Design of an online health-promoting community: Negotiating user community needs with public health goals and service capabilities

activities, the emphasis in online communities is on learning and information exchange [5,6]. Self-directed learning, where the individual is in command of what should be learned, stands in contrast to health education, where health experts provide information that they think the recipients need [7]. An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. In Sweden more than 90% of adolescents have Internet access and go online several times a week [8]. However, an OHPC must be managed and even if advances in web technologies simplify the initiation of online communities, management and maintenance must be sustainable. An online community involving the health care service needs to be in accordance with public health goals and service capacity. Public health representatives cannot be expected to invest time and funding in an intervention at odds with the goals of the public health service. In Sweden, obesity among children has not yet matched the epidemic proportions reported from other parts of the world [9-12]. However, among adolescents, overweight and self-consciousness regarding body shape, diet and exercise influence their social, psychological and physical health [13-15]. Obese children may be in need of secondary prevention because of the adverse effects related to obesity, such as development of coronary heart disease, related to long-term obesity [16], but it is less obvious what to prevent in the remaining population. General interventions, such as health education, to prevent overweight and obesity are problematic because of the lack of procedures that have general application [13,17]. There is a need for personalized community-based health promotion [18]. Online interventions are especially suitable for this purpose when considering the amount of time adolescents spend online [19]. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities. The study was performed in a health care region (population 1 200 000) in the south east of Sweden, where analyses of obesity data had shown that the need for obesity prevention among adolescents was greater than the resources available [20]. The results indicated that obese adolescents would benefit from more specialized interventions; a need for an online public health intervention addressing the non-obese adolescent population was also identified. Methods Community-based participatory research methods [21,22] were used for the study and participatory design principles were used for the OHPC systems development [23]. Community-based participatory research methods provide an arrangement for balanced influence and control over research processes by non-academic researchers and support structures and processes for academic–community partnerships to improve health [24]. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region. Using a three-step analysis, the data were transformed to specify the structure and functions of an OHPC intervention (Figure 1). In the first step, the crude data were analysed and structured into health information needs. The identified needs were then transformed into requirements for an OHPC intervention by an interdisciplinary expert team. In this context, needs refer to problems expressed that warrant a solution; requirements are associated with the design of an information system [25]. In the third step, a prototype based on the user-derived requirements was compared with regional public health goals and service capabilities by public health official representatives from the region, and modified accordingly. Conflicts between the system requirements derived from the adolescents and public health goals and resources were identified. Data collection The model population for the development of the OHPC intervention consisted of high school students in their senior year (17–18 years of age). A convenience sample (n = 65) representing the population of adolescents aged 15–20 years (n ≈ 50 000) in the study region was recruited. Focus group interview sessions were arranged with adolescents according to two criteria: home community sociocultural profile (industrial–technological, small business–church dominated, small business–agricultural) and high school program profile (high school program in science, arts or nursing). High schools corresponding to the listed program profiles in each study community were contacted and asked for assistance with recruiting students for focus group meetings. Qualitative data were collected using two sets of focus group interviews. The topics for the first set of interviews were physical health, psychological health, and health products; the second set of interviews covered health information in the media, information needs and information-seeking behaviour. The protocol for the focus group sessions is provided in Additional file 1. Initially, each student was asked to pa