This study was a cross-sectional study where primary data were collected from students in selected senior high schools in the Kumasi Metropolis. Based on the formulated research questions that the researchers wanted to answer and the nature of the study, the quantitative research design was most appropriate, hence its adoption in this study. The quantitative design helped the researcher to estimate the relationships between the variables understudy. Thus, in this study, the quantitative research design helped the researcher to determine the relationship among the level of knowledge and seeking and sharing health information among the students.

Students in senior high schools in the Kumasi Metropolis were the target population. The metropolis has a number of senior high schools, both near and far from the researchers. This study employed convenience sampling to sample the schools and students (28). The schools were selected based on proximity and the willingness of the schools' administration and individual students to participate. Based on these two criteria, five schools were sampled from the study area. The study considered proximity to be how the schools were closer to each other and to the researchers as well. The researchers choose 5 out of 21 senior high schools in the metropolis based on the assumption of similar characteristics of the students. The age range of senior high school students was between 15 and 18 years. This connotes homogenous adolescent characteristics for these students understudy; hence, the study's generalization is justified. The study admits that the heterogeneous socioeconomic background of students might have caused different perspectives about the problem understudy. However, since the students were all in the same schools facing virtually the same problems, such differences were not significant to be noticed.

Again, premised on the principle of anonymity and ethical consideration, the names of the schools have been withheld and classified them as Schools A, B, C, D, and E. It is imperative to note that Schools A and B were strictly boys' schools, C and D were strictly girls' schools whereas E was a mixed school (both boys and girls). These schools were chosen because they are considered as the elite schools with most of the best educational facilities for academic work in the study area. Again, as stated earlier, the researchers assumed that since the students were in their teens, their perspectives about their health information would not differ much. Based on the aforementioned assumptions, the schools were chosen for the study. The respective population of the sampled schools are shown in Table 1.

Aside the study sampling of the schools, the study sampled the students through convenience sampling. The criteria used here were “easy access to students” (29). This study realized four places where students could be found easily. First, in classrooms during the lesson; second, at dining hall during dining time; third, at the canteen during break time, and fourth, at school entrance both in the morning and after school. Among these four places, canteen during break time and at the entrance of dining hall after dining periods were most convenient due to time and activities of the students. The assumption for choosing these places was that at least, a student would be found at one of the venues at the time of data collection. The researchers first sought the consent of participants and assured them of strict confidentiality. The researchers then read and explained the questions to the participants before answers were required. Because the researchers had a fair knowledge about the exact number of sample size they were seeking to sample, they did not continue the data collection after accurately getting the exact number (391).

The study employed Yamane (30) sample size determination formula in Equation (1) to compute the overall size for the study.

where: N signifies the population under study = 16523

e signifies the margin of error = 0.5

n signifies the sample size = 391

From the formula in Equation (1);

Therefore, the overall sample size for this study was 391. This study further used a proportionate stratified population sampling technique to determine the sample size for each school as shown in Table 2.

Among the data collection instruments (questionnaire and interview guide), this study relied on the questionnaire to collect all primary data from the students. This study used a structured questionnaire because it helped the researcher to collect standardized data, and second to collect data at a cheaper administration cost (31, 32). The questionnaire design has four sections. Section I focused on demographic data; Section II focused on the level of knowledge of health information; Section III focused on attitudes toward seeking health information; and Section IV on the attitudes toward sharing health information. All the questions contained in the questionnaire, except those under Section I (demographic data), were in the form of a five-point Likert scale.

This study collected all primary data between December 9, and December 13, 2020. The study sought permission from the headmasters or headmistresses of the selected senior high schools through an introductory letter obtained from St. Monica's College of Education. The researchers administered questionnaires in the selected schools by themselves. A strategy was devised to ensure a high response rate. This was achieved by encouraging all respondents to fill in the questionnaire in the presence of the researchers. This did not only ensure a high response rate but also offered the opportunity to clarify all misunderstandings surrounding some of the research questions.

