We conducted 21 focus groups in London, UK, at young people’s community sexual health clinics and held 6 one-to-one interviews in the Research Department of Primary Care and Population Health, University College London. Ethical approval was obtained from the University College London Research Ethics Committee (ref number 1023/001).

Young people aged 16–22 years were eligible to participate in the study.

We used multiple methods of recruitment, including approaching young people in sexual health clinic waiting rooms, distributing flyers around clinics and colleges, approaching key contacts involved in youth work, and placing advertisements on youth websites such as the UK Youth Parliament and college webpages. Snowballing was also used, where initial participants were asked to recruit potentially interested friends.

Participants were initially asked to attend only 1 focus group but were invited to subsequent groups if they were particularly engaged. Repeated attendance at focus groups over time allowed these participants to build on previous discussions. They were able to comment on refinements made to earlier website content and interactive formats.

We asked 3 focus group participants who were particularly engaged to attend a one-to-one interview. We also recruited 3 interviewees from online advertisements on youth websites and through key youth work contacts.

All participants provided written consent to their participation before attending a focus group or interview and were offered a £10 (US $16) cash incentive if they stayed for the duration.

The focus group discussions were used to explore (1) young people’s sexual health priorities, (2) their views on website look and feel, and (3) what features of an interactive sexual heath website would attract and engage them.

All focus groups were moderated by 2 facilitators who introduced the project, explained the purpose of the focus group, set ground rules of mutual respect and confidentiality, and ensured that all participants had provided written informed consent. Participants provided anonymous demographic information by completing a paper form. The discussions and interviews were audio recorded with participants’ permission.

Semistructured topic guides were used to guide the focus group discussions. These guides evolved as data were collected. Open-ended questioning was used to elicit a wide range of views, and participants were asked to elaborate on relevant topics beyond the topic guide. Less-vocal participants were encouraged to share their views. We developed the Sexunzipped website in parallel with the emerging data from the focus groups, with early website design templates prompting discussion in subsequent focus groups. This enabled participants to comment on the presentation and content of the intervention, leading to iterative changes as a form of participatory design. Focus group discussions ranged from 60 to 90 minutes, depending on the quality of the information gathered and participants’ attention spans.

One-to-one interviews lasted 60 minutes and used open-ended questioning. The interviews were used to gather views on early versions of website content and to generate anonymous quotations on sexual health issues to use throughout the website. To test the website content, we asked participants to read and comment on sample content and to give feedback on paper versions of interactive activities. To generate the quotations, the interviewer asked participants for their views on potentially controversial sex-related topics, such as “What do you think about girls carrying condoms?”. Anonymous quotations for the website were also generated by adapting comments taken from youth website discussion boards.

One researcher made detailed notes on key themes from the focus group audio recordings. The analytic notes were reviewed and discussed by the core research team consisting of a clinical psychologist, a health services researcher, and a sexual health clinician. Key findings were documented, and emergent themes were tested in subsequent focus groups until the core team was satisfied that the information gained was sufficient. Information from the one-to-one content testing and quotation generation was used to refine subsequent website content.

A total of 67 people aged 16–22 years living in the United Kingdom participated in 21 focus groups and 6 one-to-one interviews over 16 months (Table 1). We used 3 one-to-one interviews to test website content and 3 to generate anonymous quotations for use throughout the website.

Of the 67 participants, 48 (72%) were aged 16–17 years, and 50 (75%) were female. Participants were ethnically diverse, with 26 (39%) describing themselves as white British or white other, 26 (39%) as black British, 2 (3%) Asian British, 7 (10%) as mixed, and 6 (9%) as other. The median age at which they first had sex was 15 years for both young women and men, with 33 (66%) young women ever having had sex and 15 (88%) young men ever having had sex. Of the 67 participants, 57 (85%) were in education or training. Most participants lived in inner London, with 2 living outside but near London. Of the 67 participants, 20 (30%) young people participated more than once.

Focus group participants appreciated being consulted and were eager to share their views. They supported the creation of a sexual health website with input from young people because they felt that current sites did not fully address their needs. They provided a wealth of information about their sexual health priorities and what features of such a website would be attractive and engaging to them.

