This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
There is a growing trend for individuals to seek health information from online sources. Alcohol and other drug (AOD) use is a significant health problem worldwide, but access and use of AOD websites is poorly understood.
To investigate content and functionality preferences for AOD and other health websites.
An anonymous online survey examined general Internet and AOD-specific usage and search behaviors, valued features of AOD and health-related websites (general and interactive website features), indicators of website trustworthiness, valued AOD website tools or functions, and treatment modality preferences.
Surveys were obtained from 1214 drug (
Significant deficiencies in the provision of accessible information on AOD websites were identified, an important problem since information seeking was the most common reason for accessing these websites, and, therefore, may be a key avenue for engaging website users in behaviour change. The few differences between AOD website users suggested that both types of websites may have similar features, although alcohol website users may more readily be engaged in screening, prevention and self-help programs, tracking change, and may value fact sheets more highly. While the sociodemographic differences require replication and clarification, these differences support the notion that the design and features of AOD websites should target specific audiences to have maximal impact.
It is estimated that over a quarter of the world’s population use the Internet [
While there is a growing trend to use the Internet to deliver alcohol and other drug (AOD) information and resources, little is known as to how best engage “at-risk” populations, such as young people, or how to optimize its access and utilization. Given the appeal of the Internet to young people [
Much of the published literature concerning online AOD interventions is descriptive [
In relation to the reasons for use of online AOD resources and materials, out-of-hours availability has been found to be important [
Research into how people search and engage with health websites suggests that the typical user explores only the first few links on a search engine and assesses website credibility by the source of the information cited on the Web page and the professionalism of the website program design [
The way in which the information is presented can mediate the duration and frequency of visits to a website. For example, the website itself, along with the navigation configuration, needs to be attractive and easy to use [
While general Internet health access and usage is an important starting point for AOD website design, currently there is a lack of information on users’ knowledge, experience, and opinions of AOD websites. There is a need to gain an understanding of site users’ preferences and perceived gaps or deficiencies of existing sites if this medium is to be of optimal value as an AOD health promotion, prevention, and intervention tool. The aim of the current study was to address this gap in the existing research and investigate the experiences of AOD website users and their views about the content, functionality, and utility of these websites.
An open-access online survey was developed to examine Internet use and opinions of AOD and health-related websites. The current paper focuses on results relating to AOD websites only.
Initial development of the survey involved face-to-face, teleconference, and email discussion between members of the research team in order to formulate the themes and specific questions. The draft survey was submitted to the project advisory group, consisting of government and nongovernment AOD, youth, and primary care representatives, for review and comment. The final survey explored the following themes:
General Internet usage
AOD website Internet usage and search behaviours
Most-visited AOD websites
General website features
Interactive website features
Judging website trustworthiness
Preferences regarding AOD websites tools and functions
Preferences for AOD online treatment modalities and support
The survey was pilot tested online (via Survey Monkey) by members of the research team and several independent community members. Usability and functionality were improved prior to online administration.
Adaptive questioning features were employed to avoid survey respondents having to answer unnecessary questions. The presented questions, therefore, depended on answers to prior questions (eg, if respondents had never visited an AOD website, they were not asked further questions about theses websites). There were no more than four questions to a Web page (averaging two questions per page), spanning a potential 84 Web pages. Although there were 188 questions in the total survey, the adaptive questioning procedures meant that the maximum number of questions presented to a respondent was 118. All questions were forced choice, that is, to proceed to the next Web page, all responses to all questions on the preceding page were required. As there was no “back” button offered, respondents could not change answers on previous Web pages. Survey Monkey captured question responses automatically and placed them into an electronic database (Excel) that could only be accessed by the account creator.
The survey was voluntary, anonymous, and took 10 to 15 minutes to complete. Upon entry to the survey home Web page, respondents were provided with an explanatory statement outlining the study (eg, purpose of the study, funding source, name of the chief investigator, length of survey, data storage, and ethics committee approval) and were asked to provide online informed consent prior to accessing the survey questions. Respondents were also offered the chance to enter a draw to win an 8GB iPod Nano for completing the survey if they provided their name and an email address. Respondents were informed that identifying information would be stored separately from their survey data. Survey data was collected in a one-month time frame (March-April 2009). Ethics approval was obtained from the Queensland University of Technology Human Ethics Research Committee.