The participation in the study was not compulsory but students willingly participated and gave out accurate data (33, 34). The study informed the purpose of the study to all respondents and assured them strict confidentiality and anonymity. Before the actual data collection, this study ensured that the instrument used is valid and reliable. The researchers showed the research instruments to their colleagues who helped to restructure the questionnaire to be more consistent with the research objectives. For reliability, the researchers pre-tested the questionnaire at SIMMS Senior High School in the Kwabre East Municipality on 25 students. This was performed to ensure that errors in the questionnaire were corrected before actual administration.

The data collected were analyzed with the use of descriptive and inferential statistics. The data were cleaned and entered into Statistical Package for Social Scientists (SPSS) version 21.0. For the descriptive analysis, frequencies and percentages were used to analyze the data. For the inferential analysis, this study used Pearson's correlation coefficient to show the degree of relationship among the level of knowledge of health information and attitudes toward seeking and sharing information on health. In furtherance, data were presented as numbers and percentages for categorical variables.

The study was approved by the Committee on Human Research, Publication, and Ethics of the School of Medical Sciences, Kwame Nkrumah University of Science and Technology/Komfo Anokye Teaching Hospital with reference number CHRPE/AP/317/20. Again, all participants gave verbal consent for their participation in the study.

This section talks about the sociodemographic characteristics of the respondents. These characteristics included sex, class, and program of study of students understudy. The sociodemographic characteristics of the respondents (students) are shown in Table 3.

From Table 3, out of 391 respondents, 213 (54.5%) were boys whereas 178 (45.5) were girls. Even though gender parity at the senior high schools has been attained in Ghana, male students dominated in the study as against their female counterparts. This may be attributed to the willingness of the male students to take part in the study at the time of data collection. The class distribution of the respondents is shown in Table 3 as 165 (42.2%) for Form 2 and the remaining 226 (57.8%) for Form 3. The number of the Form three (3) students increased because, at the time of the data collection, all the Form 3 students were in school. However, only the gold track Form one and two students were present. This explained why the number of students from Form two was relatively lower compared with the Form three students. The students from form one were not considered since they were new to the schools; hence, any information from them may be insignificant since it would not be a true reflection of information on their health and usage behavior of the students on campus.

In relation to program of study in senior high schools in Kumasi Metropolis, Table 3 shows that 90 (23.0%) of the respondents offered home economics, 75 (19.2%) offered business, 100 (25.6%) offered general arts, 80 (20.5%) offered visual arts, and 46 (11.7%) offered science. The study shows that majority of the students offered general arts and home economics. This may be because general arts and home economic courses are now the mostly considered courses in the admission into nurses training colleges and colleges of education in Ghana. As a result, most students who want to pursue nursing end up pursuing general arts and home economics. Moreover, most of the students have the notion that general arts and home economics are easy to pass and this influences most of the students to offer both.

The study sought the respondents' knowledge on the symptoms and causes of some common diseases (malaria, cholera, and STIs) among the students. The responses were collected from the questionnaire and summarized in Table 4.

From Table 4, out of 391 respondents, 76 (19.4%) noted a low level of knowledge, 125 (32.0%) expressed a high level of knowledge, and 190 (48.6%) indicated a very high level of knowledge on the cause of malaria among students in the Kumasi Metropolis. The study shows that most of the students in Kumasi Metropolis have a high level of knowledge on the causes of malaria. This is because malaria is one of the common diseases that affect most of the students in the study schools. In addition, Table 4 further shows that 74 (18.9%) of the respondents expressed a low level of knowledge, 140 (35.8%) noted a high level of knowledge, and 177 (45.3%) indicated a very high level of knowledge on the symptoms of malaria. Thus, the study revealed that the majority of the respondents had a high level of knowledge on the symptoms of malaria. The respondents gave some of the symptoms of malaria to include feeling hot and shivery, headaches, vomiting, muscle pains, diarrhea, and generally feeling unwell. They however added that some of the symptoms are often mild and can sometimes be difficult to identify as malaria.

