PEER COMMUNICATION AND MASS MEDIA HANDLING ON THE HEALTH CONDUCT OF ADOLESCENT

Introduction

Over the last decade, the popular use of social media in the broader community has led to the development of opportunities for the use of social media in the health care sector. Worldwide, adolescents are noted, to varying degrees, as being social media savvy,1,2 the degree of savviness being dependent on governmental policy, individual socioeconomic and geographical limitations as well as societal norms.3 So much so, that market research on adolescents outpaced research by academics in the year 2000.4 Whilst ‘social media’ is a relatively new concept in the health literature, there are numerous opinions and commentary papers that promote the dangers of social media5,6 and the use of social media in health care,7,8 particularly in the area of adolescent health.

Adolescence is an acknowledged phase of individual growth and development,2 yet the term ‘adolescent’ is used inconsistently to refer to young people from a variety of age groups. For the purpose of this paper ‘adolescence’ refers to young people aged 12–24 years and incorporates the early, middle and late stages of adolescence that are individual experiences.9 These individual experiences are affected by the individual’s circumstances; that is, socioeconomic status, support network/s and the wider societal environment,9 including the use of social media. Social media provides young people with individual networks that can be used to promote and reflect the young person’s individualism and community. Social media makes up a significant portion of the young person’s life as it is central to their lifeworld, encompassing communication, work, study and leisure,10 and as such provides one possible avenue to affect adolescent participation and empowerment in the management of their health.

Social media is not a static entity. It is an evolving concept, one that changes with the development and use of technology. A simple dictionary definition describes social media as “online social networks used to disseminate information through online social interaction.”11 Essentially this means that users talk, share information, provide feedback and network on these sites,12 hence the term ‘social.’ The definition excludes technology such as texting and email not associated with sites. Examples of social networks include Facebook, MySpace, blogs, Tumblr, Reddit, Wikis, YouTube, Twitter and Instagram, with adolescents recognized as skilled users of these sites. Kaplan and Haenlein13 provide a greater understanding of social media by identifying characteristics of various social media categories as follows: (1) Collaborative projects, whereby users generate the content; (2) Blogs, where contributions are date stamped; (3) Content communities, where media is shared between users, for example YouTube; (4) Social networking sites, where users connect on a personal level, for example Facebook; (5) Virtual game worlds—three-dimensional platforms (worlds) where users create avatars to interact with others obeying strict world rules; and (6) Virtual social worlds—three-dimensional platforms where users create avatars to interact with others freely. These categories require different knowledge and skills of users for successful participation in the various networks as well as providing different opportunities for use in health care. For example, blogs require the user to simply be able to ask questions and respond truthfully to questions, whereas game worlds provide opportunities for health promotion via gaming.14

Access to web-based applications and platforms can be limited via membership or ‘friendship’ as seen on Facebook, to maintain degrees of user privacy and/or secrecy,15 an important aspect when considering use in health care. More change in social media is expected with the increasing use of mobile social media, such as Smart phones and tablets, as users manipulate and further extend the use of these communication tools. Mobile social media is recognized as facilitating timely and more efficient communication13 and is routinely used in the business operations of health practices and clinics, for example texting appointment reminders.15 As ‘digital natives,’16 adolescents are known as high users of social media,17,18 thus providing a variety of means to access and communicate with adolescents about health.

The health literature to date has focused on the negative aspects of social media related to the volume and value of information available for adolescents;19 the perceived superficial screening of selected information and the possible acceptance of this information that may, of course, be invalid; concerns over the impact of social media on the physical and psychological health of young people, including a sedentary life style, loss of sleep and associated cognitive impairment; and consequences of negative self-perception, bullying, social isolation and reduced social cohesion.10 More recently this research has focused on the use of social media with adolescent health. To date, review articles inclusive of adolescents and social media have reported on: the effectiveness of social networking sites for all phases of research;20 the use of digital media to improve adolescent sexual health;21 and the potential outcomes of adolescent social internet use.22 All review articles identified the potential of social media for use in adolescent health research.

This paper reviews the current literature on the use of social media in adolescent health to address the question: How has social media been used as a health intervention to address the health of adolescents? The objectives of this review were to (1) identify published accounts of health professionals using social media as a health intervention to address the health of adolescents; (2) conduct a quality appraisal of the selected studies; and (3) identify prospective areas of research to improve the use of social media as a health intervention in adolescent health.

Search strategy

The study was conducted systematically and documented to provide transparent reporting of the review process, demonstrating best practice.23,24 Social media being a relatively new term, the search strategy was limited to literature from January 2000 through to December 2013. Six databases were searched, including CINAHL, Medline, Scopus, ProQuest, Psych Info and Science Direct. Prior to the searching of all databases, search terms were initially tested to determine effectiveness in delivering research articles that met the inclusion criteria. The search terms used were adolescen,* and social media. The search was conducted consecutively using the identified databases and search terms. Duplicates of papers were removed. Reference lists from the selected papers were also reviewed for potentially relevant articles, with five additional papers meeting the criteria after review.

Following the electronic literature search, the titles and abstracts of the resulting 1010 papers were reviewed by two authors independently (JS and CM) to assess suitability for inclusion. Inclusion criteria for this review were: original research studies that reported on social media use as a health intervention and the resultant adolescent health outcomes; published in peer-reviewed journals; studies published using the English language; studies with the focus on participants in the 12–24 years age group. Literature that was opinion based or anecdotal was excluded from the review. Studies were excluded that reported on the prevalence of adolescent social media use;25–27 the use of email and texting in adolescent health care;15,28,29 the effectiveness of social media for recruitment of20 and access to adolescents;30,31 conference proceedings;4,32 the positive impact of social media use on adolescents;33 and those that described the negative impacts of social media use on adolescents.34–37

Of the original 1010 papers, 104 papers were read and assessed by two reviewers (JS and CM) to further determine suitability for inclusion in the review. Differences of opinion were resolved via discussion and consensus. On completion of this assessment three papers were available for further appraisal. No further attempt to limit the number of studies on quality grounds was undertaken, given the small number of papers. The limited number of papers for review is explained by the exclusion of papers as follows: 16 papers were excluded as they were not research based; 17 papers were excluded as participant age was outside the age limit of the review; 28 papers were excluded as social media, earlier defined,15 was not part of the individual studies, that is, technology such as email or texting may have been used; and 40 papers that included social media were excluded as the health intervention did not involve the use of social media; that is, social media may have been used for identification of risky behavior,38 recruitment,20 or follow-up but not for the actual health intervention in the study.

Appraisal of selected literature

Appraisal of the selected literature was undertaken by two of the authors (JS and CM) using the QualSyst scoring system, developed by the Alberta Heritage Foundation for Medical Research39 to evaluate primary research papers. QualSyst was deemed appropriate for this review as it provided a process for the appraisal of a variety of quantitative research methodologies39 as found in the selected studies. The use of QualSyst assisted in detecting risk of bias within the studies. The papers for review were considered on methodological quality and the quality of social media information provided, which in turn minimized reviewer bias.