The survey and Web link was advertised via Facebook, AOD and health-related websites, and a range of industry, consumer, and tertiary institutional email lists. A copy of the survey announcement can be found in
To be eligible to participate, respondents were required to be an Australian resident and at least 16 years old. (Ages of respondents ranged from 16 to 70 years.) Of the 3313 people who accessed the survey, 305 were excluded for the following reasons: discontinuation at the information statement (n
Percentages and n values for gender, education, relationship status, employment status, English as a first language, and age of drug website users and alcohol website users
Demographic Variable | Type of Website Accessed | |||||||
Drug Website Users | Alcohol Website Users | |||||||
% | n | % | n | % | N | |||
|
||||||||
Male | 35 | 193 | 32.4 | 108 | 34 | 301 | ||
Female | 65 | 359 | 67.6 | 225 | 66 | 584 | ||
|
91.5 | 505 | 92.2 | 307 | 91.8 | 812 | ||
|
||||||||
None | 7.8 | 43 | 6.3 | 21 | 7.2 | 64 | ||
Apprenticeship/trade | 1.6 | 9 | 1.5 | 5 | 1.6 | 14 | ||
Other certificate | 3.1 | 17 | 3.9 | 13 | 3.4 | 30 | ||
Diploma | 5.3 | 29 | 3.6 | 12 | 4.6 | 41 | ||
Current undergraduate | 57.8 | 319 | 59.6 | 198 | 58.5 | 517 | ||
Completed undergraduate | 12.7 | 70 | 11.7 | 39 | 12.3 | 109 | ||
Current postgraduate | 1.3 | 7 | 0.9 | 3 | 1.1 | 10 | ||
Completed postgraduate | 10.1 | 56 | 12.3 | 41 | 11.0 | 97 | ||
Other | 0.4 | 2 | 0 | 0 | 0.2 | 2 | ||
|
||||||||
Single | 46.4 | 225 | 49.1 | 163 | 47.4 | 418 | ||
Married/cohabitating with partner | 28.4 | 156 | 26.2 | 87 | 27.6 | 243 | ||
In relationship, not cohabitating | 23.3 | 128 | 22.9 | 76 | 23.1 | 204 | ||
Divorced/separated and single | 1.8 | 10 | 1.8 | 6 | 1.8 | 16 | ||
Widowed and single | 0.2 | 1 | 0 | 0 | 0.1 | 1 | ||
|
||||||||
Employed full-time | 18.3 | 101 | 20.8 | 69 | 19.3 | 170 | ||
Employed part-time/casual | 53 | 292 | 52.1 | 173 | 52.7 | 465 | ||
Home duties | 2.4 | 13 | 2.4 | 8 | 2.4 | 21 | ||
Disability support | 0.4 | 2 | 0.6 | 2 | 0.5 | 4 | ||
Unemployed | 12 | 66 | 10.2 | 34 | 11.3 | 100 | ||
Retired | 0.2 | 1 | 0.6 | 2 | 0.3 | 3 | ||
Student | 10.5 | 58 | 10.2 | 34 | 10.4 | 92 | ||
Student and working | 2.2 | 12 | 2.1 | 7 | 2.2 | 19 | ||
Self-employed | 0.7 | 4 | 0.6 | 2 | 0.7 | 6 | ||
Other | 0.4 | 2 | 0.3 | 1 | 0.3 | 3 | ||
|
85.3 | 469 | 88.3 | 293 | 86.4 | 762 | ||
|
||||||||
16-24 | 65.9 | 405 | 63.3 | 228 | 64.9 | 633 | ||
25-33 | 17.6 | 108 | 18.1 | 65 | 17.7 | 173 | ||
34-43 | 6.5 | 40 | 8.3 | 30 | 7.2 | 70 | ||
44-52 | 7.3 | 45 | 6.1 | 22 | 6.9 | 67 | ||
53-61 | 1.6 | 10 | 3.1 | 11 | 2.2 | 21 | ||
62-70 | 1.1 | 7 | 1.1 | 4 | 1.1 | 11 |
There were no significant differences between the alcohol website users and the drug website users on any demographic variable: gender (Fisher exact test χ²1 = 0.6,
Drug and alcohol website users reported primarily accessing the Internet from home (959/1214, 79.4%) or at university, school, or work (232/1214, 18.7%), via cable broadband (306/1214, 39.9%), ADSL (243/1214, 20.0%), or ADSL2 (185/1214, 24.2%). Respondents commonly accessed the Internet daily (1178/1214, 97.0%) and were typically online for periods ranging from 5 to 30 minutes (217/1214, 17.9%), 30 to 60 minutes (316/1214, 26.0%), 1 to 2 hours (315/1214, 25.9%), or 2 or more hours (366/1214, 30.1%). Daily online activities were email (1060/1209, 87.7%), social networking, (eg, Facebook and MySpace) (688/1203, 57.2%), news (574/1197, 48%), and random “surfing” (506/1200, 42.2%). Over 90% (1112/1214, 91.6%) said they felt comfortable/confident when using the Internet. There were no significant differences between the alcohol and drug website user groups on any of these general Internet usage variables.