Again, Table 4 shows that 90 (23.0%), 135 (34.5%), and 166 (42.5%) expressed low, high, and very high levels of knowledge on the cause of cholera, respectively. The study shows that majority of students in Kumasi Metropolis have a high level of knowledge on the causes of cholera. This may be as a result of the fact that most of the students asserted, that they had suffered from the disease since they came to the school. The results in Table 4 reveal that 85 (21.7%) expressed a low level of knowledge, 145 (37.1%) showed a high level of knowledge, and 161 (41.2%) indicated a very high level of knowledge on the symptoms of cholera among students in senior high schools in Kumasi Metropolis. The results show that majority of the students have more information and knowledge about the symptom of cholera.

Moreover, from Table 4, out of 391 respondents, 78 (19.9%) noted a low level of knowledge, 165 (42.2%) indicated a high level of knowledge, and 148 (37.9%) expressed a very high level of knowledge about the causes of sexually transmitted infections (gonorrhea and syphilis). The study revealed that students in senior high schools in the Kumasi Metropolis have a high level of knowledge on the causes of STIs (gonorrhea and syphilis). Table 4 shows that 88 (22.5%) noted a low level of knowledge, 158 (40.4%) indicated a high level of knowledge, and 145 (37.1%) expressed a very high level of knowledge on the symptoms of STIs in the Kumasi Metropolis. The study revealed that most of the students in Kumasi Metropolis know the symptom of STIs. They however could not give more important symptoms of STIs.

The section further sought to determine the attitudes of students toward seeking information on their health in the Kumasi Metropolis. The study asked the respondents to indicate how often they use any of the following sources to seek information on their health. The responses were collected from the questionnaire and summarized in Table 5.

Results from Table 5 show that 90 (23.0%) noted rarely, 145 (37.1%) not often, 75 (19.2%) often, 43 (11.0%) very often, and 38 (9.7%) expressed extremely often that they seek information on their health using the internet. This shows that most of the students in Kumasi Metropolis do not use the internet to seek information on their health. Again, from Table 5, the results show that 34 (8.7%), 54 (13.8%), 48 (12.3%), 130 (33.2%), and 125 (32.0%) noted rarely, not often, often, very often, and extremely often, respectively, that they seek information on their health from health professionals. This clearly shows that the majority (77.5%) of the respondents often seek information on their health from the health professionals.

Moreover, results in Table 5 show that 39 (10.0%) indicated rarely, 42 (10.7%) not often, 20 (5.1%) often, 120 (30.7%) very often, and 170 (43.5%) extremely often seek information on their health from their friends. This suggests that the majority (79.3%) of the respondents asserted that they seek information on their health from their friends. In addition, from Table 5, 37 (9.5%), 32 (8.1%), 30 (7.7%), 168 (43.0%), and 124 (31.7) of the respondents noted rarely, not often, often, very often, and extremely often, respectively, that they seek information on their health from textbooks. The study reveals that most of the students in Kumasi Metropolis seek information on their health from their textbooks.

Last but not least, Table 5 shows that 165 (42.2%) noted rarely, 80 (20.4%) not often, 50 (12.8%) often, 55 (14.1%) very often, and 41 (10.5%) extremely often that they seek information on their health from newsletters. This suggests that the students in Kumasi Metropolis do not seek health information from newsletters.

This study used the chi-square test to test for a statistical association between each source of information on their health and the level of knowledge on the same. The results have been illustrated in Table 6.

From Table 6, the study found a significant association between the level of knowledge of the causes of malaria and seeking health information from the internet (chi-square value = 15.456, p = 0.014), health professional (chi-square value = 20.354, p < 0.001), friends (chi-square value = 18.867; p < 0.001), and textbooks (chi-square value = 19.578, p < 0.001). That is, as the students seek information on their health from the internet, health professionals, friends, and textbooks, their level of knowledge on the causes of malaria is increased.

Further, Table 6 shows that there is significant association between the level of knowledge on the symptoms of malaria and seeking information on their health from the internet (chi-square value = 13.322, p = 0.012), health professionals (chi-square value = 19.689, p < 0.001), and textbooks (chi-square value = 18.795, p < 0.001) at 5% significant level. This shows that students' level of knowledge on the symptoms of malaria increases when they seek information on their health from the internet, health professional, and textbooks.

