‘Am I normal?’ Teenagers, sexual health and the internet

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Abstract

The development of new communication technologies has created a wide variety of new fields in which human beings can construct identities. The past decade has seen a proliferation of opportunities to use the internet for health related advice and information and many new sites have been created where participants can construct identities, formulate problems and seek solutions concerning health related issues. This paper will report on a study of emails written in to a UK-based website concerned with health issues for young people. Our analysis was driven by corpus linguistics, a computational methodology for interrogating extensive datasets, and we have combined both quantitative and qualitative approaches to the study of language. We interrogated a 400,000 word dataset of messages and were able to identify terms whose usage was elevated compared to the English language as a whole. As well as personal pronouns, these included many terms related to sexual health and bodily development, as well as terms such as ‘normal’ and ‘worried’ which were identified for further exploration. Whereas previous research on sexual health has discovered the use of vague terms and euphemisms, here, young people described themselves, their anatomy and their identities in meticulous detail. This study enables us to define the role of health topics raised, the presentation of health concerns, and contributes towards the discovery of a distinctive ‘genre’ of health messages concerning sexual health which differs from that found by other researchers concentrating on face to face encounters. In conclusion we suggest that for researchers and practitioners working in health with young people in the medium of English there could be valuable lessons in communication to be learned from examination of corpora of the health care language concerned.

Introduction

The rise of the internet has led to a substantial increase in the number of websites dedicated to providing health advice and information. Many new fora have been created whereby internet users can formulate problems and seek solutions concerning health related issues. Although many commentators have reported that the electronic landscape is populated by many unreliable, misleading and unscrupulous sites purporting to provide accurate medical information (e.g. Barkham, 2000; Henk, 2002; Thurlow, Lengel & Tomic, 2004), the internet nevertheless remains a popular source of medical advice and information with the potential to contribute to positive health care outcomes and intervention (Car & Sheikh, 2004; Gray, Klein & Noyce, 2005).

With the rise of internet health resources over the last decade there has been an increased demand for health provision tailored to the needs of young people (Aynsley-Green et al., 2000; Jones, Finlay, Simpson, & Kreitman, 1997), resulting in a growth of internet-based resources tailored to delivering reliable and accurate health information for young people. These sites typically provide interactive advice in accessible, non-technical language through which young people can freely express their health questions to professionals, as well as sharing their concerns with fellow teenagers. Consequently the internet has become a popular source of health advice and information for adolescents, with the electronic gateway offering confidential advice and information that might be otherwise hard or compromising to obtain (Borzekowski & Rickert, 2001; Suzuki & Calzo, 2004). For example, the UK based Samaritans charity, an organization that provides confidential emotional support in response to enquiries by distressed individuals, report that since their email service was introduced in 1995, ‘it has been used by many young people as their preferred way of discussing difficult feelings’, noting that this service had increased by almost 80% between 2002 and 2004 (Samaritans, 2004).

The issues raised by researchers on internet health in different countries are intriguingly similar, especially given the differentiation in face to face health care cross-nationally. Nations with substantial public provision yield similar concerns to those with largely insurance-funded systems. On both sides of the Atlantic, and even as far afield as China, the anonymity afforded by the internet is valued (Lou, Zhao, Gao, & Shah, 2006; Rice, 2006; Rogers & Mead, 2004) and this is particularly important for young people, since they are often reluctant to disclose potentially embarrassing and sensitive problems and request personal health advice from their doctors (Ackard & Neumark-Sztainer, 2001; Biddle, Gunnell, Sharp, & Donovan, 2004; Klein & Wilson, 2002). They make fewer visits to office-based doctors than other age groups (Monson, Jackson & Livingston, 1996). This is of concern given that adolescence is a time of physical, emotional and social change with profound needs to address numerous delicate questions concerning health, sexuality, and relationships (Klein & Wilson, 2002; Suzuki & Calzo, 2004).