Most respondents found the websites via search engines (610/766 or 79.6% of drug website users and 341/448 or 76.1% of alcohol website users). Both groups were primarily interested in finding information about effects of the substance used (688/740 or 93.0% of drug group and 307/421 or 72.9% of alcohol group).
When respondents chose to specify the information they looked for on websites, 74 drug website users reported searching for information on the chemical composition of drugs, firsthand drug user accounts, why people used drugs, health risks and side effects of using drugs, harm minimization strategies, referral links to supports, online assessment, self-help programs, general usage statistics, or drug sentencing laws. The responses of 60 alcohol website users stated that they were looking for information about standard drinks, alcohol content in cocktails and safe drinking limits, alcohol use in pregnancy, alcohol and violence, effects of combining drugs and alcohol, short and long term health issues associated with drinking, hangover cures, relapse prevention information, or reasons why people drink.
Finding the desired information appeared to be difficult for respondents searching alcohol websites. Rating the success of their search on a 3-point scale (yes, somewhat, no), almost half (211/431, 49%) reported they were only somewhat successful in finding what they wanted, and only 47.3% (204/431) said they did find it. Percentages for respondents searching drug-related websites were similar (348/745, 46.7% somewhat; 392/745, 52.6% yes). Just over half of respondents in the drug group (408/736, 55.4%) and alcohol group (232/414, 56.0%) reported being able to source information they wanted within 5 to 15 minutes.
AOD website users were presented with 14 AOD websites (see
The drug and alcohol website user groups were presented with a series of general website features and asked to rate how important (very, somewhat, or not at all) they thought these features were for AOD and health-related websites. As shown in
General website features rated very important
General Website Features Rated Very Important | Drug Website Users | Alcohol Website Users | ||
% (n) | N | % (n) | N | |
Easy navigation | 88.5 (676) | 764 | 88.3 (392) | 444 |
Open access | 87.1 (666) | 765 | 86.2 (381) | 442 |
The right amount of information | 82.1 (624) | 760 | 81.2 (358) | 441 |
Internal search function | 79.4 (608) | 766 | 79.1 (351) | 444 |
Easy to understand language | 75.7 (575) | 760 | 77.9 (346) | 444 |
No need for extra software | 73.9 (564) | 763 | 73.5 (324) | 441 |
Interesting Web pages | 50.7 (386) | 762 | 56.0 (248) | 443 |
Does not require a high bandwidth | 46.3 (353) | 761 | 47.3 (209) | 442 |
Attractive website layout | 40.1 (307) | 765 | 45.9 (204) | 444 |
A glossary | 30.6 (232) | 758 | 34.2 (151) | 442 |
A sitemap | 27.9 (212) | 761 | 26.4 (117) | 443 |
There were no significant differences in the preferences of men and women for general website features. However, the relative importance of a site map (χ²10 = 19.8,
