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Health Education Research Advance Access originally published online on May 19, 2006
Health Education Research 2007 22(1):1-13; doi:10.1093/her/cyl010
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© 2006 The Author(s).
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (
http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Feasibility, acceptability, and quality of Internet-administered adolescent health promotion in a preventive-care setting

RT Mangunkusumo1, J Brug1, JS Duisterhout2, HJ de Koning1 and H Raat1,*

1 Department of Public Health, Erasmus MC–University Medical Center, Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
2 Department of Medical Informatics, Erasmus MC–University Medical Center, Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands

* Correspondence to: H. Raat. E-mail: h.raat{at}erasmusmc.nl

An Internet tool for monitoring, personalized feedback and referral was developed to support routine adolescent preventive care and was compared with usual practice using paper and pencil (P&P). A total of 1071 students (average age 15 years) from seven secondary schools were randomly assigned to the Internet or P&P group. The Internet group received a health and health-behavior assessment, tailored feedback on health and health behavior (specifically fruit consumption), and an online referral to see a physician/nurse if necessary. The P&P group received the same assessment, preprinted generic advice on fruit consumption and a mailed referral (where applicable). Students and physicians/nurses completed evaluation forms to assess indicators of feasibility, acceptability (i.e. satisfaction) and quality of each administration mode. Student participation rate was 87%. The electronic health feedback was positively evaluated. Students perceived the Internet-tailored fruit advice as more pleasant, more personally targeted and more enjoyable, but less credible than the generic preprinted advice (P < 0.01). No differences in indicators of acceptability and quality of consultation were found (P ≥ 0.05). Thus, the Internet can be a valuable tool to support physicians/nurses in the field of preventive care. It is recommended to further optimize and evaluate the Internet as a tool.


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