While eager to broach sensitive concerns about their health with other people, adolescents often find it difficult to articulate their concerns to adults (Boekeloo, Schamus, Cheng, & Simmens, 1996). Many adolescents want to discuss health concerns with their GPs but are very particular about whom they consult, being only likely to see a practitioner with whom they feel comfortable (Kapphahn, Wilson, & Klein, 1999). According to Holland, Ramazanoglu, Sharpe and Thomson (1996), teenagers are often reluctant to talk to parents about sex and sexual health because of potential embarrassment and in case their parents think they are sexually active.

With such an apparent generational gap, it is important to advance understandings of how adolescents request advice on sensitive matters such as sexual health so as to better inform the strategies of engagement with this population by health practitioners. In this context we would argue that corpus linguistics is a valuable methodology for studying adolescent health communication, providing not only an original and valid means for identifying the issues and troubles young people face in their everyday lives (Michaud, Suris, McPherson, & Macfarlane, 2004) but also as a means of describing a distinctive ‘genre’ of health messages concerning sexual health which differs from that of much other research which has focussed on face to face encounters.

Widely used in other areas of linguistic analysis, corpus linguistics is a relatively new application in relation to health care communication. However, its benefits are quickly coming to be recognised by medical researchers and professionals and recently there has been a variety of insightful corpus studies into the domain of health care discourse (e.g. Adolphs, Brown, Carter, Crawford, & Sahota, 2004; Brown, Crawford, & Carter, 2006; Skelton & Hobbs, 1999; Skelton, Wearn, & Hobbs, 2002; Thomas & Wilson, 1996). Studies in health communication have almost exclusively utilised observational, qualitative methods (Skelton & Hobbs, 1999). Such research adopts a close language-based focus in order to provide a penetrating description of the medical interaction/practice under consideration. Yet qualitative studies in health communication often work with small data sets. Critics allege that a drawback of using limited samples of data, such as a small set of doctor–patient encounters, is that conclusions will not necessarily represent the wider field of language used in that particular domain (Stubbs, 1997). By contrast, corpus linguistic studies involve interrogating large sets of data so as to describe and explicate patterns of communication. The methodological advantage of analysing large data sets is that they are more likely to be representative of the text type under consideration than short fragments of data. Using large data sets, furthermore, allows the analyst to account for a wide range of variation which might be present in the texts and therefore ground generalisations on more substantial and representative textual evidence.

A distinguishing feature of corpus linguistics is its use of computer software to generate word frequencies and concordances. The calculation of lexical frequencies is an important part of linguistic description, since it allows precise quantification of the most commonly used words in a given communicative context. By identifying strings of text containing such frequently or commonly occurring words, concordance lines provide a picture of how these important items are being used in a particular communicative context. The combined computational tools (word frequency lists and concordance outputs) therefore harness both quantitative and qualitative methods and provide a novel and increasingly popular approach to the analysis of language and communication in health settings.

Section snippets

Method

We interrogated the content of a 400,000 word corpus of emails sent to the popular adolescent health website, Teenage Health Freak (www.teenagehealthfreak.org). Operated by two doctors based in the UK and specialising in adolescent health, Teenage Health Freak has been running and continuously updated on a weekly basis since 2000. The site is designed to be user friendly, interactive, confidential and evidence based, employing non-technical, accessible language. During the design of the site,

Results and discussion

The entry point into our collection of adolescent health emails involved using corpus linguistics software to compare this dataset with a corpus of general English. This yielded a number of keywords (see Table 1 below) that appear more than one would expect in the English language as a whole, based on a comparison with the cancode corpus, a 5 million word database of general english. Table 1 lists the absolute frequencies of the keywords salient to the teenage health messages and their

Discussion

The present paper has illustrated the role that studies informed by corpus linguistics can have for understanding subjective, culturally embedded and linguistically displayed notions of illness and health. In the study of health care encounters, whether over the internet or face to face, it offers researchers, practitioners and policymakers the opportunity to contextualise their insights within a much larger data set. Moreover, based on the experience of language learning, there is a growing

Acknowledgements

We would like to thank the two anonymous reviewers for their trenchant and constructive comments and ideas.

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