The drug and alcohol website user groups were presented with a series of interactive website features and asked to rate how important (very, somewhat, or not at all) they thought these features were for AOD and health-related websites. As
Interactive website features rated very important
Interactive Website Features Rated Very Important | Drug Website Users | Alcohol Website Users | ||
% (n) | N | % (n) | N | |
Print/download information | 68.8 (526) | 765 | 72.5 (321) | 443 |
Being able to ask a question | 57.3 (437) | 763 | 58.2 (258) | 443 |
External links | 52.5 (400) | 762 | 54.9 (242) | 441 |
Pictures and graphics | 46.8 (357) | 763 | 51.8 (230) | 444 |
Automated personal feedback | 23.6 (179) | 759 | 26.9 (119) | 442 |
Video | 16.1 (123) | 762 | 17.0 (75) | 442 |
Quizzes | 15.3 (117) | 763 | 19.7 (87) | 442 |
Flash / Animations | 11.3 (86) | 760 | 10.6 (47) | 442 |
Audio | 11.3 (86) | 763 | 10.9 (48) | 442 |
Access to a chat room | 11.1 (85) | 763 | 12.7 (56) | 441 |
SMS or email reminders | 7.7 (58) | 757 | 9.6 (42) | 437 |
Blogging | 8.7 (66) | 759 | 6.8 (30) | 439 |
Games | 4.5 (34) | 758 | 7.0 (31) | 441 |
Of the all respondents, 31 specified other important general and interactive website features not listed in
Preferences for specific interactive website features did not differ according to gender or educational level. However, being able to ask a question was influenced by age group (χ²10 = 36.1,
Respondents were asked to rate the importance (very, somewhat, or not at all) of a number of trustworthiness indicators when they judged whether or not they could trust a website. The percentage of trustworthiness indicators judged as very important are provided in
Indicators of website trustworthiness judged very important
Indicators of Website Trustworthiness |
Drug Website Users | Alcohol Website Users | ||
% (n) | N | % (n) | N | |
It provides evidence for its claims |
86.8 (664) | 765 | 87.3 (385) | 441 |
It says where it got its information from |
81.3 (621) | 764 | 81.9 (363) | 443 |
There is enough information to tell whether the writers are experts |
71.7 (548) | 764 | 75.5 (335) | 444 |
It tells you when it was created or last updated |
70.4 (539) | 766 | 72.7 (322) | 443 |
I can easily find who owns and wrote the website |
67.9 (518) | 763 | 73.3 (324) | 442 |
It tells you it has a privacy policy |
55.5 (422) | 761 | 58.1 (257) | 442 |
It tells you whether sponsors are involved |
52.7 (400) | 759 | 53.2 (236) | 444 |
Past experience |
50.4 (384) | 762 | 51.8 (228) | 440 |
Has reference or links to other websites |
46.4 (354) | 763 | 50.3 (222) | 441 |
It displays a quality seal of approval (eg, HONcode) |
44.3 (337) | 761 | 47.1 (209) | 444 |
It has been recommended to me by my peers |
37.9 (289) | 762 | 42.1 (187) | 444 |
It has been recommended to me by my family |
32.8 (249) | 760 | 37.2 (165) | 443 |
Another site said it was good | 18.2 (138) | 757 | 20.1 (89) | 442 |
Over 80% of respondents identified the provision of evidence for claims made on a website and statements describing the source of information provided as very important factors for judging website trustworthiness. No significant differences were found between the two groups on any indicator of trustworthiness.
