Effectiveness of web-based education on Kenyan and Brazilian adolescents' knowledge about HIV/AIDS, abortion law, and emergency contraception: findings from TeenWeb.

Little evidence is available about the utility of web-based health education for students in low resource settings. This paper reports results from an evaluation of the TeenWeb project, a multi-year, web-based health education intervention implemented in two urban settings: Nairobi, Kenya (N=1178 school students) and Rio de Janeiro, Brazil (N=714 school students). A quasi-experimental, school-based pre-test/post-test design was implemented at each study site to determine if easy access to web-based reproductive health information, combined with intellectual "priming" about reproductive health topics, would result in improved knowledge and attitudes about topics such as condom use, access to HIV testing, emergency contraception and abortion laws. Students in web-access schools completed one web-based module approximately every 6-8 weeks, and in return, had access to the Internet for at least 30 min after completing each module. Although students were encouraged to access project-supplied web-based health information, freedom of web navigation was an incentive, so they could choose to access other Internet content instead. Most measures showed statistically significant differences between students in "web" and "comparison" conditions at post-test, but only about half of the differences were in the hypothesized direction. Results of an embedded experiment employing more directed feedback tripled the likelihood of correctly reporting the duration of emergency contraception effectiveness. Review of URL logs suggests that the modest results were due to inadequate exposure to educational materials. Future intervention should focus on teen's purposeful searching for health information when they are in personal circumstances of unmet health needs.