Fifty-four percent (n = 23) of our sample was female, 7% (n = 3) identified an ATSI background, and 21% (n = 9) reported that English was not their first language. One-third of participants (n = 15) were currently single, and 33% (n = 14) were currently living with a partner. Most were employed at least part-time (n = 25, 58%), with 16% (n = 7) receiving disability or unemployment benefits. The majority of respondents had completed secondary schooling (n = 27, 63%).
Focus group discussion
Website evaluation
Participants were asked to comment on features of websites they visited during the unguided search, which contributed to their ease of use and appeal. The main issues to emerge were: effective information provision; objective, non-judgemental approaches; defined/limited to a specific target audience; interactivity that personalised the website access; clear, simple layout and design; attractive, aesthetically pleasing characteristics; relevant life experiences or graphics; a match between the website's content and the title and description of the site provided by the search engine; and whether it was provided by known and trusted organisations.
Across focus groups, websites that provided clear, concise information regarding AOD use were considered the best. Key features of sites that did this best were use of images and pictures in place of text, provision of evidence to support information, avoidance of jargon (e.g. used street names of drugs), and presentation of information that was easily understood and accessible by a range of people who differ in reading ability, internet use history and cultural background.
"Plenty of them had too much information... it takes a lot of time, and whoever has the problems, I assume, doesn't have enough patience..." [Member of CALD Group]
Participants in the 16-25 year focus groups said the tone of language was critical in their perception of usefulness and acceptability. Websites that seemed objective, unbiased and non-judgemental were more acceptable than ones that took a "preachy" approach to information provision. Explanations of why and how issues were relevant and important to the issue of AOD use were valued, as opposed to provision of advice about what "should" or "shouldn't" be done.
"...to me I think, when these websites say don't do this, don't do that, I don't want to listen...whereas if it says if you are going to do it, do it responsibly... that is more interesting." [Member of 16-25 year groups]
Clear website affiliations were not as important for younger people (16-25 group) than older participants, nor was having knowledge about who created and maintained the website.
"I'd look for their policy statement or something, and their mission statement, anything that gives a sense of their values, and I tend to look for it, to be honest. I tend to have in my mind, I won't go further if this doesn't tell me where they are coming from..." [Member from 25-65 year Groups]
Websites that were tailored to a specific audience, and only provided information that was relevant to that audience (e.g. young people), were also valued. This included the layout and pitching of website content, and linkage to geographically-relevant information and resources to the user's city or rural location).
Greater interactive options increased a website's appeal to younger participants. Opportunities to complete self-assessments online (with caveats regarding accuracy and validity of results), quizzes, question and answer sections and animations were all identified as features of a website that kept attention of site users. Interactivity options needed to be relevant to the site's target group, and needed to engage users while not distracting attention away from the seriousness of the issues addressed.
All focus group discussions considered the layout of the website (and particularly the home page) of paramount importance in rendering it appealing, engaging, interesting and accessible. Key features were clear, easy-to-read text (including level of language and style of font), a "clean", uncluttered layout (avoiding excessive text, graphics), simple navigation (including ability to readily returning to the home page), and a logical flow of information throughout the site. A site's "look and feel" was important to many participants. Minimizing "pop-up" advertising and other promotional information reportedly affected perceptions of 25-65 year participants. Websites needed to be "eye-catching within the first few seconds", with engaging use of colour, graphics or images and interactive options.
"I like colour- believe it or not, and I just feel, when it is very clinically written, I just sit back. But when it is colour and it gives a genuine feeling of welcome, then I wanted to have a look..." [Member of 25-65 year Groups]
Participants suggested that links to other websites and resources should be minimised, and information relevant to the website's objectives (and to the target audience) should be accessible and contained within the website.
"...you don't want to have to go through too many links either...you just want [it] to come up on the page...for it to be clear, concise and to the point, and not having to filter through different links... it gets confusing..." [Member from 16-25 year Groups]
Some focus group members in the 16-25 year, 25-65 year and the ATSI groups said that inclusion of life stories was important, as it personalised the experience (and accentuated the relevance) of information. Young people suggested that including success stories available, such as the "rise and fall and rise again" of well-known personalities may engender hope. Younger participants also suggested that inclusion of graphic images of the consequences of AOD use added a curiosity factor to some websites, encouraging users to explore the website further.