The analysis in Table 6 shows that there is significant association between the level of knowledge on the causes of cholera and seeking information on their health from the internet (chi-square value = 14.482, p = 0.022), health professional (chi-square value = 21.856; p < 0.001), and textbooks (chi-square value =14.533, p = 0.022). This shows that students' level of knowledge on the causes of cholera increases when they seek information on their health from the internet, health professional, and textbooks. Similarly, the level of knowledge on symptoms of cholera was significantly associated with seeking information on health from the internet, health professionals, and textbooks. Again, from Table 6, there is a significant association between the level of knowledge of the causes of STIs and seeking information on their health from the internet (chi-square value = 22.259, p < 0.001), health professional (chi-square value = 23.523, p < 0.001), and textbooks (chi-square value = 18.120, p < 0.001). That is, the more the students seek information on their health from the internet, health professional, and textbooks, the higher their level of knowledge on the causes of STIs. Similarly, the level of knowledge on symptoms of STIs is significantly associated with seeking information on health from the internet, health professionals, textbooks, and newsletters.

Again, this section sought to know the attitudes of students toward sharing information on their health. The researchers asked the respondents to indicate the extent of their agreement or disagreement with each of the following statements. The responses were collected from the questionnaire and summarized in Table 7. This study further used the chi-square to test the significance of association between attitudes toward sharing information on their health and the characteristics of the respondents.

From Table 7, out of 42 respondents who noted strongly disagree that they share information on their health with friends, 18 (42.9%) were boys and 24 (57.1%) were girls. From Table 7, out of 38 respondents disagreed that they share information on their health with friends and of out this number, 22 (57.9%) were boys and 16 (42.1) were girls. Furthermore, out of 391 respondents, 25 of the respondents who expressed neutral that they share information on their health with friends 10 (40.0%) and 15 (60.0%) were boys and girls, respectively. Among the 184 of the respondents who agreed that they share information on their health with friends, 58 (31.5) were boys and 126 (68.5%) were girls. In addition, out of 102 respondents who noted strongly agree, 37 (36.3%) were – boys and 65 (63.7%) were girls. The study further reveals that there is a strong association between the sex of student and sharing information on their health with friends (chi-square value = 17.285, p < 0.001). Thus, the study ascertained that female students strongly share their information on health with friends than their male counterparts.

Table 7 further revealed that out of 42 respondents strongly disagreed that they share information on their health with friends, 16 (38.1%) were in Form two and 26 (61.9%) were in Form three. Out of 38 respondents who noted disagree, 18 (42.4%) were in Form two and 20 (52.6) were in Form three. From Table 7, out of 25 respondents who expressed neutral, 14 (56.0%) were in Form two and 11 (40.0%) were in Form three, and out of 184 respondents who indicated agree, 65 (35.3%) were in Form two and 119 (64.7%) were in Form three. In Table 7, out of 102 respondents who strongly agreed that they share information on their health with friends, 52 (51.0%) were in Form two and 50 (49.0%) were in Form three. The study also reveals that there is a significant association between the class of the student and sharing information on their health with friends (chi-square value = 19.258; p < 0.001). Thus, the study gives an indication that Form three students strongly share their information on health with friends than Form two students.

In furtherance, Table 7 shows that out of 105 respondents who strongly disagreed that they share information on their health with parents, 60 (57.1%) were boys and 45 (42.9%) were girls. From Table 7, out of 58 respondents who noted disagree, 32 (55.2%) were boys and 26 (44.8) were girls; and out of 55 of the respondents who expressed neutral, 18 (32.7%) were boys whereas 37 (67.3%) were girls. As shown in Table 7, out of 125 respondents who agreed, 50 (31.5%) were boys and 75 (68.5%) were girls. Again, out of 48 respondents who strongly agreed, 28 (58.3%) were boys and 20 (41.7%) were girls. The study reveals that there is a significant association between the sex of student and sharing information on their health with parents (chi-square value = 13.285, p = 0.004). Thus, the study gives an indication that female students share information on their health with their parents more than their male counterparts.

