity (Rosen, 2007) Traditionally, studies show three problems of health literacy: (1) problems in understanding simple self-care directions or prescription instructions, (2) fear of taking medications without assistance, and (3) unfamiliarity or lack of understanding of basic health care terms (Norman & Skinner, 2006) This shows that it is required for individuals to know relevant health terms and to be able to situate health information within the appropriate context to be able to make appropriate health decisions With the lack of such skills, it may be difficult for a person to follow directions or to engage in essential appropriate self-care activities (Ratzan & Parker, 2000)

In this information age, seeking health information differs comparatively from the past New information and communication technologies, particularly the Internet, are seen as beneficial to assist in health or health care (Eng, 2001) However, health educators see a need for young people to have media literacy before they can actually be health-literate They need to have the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health issue (Norman & Skinner, 2006)

Chapter Two – Literature Review

Having online literacy is more pertinent because of three factors: (1) the topic is health-related as the need for quality and credibility is more crucial, (2) individuals lack skills in assessing the accuracy of online information and depend on indirect cues, and (3) there is difficulty in balancing the number of pro-health messages with negative and harmful messages in the mediascape (Freeman & Spyridakis, 2004; Rieh & Danielson, 2007) Also, past literature indicates that while seeking health information may be popular, the activity is not necessarily frequent among most people unless they have chronic diseases (Eysenbach, 2008) The implication of this usage pattern of health information is that people may have inadequate experience and competence with health Web sites as they are generally not used on a day-to-day basis (Eysenbach, 2008) Given that health and medical questions arise infrequently, people do not necessarily have a trusted brand name or portal in their mind as they begin a search Thus, whereas people may be savvy and experienced enough to evaluate the credibility of general news Web sites or e-commerce sites (Eysenbach, 2008), the case differs for health information sites

Media literacy is also an essential element as it controls credibility judgments (Rieh & Hilligoss, 2008) One of the primary markers for judging the quality of Internet-based health information is source credibility (Tu & Hargraves, 2003) A source is considered more credible if it comes from a recognized expert who keeps information current, and who has no competing interests in providing the information This is opposed to a non-expert source that provides outdated information, or that has commercial interests in providing the information (Bates et al., 2006)

Chapter Two – Literature Review

Although the Internet is perceived as a major source of low-quality information; the problem of health credibility assessment is not unique to the Internet because inaccurate information is also present in other media (Eysenbach et al, 2002) Also, Internet self efficacy partially mediates (1) the relationship between individuals’ experience with using the Web and their attitude to the quality of health information available online and (2) the relationship between individuals’ desire to be informed about their health and being involved in medical decisions, and their attitude towards information quality (Rains, 2008) For individuals, these factors make it difficult to seek information, and it is therefore essential to have the required skills to plough through the online content

Another factor for consideration in information seeking is that it is sometimes conducted for other individuals This information sought could directly/indirectly impact other people Therefore, in these cases, as one respondent said, “when other people are involved, and other people are going

to use the information, you definitely need to have good sources of credibility” (Rieh & Hilligoss, 2008)

Overall, in information seeking, the way individuals gather information

is a result of a continuous process of learning; that is, individuals start strengthening their media literacy The strength of individuals’ overall perspective on media determines the various points at which individuals are placed along the continuum (Potter, 2004) In the following section, the paper will provide literature on individuals seeking information and detail out the problems they encountered while seeking information online To understand where individuals are placed along this continuum, the chapter will look at

Chapter Two – Literature Review

three crucial factors: (1) personal locus, (2) knowledge structures and (3) skills used in information seeking These factors serve as building blocks in Potter’s media literacy (2004; 2008) The accumulative strength of these factors will determine how one carries out information seeking

2.2.1 Personal Locus

Information seeking is a conscious undertaking to receive information Individuals carry out information seeking to respond to an information need or knowledge gap which appears when they identify that their knowledge is insufficient to satisfy their goals (Case, 2007) Goals may be long-term, leading or current search goals A long term goal refers to a personal goal to

be achieved over a long period of time, a leading search goal is a current information task-related goal, and a current search goal involves a specific search There can also be sub goals achieved, which refer to interactive intentions while seeking information results

Several authors emphasised the importance of personal locus,

comprising goals and drives, in information seeking (Case, 2007; Potter, 2004; 2008; Rieh & Hilligoss, 2008) They explain that it motivates individuals

to be involved in related activities, and administer the processing tasks (Case, 2007; Rieh & Hilligoss, 2008) An individual who takes notice of his locus is better able to control the process of acquiring and using information When his locus is weak, he can be subjected to media control; that is, the media may exercise great control over his exposures and information processing (Potter, 2008) Hence, when he understands more about this locus and take steps to shape it; he can better control the process