What New Mothers' Favorite Web Sites and Features Tell Us About Designing Web-Based Health Promotion: A Content Analysis

Introduction

After giving birth many women experience needs that go unmet by the healthcare system. ¹ Some of these needs may potentially be reduced by use of Internet-based information, advice, decision support, and social networking. Internet-based health information is convenient and rapid and may supplement information from healthcare professionals and enrich the healthcare received. ² To increase positive use of Web sites designed for new mothers' needs, their preferences and demographic differences in preferences must be understood.

In the general population, the most popular sites are commercial search engine and social networking sites. ³ Reasons for appeal of health-related Web sites among various populations include theory-based ones, such as active trust, ⁴ and user-reported ones, such as usefulness, ease of use, and interaction with others. ⁵ Similar knowledge about new mothers' preferences is needed in order to better design Internet-based health resources for them. Thus, the purpose of this study was to determine the Web site preferences of new mothers and to explore key demographic variables (race/ethnicity, income level, age, education, and number of children) associated with their Web site preferences.

Materials and Methods

To understand these preferences, we used data from a larger mail survey ⁶ of health and technology use to conduct a content analysis of new mothers' favorite Web sites and reasons for their appeal. With Institutional Review Board approval, we used state birth records to identify women with term births in Central Texas who gave birth in the preceding 5–10 months. The survey was mailed to 600 randomly selected women within strata of race/ethnicity and income level, defined by Medicaid coverage for delivery (lower income) or private insurance (higher income). For Hispanic women the survey questionnaire was sent in both English and Spanish. After correcting for undeliverable questionnaires, the response rate was 27.6%. As previously reported, ⁶ 84.1% of mothers had a home computer with Internet access. Other aspects of the larger study are reported elsewhere. ⁶

Besides demographic data, in this study we focused on responses to two open-ended questions (previously used in the Teen Tech Survey): ⁷ “What is your favorite Web site?” and “What do you like best about your favorite Web site?” Descriptive content analysis ⁸ with inductively developed categories was used to classify responses. Initial codes were developed by two authors (E.R.N. and L.O.W.) and critically reviewed by two others (B.X. and M.W.V.). After refinements, the intercoder agreement was 90% between two trained student coders. The final coding scheme included seven categories for mothers' favorite Web site and 10 categories for most liked attributes of these Web sites. Categories and brief descriptions are contained in Tables 1 and 2.

Results

Survey respondents (n=145) ranged in age from 19 to 45 years (mean, 30.49 years), and 28.3% were Hispanic, 25.5% were African American, and 46.2% were white. Based on type of delivery coverage, 35.9% of women were of lower income (Medicaid), and 64.1% were of higher income (private insurance). Their education was as follows: college completion, 55.9%; some college, 21.4%; high school completion, 11.7%; and partial high school, 9.7%.

Overall, 73.1% of mothers responded to both questions regarding their favorite Web site and why they liked it. Of those with a home computer with Internet access, 79.3% responded to both questions, whereas 45.5% of those without a networked home computer responded (χ² [1]=11.144, P=0.001).

The two most frequent categories of favorite Web sites were commercial search engine sites and social networking sites (Table 1). Within these two categories and overall, the most frequently cited Web sites were Google, Facebook, and Yahoo. Best-liked attributes of favorite Web sites (Table 2) were facilitation of social interaction between users (26%), followed by ease to navigate (9.0%) and provision of access to information sought (9.0%).

For analysis of favorite Web site categories by demographic variables, the two most frequent categories—social networking and search engines—were unchanged, and those remaining were compressed into one miscellaneous category because of insufficient numbers (Table 3). Mothers whose favorite Web sites were classified as a social networking Web site were significantly younger than those whose favorite Web sites were classified as miscellaneous. Similarly, for analysis of favorite Web site attributes by demographic variables, the three most frequent attributes were unchanged, and the remaining were compressed to one miscellaneous category (Table 4). Demographic variables did not differ significantly by Web site attributes.

Discussion

To our knowledge this is one of the first studies about Web site preferences of new mothers and related demographic differences. Almost half of mothers' favorite Web sites were commercial search engine or social networking sites. In these two categories, the three most mentioned Web sites—Facebook, Google, and Yahoo—are also among the top Web sites worldwide. ³ Thus, new mothers' favorite Web sites parallel those of the population overall in which the search for information and social networking predominate. What mothers liked best about their favorite Web sites was the facility to communicate with others, the ease of use, or the capacity to find information easily—attributes previously reported. ^5,9 With one exception, new mothers' favorite Web sites and their attributes were robust across demographic characteristics.

These findings offer some preliminary guidance for developers creating Internet-delivered health resources for new mothers. The prominence of Facebook and social networking suggest ways to improve the likelihood of reaching new mothers. These include producing Web sites that can be “Liked” at the individual Web page level on Facebook, offering the option of the integration of Facebook sign-on capabilities, and injecting tailored advertising into Facebook about health resources for new mothers. The prominence of social networking and search engine sites also suggest that online health resources for new mothers might include capability to ask and answer questions (e.g., online forums), ^{10 –12} options to share personal information or baby stories similar to Facebook, and ability to search for relevant content. A key next research step is assessing what women are specifically seeking in these Web sites related to being a new mother, ¹⁰ that is, the gateway to their time and attention.

A strength of this study is its stratified random sampling design. Among its limitations are a low response rate, a small sample size, and only brief information on why mothers liked Web sites. Another limitation is the two open-ended questions queried mothers about existing Web sites, which may only partially meet new mothers' needs. Thus, future surveys might probe more broadly with questions, such as “What content and features would you like to have on a Web site for new mothers like you?” The survey was also limited in not asking how mothers accessed their favorite Web sites. With expanding use of smartphones and tablets in the United States and abroad, many may use devices besides computers. The prominence of a device would suggest what direction the overall design should take first (e.g., should it be a “mobile-first” design?). Thus, an expanded survey with more detailed questions about preferences and devices, along with incentives for participation, would advance knowledge about designing e-health resources for new mothers.