The results in Table 7 show that out of 105 respondents who strongly disagreed, 30 (28.6%) were in Form two and 75 (71.4%) were in Form three, and out of 58 respondents who noted disagree, 24 (41.4%) were in Form two and 34 (58.6%) were in Form three. From Table 7, out of 55 respondents who expressed neutral, 14 (25.5%) were in Form two and 41 (75.5%) were in Form three; out of 125 respondents who agreed, 68 (54.4%) were in Form two and 57 (45.6%) were in Form three. Table 7 shows that out of 48 respondents who noted strongly agree that they share information on their health with parents, 29 (60.4%) were in Form two and 19 (39.6%) were in Form three. The study found no significant association between the class of the student and sharing information on their health with parents (chi-square value = 9.527, p = 0.069).

Furthermore, Table 7 shows that out of 44 respondents who strongly disagreed that they share their information on health with the health professionals, 26 (59.1%) were boys and 18 (40.9%) were girls. Again, out of 49 respondents who noted disagree, 22 (44.9%) were boys and 27 (51.1%) were girls, and out of 38 respondents who expressed neutral, 16 (42.1%) were boys and 22 (57.9%) were girls. In addition, out of 145 respondents who indicated agree, 70 (48.3%) were boys and 75 (51.7%) were girls; out of 115 respondents who noted strongly agree, 82 (71.3%) were boys and 33 (28.7%) were girls who expressed that they share their information on health with health professionals. The study reveals that there is a strong significant association between the sex of student and sharing information on their health with health professionals (chi-square value = 17.987, p = 0.015). The implication of this is that female students share their information on health with the health professionals more than their male counterparts.

The results in Table 7 further show that out of 44 respondents who strongly disagreed, 16 (36.4%) were in Form two and 28 (63.6%) were in Form three; out of 49 of the respondents who noted disagree, 20 (40.8%) were in Form two and 29 (59.1%) were in Form three; out of 38 of the respondents who expressed neutral, 14 (36.8%) were in Form two and 24 (63.2%) were in Form three; out of 145 of the respondents who indicated agree, 60 (41.4%) were in Form two and 85 (58.6%) were in Form three; and out of 115 respondents who noted strongly agree, 55 (47.8%) were in Form two and 60 (52.2%) were in Form three, who noted that they share information on their health with health professionals. The study reveals that there is a significant association between the class of the student and sharing information on their health with health professionals (chi-square = 19.527, p < 0.001). The senior students were found to share their health problems with the health professionals.

From Table 7, out of 32 respondents who strongly disagreed that they share information on their health with school authorities, 18 (56.3%) were boys and 14 (43.8%) were girls; out of 52 of the respondents who noted disagree, 32 (61.5%) were boys and 20 (38.5) were girls; out of 42 of the respondents who expressed neutral, 24 (57.1%) were boys and 18 (42.9%) were girls. Again, from 155 of the respondents who indicated agree, 85 (54.8%) were boys and 70 (45.2%) were girls, and out of 110 respondents who noted strongly agree, 54 (49.1%) were boys and 56 (50.9%) were girls. The study did not find any significant association between the sex of students and sharing information on their health with school authorities (chi-square value = 16.231, p = 0.023).

Table 7 further revealed that out of 32 respondents who strongly disagreed for sharing information on their health with school authorities, 17 (53.1%) were in Form two and 15 (46.9%) were in Form three; from 52 of the respondents who noted disagree, 17 (32.7%) were in Form two and 35 (67.3%) were in Form three; out of 42 of the respondents who expressed neutral, 19 (44.5%) were in Form two and 23 (54.8%) were in Form three; from 155 of the respondents who indicated agree, 69 (44.5%) were in Form two and 86 (64.7%) were in Form three and out of 110 respondents who noted strongly agree, 43 (39.1%) were in Form two and 67 (60.9%) were in Form three. The study also reveals that there is a significant association between the class of students and sharing information on their health with school authorities (chi-square value = 18.258, p < 0.001). Thus, the study gives an indication that Form three students strongly share information on their health with school authorities than Form two students.