Crucial to a website's appeal was that expectations for its content were met. The title of a website (or the URL) and the description provided by the search engine needed to match the objectives of the site and what it offered. A title that minimised use of jargon was more appealing, as was a "catchy" name, as it would be easily remembered and recognised. Ranking on the search engine list was also considered important.
A few participants felt most comfortable visiting websites that represented organisations with a public profile separate from the internet. Well-known (and therefore trusted) community groups or companies were frequently visited by participants, as were sites with ".org" or ".gov" in their address. Federal and state-sponsored websites were often the first port of call and were considered a safe place to start a search for sensitive information.
"I was pretty new in this kind of internet researching and, I wanted to get into some very general first sites, first choices were government, and I spent more time in a few of them, 'cause I wanted to see all of the things that they are offering there...' [Member of CALD group]
Gaps in existing online resources for AOD use
When asked about what was missing in their online search results, participants identified the following: websites related to prevention; websites related to comorbidity; explanations as to why AOD use can be harmful; practical advice and suggestions; a "hub" site or AOD portal through which other websites can be accessed easily; graphics of illicit drugs and consequences of use; online forums; the ability to access immediate help; websites containing simple information and that used images; and assistance for non-English speaking persons.
Young people wanted practical advice and suggestions about how to stop drinking or bingeing, rather than just advice to avoid this alcohol use. They suggested that information and advice to families and friends of AOD users was not available online, with many websites instead providing links to telephone advice.
"...I know at the end of the day you need to know what those issues are, but there seemed to be too much of a focus on that, rather than how to help people or where you can refer too..." [Member from 16-25 year Group]
A harm reduction message was sought by young people with practical tips about how to minimise or avoid risks.
"I guess how to like, you can't stop drinking all of a sudden, there was nothing that said how to ease off, it was just, don't do it all. Or you will go to jail, blah, blah, blah...I just switched off" [Member from 16-25 year Groups]
Participants across the focus groups wanted a hub or portal site that provided a "one stop shop" for AOD information. That site would contain links relating to AOD issues e (e.g. information about drugs, how to assist friends, legal information, etc.) and would be placed high on search engine results. This approach was also a way to access local information.
"...as far as the information is concerned, in the website stuff, a uniform [approach] would be good, so that everyone can access the same information in the same ways...". [Member from CALD Group]
There was a lack of websites providing concise information in plain English that was coupled with relevant images. This type of information was identified as being particularly important to people with limited facility in written English. No website seemed to accommodate people from CALD backgrounds.
Older participants (25+ groups) and those from CALD groups found it surprising they could not access immediate help online.
"You asked did the website meet our expectations... I thought if someone was trying to get help, from the internet, how to solve a problem, the first thing I expected is, online counselling or something like that, so you don't go to GP, you don't go nowhere, you just want to get help [online]... I found it on none of the websites..." [Member from CALD Group]
Acceptability of online treatment for AOD use
The most common response when asked for opinions about online AOD treatment was confusion. In every group, the facilitator spent several minutes providing examples of potential online treatments. This appeared largely due to a lack of previous experience with online AOD treatment programs.
"Like, how so?" [Member from 16-25 year Groups]
"You mean like online AA?" [Member from 16-25 year Groups]
"...do you mean like...an online messenger thing, were you could chat with, I guess, someone at the other end?" [Member from 16-25 year Groups]
"How do you talk to someone on the internet, unless you are like chatting on msn? Is that just giving information?" [Member from 16-25 year Groups]
"So you are saying, what do you mean by treatment, do you mean abstaining for a period of time or...?" [Member from 25-65 year Groups]
Initial responses of each group towards the idea of online treatment were cautious and somewhat negative, with concerns raised regarding the perceived impersonal nature of online treatment, reliability and validity of reports of behaviour and of suggested strategies, and concern about the degree of access to ongoing maintenance and support.
As discussion developed, participants became more open to the idea of accessing online treatment, but saw it as being dependent on characteristics of the person seeking treatment, as an initial step in the treatment process, and as primarily relevant to situations where confidentiality and anonymity were especially important.
