Table 3.

Mapping of adolescents’ feedback on health information websites, their neurodevelopmental underpinnings, and design indicators.

Adolescents’ feedback	Specifics	Psychological profile	Neurodevelopmental underpinnings	Recommendations from adolescents	Design indicators
Visual appearance	Bright colors ✓a; Blank space xb; Too much text x	Novelty-seeking, high susceptibility to rewards [57]	Hypersensitivity of reward regions. There is an adolescent peak in reward-related ventral striatum, specifically nucleus accumbens, activity [58]	More color	Balance of white space to avoid clutter; clear correlation between input and output (reward value); consider accessibility of color options—target Web Content Accessibility Guidelines 2.0 conformance level AA; use images only where they add value; chunking pages into smaller bite-size bits
Navigation burden	Search features ✓; Use of hyperlinks ✓; Slow loading pages x; Difficult log-in x	Low tolerance for delayed gratification [59]	Delay tolerance positively correlates with the resting state functional connectivity between the dorsal anterior cingulate cortex and the left dorsolateral prefrontal cortex, a critical functional circuit in the cognitive control network [59]	Search bar; drop-down menus; hyperlinks to other pages	Consider weight of page, especially as images, graphics, and videos can add to slow loading; resize images to decrease weight on page; enable different ways to search and access, including effective tagging, use of synonyms, filtered and faceted search, and drop-down filters; create different ways for users to search or browse, including effective use of breadcrumbs and anchors; use language appropriate for adolescents for navigational menus; create user journeys with relevant links between sections of the site; use meaningful words to describe links; clearly display whether an in-site link or to an external site; user test log-in process; only capture data as required for fulfilment of service; clear links to privacy statements; clear wording around opt-in and opt-out permissions; 1 click log-in functions, that is, login through Google or Facebook
Delivery of content	Videos ✓; Images, graphics, and charts ✓; Audio ✓; Animation ✓	Processing narratives, emotional stimuli, self-relevance, and attention from salient stimuli [60]	Effective video health messages for young people involve responses in dorsomedial prefrontal cortex, insulae, and precuneus [61]	Sound easy to control; clearly visible; videos not too long; images or graphics not difficult to comprehend; websites that were not too cluttered	Position on page relevant to content; embed videos with uploaded image; play through YouTube, Vimeo, or dedicated video service; use of playlists to manage video length; ensure transcript available for accessibility; resize images; include meaningful alt tags; use images that add value (eg, infographics); consider use of suitable images to break up text, but must be relevant and not just decorative (especially as any image will add to page load); review how screen readers will deal with images
Delivery of content	Information from health professional ✓; Questions from adolescents ✓; Vignettes and testimonials from adolescents ✓	Conscious viewing of credentials for medical expertise and to judge credibility of web-based health information [62]. Especially sensitive to how adolescents fit into their social environment [63]	Neural substrates for social behavior overlap with neural substrates underlying physical pain. This involves the dorsal anterior cingulate, subgenual/ventral anterior cingulate cortex, right ventrolateral prefrontal cortex, medial prefrontal cortex, posterior cingulate, and insula. These regions overlap, continuing to develop structurally and functionally during adolescence [62]	Structured answers from health professionals; positive testimonials from other adolescents	Clear acknowledgment of expertise; ensure consent for any personal data disclosed; framing of adolescent testimonials
Message source	Gender imbalanced pages x; unclear logo and website name x; Age-appropriate ✓	Low tolerance for delayed gratification [59]	Delay tolerance positively correlates with the resting state functional connectivity between the dorsal anterior cingulate cortex and the left dorsolateral prefrontal cortex, a critical functional circuit in the cognitive control network [59]	Make websites age-appropriate; adapt websites to both gender	Use age-appropriate language; use of age-appropriate skins; ensure design reflects trends in adolescent behavior; recognize different age ranges with age-appropriate backgrounds, images, and personalization; consider age-based content segmentation; use colors and designs appropriate for all genders; clear positioning of website name and logo to create credibility in the brand
Participation	Quizzes ✓; Games ✓; Customized webpages ✓; Social networking ✓	Heightened attraction to novel and exciting experiences known as sensation seeking [57]; Friends are more important than at any other stage of life [64]	Rising dopaminergic activation during adolescence, which may reflect activity in the midbrain dopamine pathway ascending from the ventral tegmental region [57]	Interactive content	Break up text with interactive content; use games and quizzes to help teach health content, but must be relevant and necessary (especially as any interactive content will add to page load); polls to receive feedback from adolescents (such as polls on Twitter); allow personalization of webpages; enable peer-to-peer interaction and user-generated content; moderation to prevent trolling; manage safeguarding concerns; manage data protection concerns, access, and verification controls

^a✓: indicates that this is a good feature.

^bx: indicates that this is not a good feature.