In addition, 25 respondents were able to specify other important indicators of trustworthy websites not listed in
Alcohol and drug website user groups were asked to consider whether they would use a range of website tools/functions and how important (very important, somewhat, or not at all) these features would be. The percentages of respondents endorsing the tool/function as very important are presented in
Alcohol and drug website tools/functions rated very important
Website Tools/Functions | Drug Website Users | Alcohol Website Users | ||
% (n) | N | % (n) | N | |
Downloadable fact sheets for consumers | 55.6 (348) | 626 | 62.2 (224) | 360 |
A Web portal site that has information on the best site and treatment options | 49.5 (308) | 622 | 51.5 (185) | 359 |
Online tests or other tools to help gauge if there is an AOD problemc | 42.6 (266) | 624 | 52.6 (190) | 361 |
A quick and easy user profile system that tailors information to need | 42.7 (268) | 628 | 44.2 (159) | 360 |
Downloadable fact sheets for friendsb | 37.4 (232) | 620 | 44.9 (162) | 361 |
Prevention programs for those “at risk” of developing an AOD problemc | 34.9 (217) | 622 | 48.5 (174) | 359 |
Downloadable fact sheets for family or carersb | 35.7 (222) | 621 | 45.9 (166) | 362 |
An online treatment program with assistance (phone, IM, email or webcam) | 32.0 (199) | 622 | 32.7 (118) | 361 |
A tracking functionb | 26.8 (167) | 624 | 35.9 (129) | 359 |
An online self-help treatment program a | 25.7 (160) | 622 | 33.1 (120) | 362 |
A consumer information sharing hub to share experiences | 29.5 (184) | 624 | 25.3 (92) | 363 |
Material/text presented in a different language | 10.9 (68) | 623 | 12.5 (45) | 360 |
A chat room | 9.8 (61) | 625 | 8.9 (32) | 361 |
Being able to start up your own online support group | 8.9 (55) | 619 | 9.2 (33) | 358 |
a P < .05
b P < .01
c P < .001
Alcohol website users were significantly more likely to endorse a range of tools/functions as very important in comparison with the drug website users, specifically: online screening tools (χ²2 = 15.8,
Preferences for specific website tools or functions did not vary by gender. However, several significant differences were found for age and higher educational level. Age group impacted on the Web portal feature (χ²10 = 29.1,
Respondents without higher education valued support groups most, and those completing an undergraduate degree valued support groups least in comparison with other education groups (χ²16 = 27.1,
Respondents were asked to consider what type of online service they would prefer if they had an alcohol or drug problem. As shown in
Most preferred support mode if the respondent had a drug or alcohol problem (n = 994)
Type of Treatment Support | Treatment for Drug Problem | Treatment for Alcohol Problem | ||
Drugs |
Alcohol |
Drugs |
Alcohol |
|
Website with email support from a therapist | 34.0% (214) | 33.4% (122) | 34.8% (219) | 36.2% (132) |
Website with face-to-face support from a therapist | 23.7% (149) | 29.0% (106) | 21.0% (132) | 21.9% (80) |
A self-help website with no therapist support | 18.9% (119) | 15.3% (56) | 20.3% (128) | 17.8% (65) |
Website with telephone support from a therapist | 17.8% (112) | 18.1% (66) | 18.0% (113) | 19.2% (70) |
Other (Please specify) | 5.6% (35) | 4.1% (15) | 5.9% (37) | 4.9% (18) |
Respondents were again able to specify other preferred support options and 55 respondents did so. The most common responses were “all the above,” only wanting to see a healthcare practitioner on a face-to-face basis without a treatment website, an alcoholics/narcotics anonymous online group, synchronous online one-to-one counselling, and an Internet site with chat room support.
No demographic variables were found to impact upon preferences for online treatment and supports.
This study was the first to capture information on the content and functionality preferences of AOD and health-related websites users in Australia. Consistent with previous research on health-related websites, such as the study by Brouwer et al [
Presentation was also important: approximately half the sample highly valued interesting Web pages, pictures and graphics, and external links, although video, audio, and flash or animations were far less preferred. Being able to ask a question was also valued by more than half of respondents, but other interactive features such as quizzes and online games were highly valued by less than 20% of the sample. This clearly raises important questions for website developers with respect to the prioritization of elements and features to be incorporated, particularly given the high cost of games, videos, and animations.
Respondents were more likely to reply that website trustworthiness was primarily indicated by evidence, cited sources, expertness of its writers, and documented currency, rather than by recommendations or seals of approval. These results suggest that this sample of users was relatively sophisticated in its ability to judge the quality of websites for themselves.
Alcohol website users were more likely than respondents who had accessed sites on other drugs to highly value online screening tools, prevention and self-help treatment programs, tracking functions, and fact sheets for family and friends. It is unclear why this result was found, and in particular, whether it reflected a greater willingness in this sample to consider addressing problems with alcohol than addressing problems with other drugs. Replication of the result and further investigation of its implications for website marketing and design are needed. In other respects, the alcohol and other drug samples provided very similar responses.