Concerns were raised by each group regarding the impersonal nature of online treatment, and the perception that internet-based treatment was a "one size fits all" approach to addressing a very individual problem. Participants said that, particularly for AOD related issues, face-to-face contact was important in order to "make treatment real" and to encourage people in therapy to take full responsibility for their problems.
Internet-based treatment was also seen to be "easier to ignore". Concerns were raised that less commitment to treatment was likely, as there were fewer opportunities for engagement with a therapist and treatment program. It would be easier to disengage or "not to bother and drop out" from online programs than from face-to-face treatment.
The reliability and validity of treatment online was brought into question by many participants across the focus groups. Participants were anxious about the potential for people to misrepresent themselves as therapists online, without an accurate way to determine a therapist's qualifications, or their true identity.
Some participants felt that dangers of online self-diagnosis and treatment outweighed its benefits, raising concerns raised about information, treatment strategies and advice being misinterpreted and misused by site users.
"Text can be provided in different interpretations, to different people, so [the way they] might interpret it is different from somebody else...the information might then not turn out to be accurate, and mightn't be helpful..." [Member from 16-25 year Groups]
Other participants strongly argued that online treatment sites should be evaluated to ensure that they worked in the intended way.
After considering a range of possibilities for online treatment provision, participants were generally supportive of the idea. Depending on the individual and the circumstances, this mode of delivery may have important applications.
"I think it could be interesting, 'cause you are not going to freak out and stuff, and you can just try, just try at home, you know? Get an idea you know." [Member from 16-25 year Groups]
Participants suggested that online treatment would require more motivation and commitment than would be required from face-to-face approaches. Individuals pursuing online treatment would need this to be explained upfront.
Internet-delivered treatment was seen as a potentially useful initial step within a larger therapeutic process, rather than being suitable for more severe problems.
"But maybe with a screening process, like if you thought you had an addiction and you were trying to break it, you jump on and you go, I smoke marijuana three times a day, what can I do, they will say well maybe go and see your GP or well find out some information, and maybe build up a bit of a profile and help them to access treatment." [Member from 16-25 year Groups]
Participants said that websites would be good for online screening, provision of brief advice (including links to appropriate support services) for people with mild to moderate problems, and for online contact with another person (a therapist or sponsor) to whom the site user is accountable for change and program completion.
For people with concerns about privacy and confidentiality, the internet-based approach was seen as potentially allowing access to resources in a safe and secure environment.
"... some people wouldn't be able to walk into a doctor's, and you know and tell your parents, it is like nope...It is easier to talk to a complete stranger and type it in..."
[Member from 16-25 year Groups]
"I just had a thought, you are from a small town ...there is a privacy thing, everyone knows everyone, if you are in the waiting room, somewhere, you really don't want someone to see you in a waiting room somewhere... it is the privacy thing of the internet, you know at least getting some of the idea, getting started..." [Member from 25-65 year Groups]
Participants had a range of ideas for marketing of AOD websites, including: a portal or hub site that could be branded and promoted, advertising the websites on other sites, and, the use of interactivity sites such as Facebook and Twitter.
Specific suggestions included paid television advertisements and print media, advertising on the side of buses, graphic images or slogans on alcohol bottles, merchandising website logos (e.g. on stickers, hats, magnets, t-shirts), sponsored links on search engines, promotion in bars, or community events, or using word of mouth.
"like all the forums, all the messenger stuff, like you need [something] that they can forward on to all their friends, cause it is all about forwarding...
"but within that information, you need to have something relevant, not just have, not just don't use drugs..." [Members from 16-25 year Groups]
Some participants suggested promoting websites through schools, developing "catchy" titles for sites and branding to facilitate website recognition, placing promotional material in General Practice waiting rooms, recruiting a well known person for an advertising campaign, using reality television approaches to describe personal journeys involving AOD use, and using organisations that are known to the target group.
To continue the engagement of registered site users, they suggested that SMSs be sent to their mobile phones at key times when AOD use was likely (e.g. early to late evening on weekends),
"...you could actually set up something before you went out, to send yourself an SMS text ... to remind yourself to eat between drinks, or alternate your drinks, or ... when the last train or bus was leaving to get home safely."
[Member from 16-25 year Groups]