Paying particular attention to young people’s desire for interactivity, we integrated young people’s views with psychological theories of behavior change to create the Sexunzipped theory-based intervention website [9]. Reflecting young people’s suggestions and priorities, the website content is divided into three major sections: Relationships, Safer Sex, and Sexual Pleasure. Each section contains a combination of interactive quizzes and decision-making activities, as well as text-based information. Links to other related topics on the site are provided at the end of all activities and text-based pages.

Participants were actively engaged in the focus group discussions and enjoyed taking part. They offered key insights into the content, look, and feel and interactive features of the Sexunzipped sexual health website. The resulting intervention has been tested in a pilot online trial (trial registration number ISRCTN55651027).

The strongest message to emerge from this research was the importance of providing young people with honest sexual health information that features content on sexual pleasure and relationships. Participants desired a website that reflects a mature, trustworthy, and true-to-life feel, conveyed through the voice of a knowledgeable youth worker or older sibling. The need for the website to appear trustworthy [10,11] along with the potential to share and compare real-life experiences [12] is consistent with previous findings. Our focus group findings align with other research, which found that young people are interested in receiving sexual health information through digital technologies such as the Internet and mobile phones [11,13], and are interested in knowing more about sexual pleasure, feelings, and emotions [14].

The integration of pleasure and relationship information with traditional risk-focused sexual health promotion was seen as novel and attractive, with participants preferring this approach to their experiences of sexual health education delivered by schools or by health authorities. Giving equal weight to traditional risk-based messages and sexual pleasure (including masturbation, for example) would give the message that both are important for healthy sexual lives [15,16].

A wide variety of sexual health websites targeted at young people are available on the Internet, for example, those developed in consultation with young people [17], those including information on sexual pleasure [18,19] and those offering multimedia features such as videos of people talking about their experiences [20,21]. The Sexunzipped website combines these elements in that it was developed with young people, features sexual pleasure, and includes theory-based interactive activities.

Perhaps the greatest challenge was to integrate young people’s preferences with psychological theory [9] within technical and budgetary constraints to create an acceptable and engaging sexual health website.

Participants expressed their desire for direct social interaction with other young people online (eg, via discussion boards and instant messaging). These features are expensive, require moderation, and raise ethical issues, for example, regarding online bullying, or disclosure of illegal or dangerous activities. There was also a risk that if no one used the discussion board, the site would appear unpopular and therefore unattractive. Young people wanted to see themselves reflected on the site (eg, in videos and drama), but this is expensive to produce and is difficult to pitch correctly. Young people are accustomed to the actively changing landscape on the Internet and wanted new activities and information added on a regular basis, which is resource intensive.

Consultation with users is essential in the development of websites targeted at young people, as this group can be particularly influenced by look and feel. This research and previous research suggest that listening to and meeting young people’s desires in terms of website design and content is essential in engaging them [10,12]. However, websites may quickly look and feel out-of-date due to the rapidly changing online environment, which necessitates regular user consultation and updating. This requires careful financial planning by those involved in site maintenance in order to support the continued user consultation and updating.

Focus group participants were London-based young people, which could mean that any differences in sexual health priorities due to geographical location may be underrepresented in the content of Sexunzipped. However, we thought that young people in other areas of the United Kingdom would be able to recognize and relate to inner-city youth culture to some degree. The Sexunzipped website design was intended to appeal to a broad range of young people, avoiding any specific styles that could alienate particular groups or become quickly out-of-date.

The sample contained 75% (50/67) women because greater numbers of young women attend community sexual health clinics. This may have resulted in views more representative of female needs and priorities. We made attempts to include more young men such as contacting male youth organizations, but this group proved to be less accessible than young women.

Although most focus groups included participants who did not know each other, the snowballing method of recruitment meant that the sample could have resulted in participants having similar views.

Consultation with the target audience is valuable and necessary in developing sexual health interventions, particularly in developing interventions for young people. It can be difficult to pitch content correctly, but it is possible with repeated consultation with users. It is challenging to incorporate all of young people’s technological desires, but digital technology makes it possible to create an engaging online intervention that includes a variety of interactive formats covering a broad range of topics. Young people are willing to talk about sensitive issues, enjoy the discussions, and can offer key insights that influence intervention development.