Young people's perspectives on the use of reverse discourse in web-based sexual-health interventions

Abstract

Web-based sexual-health promotion efforts often utilise reverse discourse - the acknowledgement and rejection of shame associated with stigmatised terms - both to challenge judgments about 'risky' behaviours (e.g., casual sex) and to appeal to young people. This study examines the use of reverse discourse in Internet-based sexual-health promotion and analyses young people's perspectives on this approach. During in-depth interviews and focus groups with young people (aged 15-24), participants shared their perspectives on written (e.g., clinical language; colloquial language) and visual (e.g., generic, stock images; sexualised images) depictions of sexual-health topics on the websites. More explicit styles elicited negative responses from young people in terms of perceived appeal, trust and quality of websites. Negative social mores were associated with some of the more explicit portrayals of young people's sexual lives on the websites, revealing how reverse discourse re-stigmatises young people by re-emphasising young people's sexual activity as inherently risky or immoral. Reverse discourse was perceived to have negative effects on the saliency and credibility of online sexual-health information. We discuss the theoretical basis for the operationalisation of reverse discourse in this context, and discuss the importance of considering sociotechnical aspects of Internet-based sexual-health interventions.

Sexual health promotion for young people delivered via digital media: a scoping review

“…The types and number of interactive features were highly variable, as were the identified Behaviour-Change Theories that could be applied. The threat of HIV and STIs, a discourse more likely to stigmatise young people, 149 was more commonly featured than promotion of positive reinforcing messages and social norms. Most contained some skills and self-efficacy-building content.…”

“…These authors found that threat-inducing techniques did not enhance condom promotion for any recipient group, suggesting that theories highlighting fear arousal are not helpful to the design of condom use promotion interventions. Similarly, the use of reverse discourse (using more explicit images and terms) has been shown to have a negative effect 149 and the use of humour can risk reducing the credibility of the message. 150 Rational models for behaviour change may be less applicable, however, in the context of sexual health.…”

“…Credibility may also be reduced by the use of 'reverse discourse', which can portray young people's sexual activity as inherently risky or immoral. 149 Formative work with users can to some extent help to identify whether or not there are particular health decisions that are shaped by unique cultural values and norms of the target group and which should be taken into account in intervention design. 126 Testing content for relevance with the target group helps to define the key messages that work 164 and elicit group-specific content that is perceived as important, such as issues around disclosure for HIV-positive youth, 118 sexuality for MSM 70 or substance misuse for youth in treatment.…”

Practical Guidelines for Development of Web-Based Interventions

“…They supported the meaningfulness of the interventions in dealing with issues that could be discussed better without disclosing identities (eg, sexual health, sexual abuse). [23][24][25][26][27][28] Moreover, Web-based interventions provide flexibility for users to control content, time, location, speed, and learning schedule. 21,[29][30][31] They allow the researchers to easily update and modify the content of the interventions 32,33 and to use various multimedia functions (eg, sound, image, and animations) in order to attract potential participants.…”

Improving Sexual Health Resources for Youth: The Use of Sex-Positive Public Health Websites

“…Cost-free services on these devices could be readily implemented to provide anonymous and non-judgemental sexual health promotion services (Garrett, Hocking, Chen, Fairley, & Kirkman, 2011;Garrett et al, 2012;Hottes et al, 2012). The Internet is becoming the norm for service provision in education and industry and, as such, providing youth with health information through Web 2.0 should be promoted and enhanced (Davis, Shoveller, Oliffe, & Gilbert, 2012;McCarthy et al, 2012;Miller & West, 2009;Public Health Agency of Canada., 2008).…”