Gender did not affect any survey responses. However, there were several differences across age and education groups. Notably, younger people were more likely to value interactive and social networking features (being able to ask a question, the consumer hub, chat room access, ability to set up an online support group, games, and the option to blog). This result may reflect the greater likelihood among younger website users to turn to peers when seeking information or support. In contrast, older respondents valued the site map, the Web portal and the ability to download information or fact sheets for family and friends more highly. The value placed on the ability to access information may reflect a greater likelihood among this group that they were caring for someone with a drug or alcohol problem, and, therefore, valued high-quality information with which to assist these people. It may also reflect a greater reliance among older respondents on expert information about alcohol and other drugs in preference to obtaining this information from peers. Interestingly, respondents without higher education valued having a support group most, and those undertaking a degree valued online treatment least. It is not clear whether less educated respondents were more likely to see their existing support system as inadequate or whether they felt less able to address alcohol or other drug issues on their own. Respondents undertaking a degree also valued multilingual options least (presumably because higher education in Australia is typically conducted in English).
Overall, these demographic differences suggest that website developers should consider the characteristics of the intended target group when designing a website. Greater understanding of each of the results is needed to know how best to address the differences in perceived needs.
Lastly, we were interested in knowing what type of online support was most preferred by the survey respondents if they were to require treatment for either a drug or alcohol problem. An Internet site with email support from a therapist was the most preferred option by both AOD website user groups, although this was selected by less than a third of respondents, with other selections being almost evenly spread across the other options. This survey did not directly compare Internet options with face-to-face treatment alone. However, as very few AOD groups endorsed the “other” option for support and only a subset of these identified standard face-to-face therapy as their preferred type of support, this suggests that standard therapy was not salient and that respondents to an online survey may be willing (and may even prefer) to use online treatment modalities should they require treatment. It is particularly noteworthy that neither the type of website accessed nor respondent demographics impacted upon the preferred type of online support. It seems that an important component of an online “treatment” program could potentially be the provision of some therapist support, especially via email.
Survey respondents were primarily a young, educated, English speaking, and employed Australian sample who used the Internet on a daily basis. Relative to the Australian population at the time of the survey, our sample had more women (66% vs 51%), was younger (median age 22.0 years vs median of 36.9 years), had higher participation rates in employment (75% vs 65.2% of 15-74 year olds), and had higher rates of post school qualifications (7% vs 31% with no tertiary qualifications) [
The interaction between these sociodemographic variables and health seeking/health literacy is well documented. For example, education can increase the likelihood of employment, thereby affecting the means by which people can improve their health and well-being as well as their ability to understand and choose pathways to better health [
Respondents answered the questions based on websites they had visited before. There was no control for variability in website exposure (eg, type, frequency, or recency of previous website visits). Nor were motivations for seeking information standardized. So, respondents may have been seeking information about their own substance use, about family members or friends, or may have been seeking information for study programs or for entertainment. Differing features may have been seen as important or satisfactory based on these differing agendas. Perhaps more importantly, we do not know whether any of the respondents had an AOD use problem (either in the past or currently) and accordingly, we do not know how these results may relate to an AOD treatment-seeking population.
Future researchers might consider conducting a comparison of similarly motivated individuals seeking websites on AOD issues. Developing and evaluating AOD websites based upon the specifications identified as highly important by this sample could lead to higher rates of engagement and usage of AOD websites. In addition, exploration of some of the functional design issues, such as determining what amount of information is considered the “right” amount could assist in the design of a more user-friendly AOD website. Targeting people with AOD use problems would also provide more specific information regarding the wants and needs of this group in accessing online AOD websites. Tailoring AOD websites based on age and education level appears to be an important line of research investigation, and whether gender is indeed an irrelevant factor when developing AOD websites will be an important finding to replicate.
Engagement of people with AOD problems in behavior change remains a difficult challenge. The Internet offers opportunities both for increased community understanding of AOD issues, and potentially, for engagement of affected individuals at an earlier stage than traditional treatment services, with lower stigma, and at less cost. However, community-wide Internet sites have not engaged young people at the rates one might have wished, with alcohol-related website users often having mean or median ages in the mid 40s, as in the study of Kramer et al, for example [
We would like to thank the Australian Commonwealth Department of Health and Ageing for providing the funding to conduct this study.
None declared
Online alcohol and drug websites: What do you think?
Alcohol and drug websites
alcohol and other drugs
Internet protocol
short message service