Text in the City: Medical Professionals Use Social Media to Reach Teens on Sexual Health


Last week one of my students called me “old school.” She’s right. Today’s young people have more computing power in their pockets than I could have found anywhere on my campus. And medical professionals are taking advantage, using text messaging and social media to help teenage patients prevent STDs. It makes sense that my old tri-fold pamphlet is obsolete. This week an article in the New York Times highlights physicians who use texting and Facebook to care for young patients. And a study in the November issue of the American Journal of Preventive Medicine found that Facebook can be effective in promoting condom use among young people.

Dr. Text

Dr. Natasha Burgert, a pediatrician in Kansas City, uses both texting and social media to provide care to her adolescent patients. She brings her i-Pad into the exam room in order to bring up information on various health topics, including STDs. She occasionally watches relevant videos with her patients. Her exam room has no brochures but numerous hyperlinks and Quick Response codes that link to “…teenager-friendly material on sexuality, alcohol, and drugs. The teenagers can photograph the board with their phones, storing the information to peruse in private.” She also writes a blog, and patients follow her on Twitter and Facebook. Burgert says, “I do as much as I can to get it on their phones, because that is what they live and die for.” She told the Times that she does get parents’ permission “… because she doesn’t want them checking a child’s phone and chancing upon sites about, say, sexually transmitted diseases.”

When Burgert communicates with her patients by text she keeps it innocuous to ensure privacy. A recent text to a patient read, “Everything is great. Go ahead with the plan we discussed. Please reply so I know you received.” She says the extra work is worth it because it can “… help patients make good, healthy decisions.” Burgert says her teen patients realize that texting with her is a privilege and tend not to take advantage of it (a claim she cannot make for first-time parents of her newborn patients).

I asked Elizabeth Casparian, executive director of Hi-Tops, a Princeton-based adolescent-health-and-education organization, about texting with teens:

“In our experience working with young people ages 13 to 26, we have found that they use their cell phones for everything.  Email is an outdated mode of communication with this group.  Text messaging is the best way to privately remind them about appointments and to find them when we need them to come in for treatment or test results.”

According to the Times, some doctors stop short of texting because of privacy laws and confidentiality. Dr. Wendy Sue Swanson, a pediatrician at a clinic outside Seattle who also practices at Seattle Children’s Hospital, says that her clinic won’t let her text because such messages are not encrypted. But she does use other forms of digital media, including a Twitter account and a blog called Seattle Mama Doc. Patients ask questions on her blog. She doesn’t answer individual questions, but if she thinks other teens have similar questions, she will post a response without naming the patient who asked. She also helps patients set daily alarms on their phones to remind them to take their birth control pills. For privacy she suggests that they, “Call it strawberry.” 

New York City’s Mount Sinai Hospital’s Adolescent Health Center created a program called Text in the City. It sends patients reminders about medications and appointments, as well as general-health tips. Patients may also ask questions that will be answered by a physician within 24 hours. At the New Generation Health Center in San Francisco, a reproductive-health clinic for adolescents, a program coordinator has created a blog, JustAskShawna, on which she answers teens’ questions anonymously.

Elizabeth Schroeder, executive director of Answer, which runs www.sexetc.org, a sexual-health website for teens, says that using the Internet meets one of the very first requirements of health education: “be learner-centered:”

“This is where young people are and how they like to get information.  It’s a brilliant strategy. Clinicians who fuse technology and social media are going to find an impact with their young patients.”

Facebook Likes

Facebook poses a challenge for health-care providers because it is less private than texting. Most physicians stop short of “friending” their teenage patients, though many suggest that parents do. Some physicians create their own Facebook pages and ask their teen patients to “Like” them so the teens can receive information. Kids Plus Pediatrics in Pittsburgh employs a communications director to manage its Facebook page and website. Most of the practice’s Facebook followers are parents, but some teens do hit the “Like” button. One of the practice’s 19 physicians explains:

The challenge is will teenagers see you as cool enough to push information that will be on their Facebook news feed? Because their friends will see it and judge them.

The new study in the American Journal of Preventive Medicine suggests that Facebook “Likes” and the information that can be provided to young people through Facebook can encourage healthy sexual behavior, at least in the short term.

Researchers recruited participants from communities, local papers, and popular websites in U.S. cities that had higher-than-average rates of Sexually Transmitted Infections (STIs). They focused on African-American and Latino youth because these young people are disproportionately affected by STIs. Each participant was asked to recruit three additional participants. 

Participants were randomly assigned to one of two groups. The intervention group signed up to “Like” Just/Us, a Facebook “community” developed to promote sexual health. Each week participants in this group learned about a new topic “… such as communicating about sexual history, skills building for condom negotiation and use, or how to access STI testing.” Youth facilitators with Just/Us provided daily updates on the topic, including video links, quizzes, blogs, and threaded discussions. Participants in the control group signed up to “Like” a page called “18-24 News,” which provided them with “… news that happened during the hours of 6 p.m. to midnight on the 24-hour clock that was of interest to 18- to 24-year-olds.” In total, 924 people were enrolled in the intervention group, and 636 people were enrolled in the control group.

Two months after the intervention, researchers asked participants in both groups whether they had used condoms the last time they’d had sex. They also asked what proportion of sex acts that participants had engaged in during the last 60 days were protected by condom use. They found that a larger percentage of the Just/Us group (68 percent) reported using a condom during the last sex act than did those in the control group (56 percent). The proportion of sex acts protected by condom use in the last 60 days showed similar results, with 63 percent of the Just/Us group reporting condom use, versus 57 percent of those in the control group.

These effects were short-lived, however; six months after the intervention, there were no differences between the two groups. Still, the researchers believe that their results show that Facebook can be an important tool for changing behavior. Sheana Bull, the lead investigator on the study, explains

The effect size from the short-term outcomes match or exceed those observed in other Internet interventions, suggesting Facebook for sexual health interventions is at least equally effective as other technology-based mechanisms, and these effects match those observed for more traditional HIV prevention programs delivered in real-world settings.  

She went on to say that this study is:

A first step in considering how to reach the overwhelming numbers of youth online, and how to maximize approaches to technology-based interventions.

Schroeder’s organization has a strong presence on both Facebook and Tumblr. She explains that:

“Teens interact more on Facebook than on our site.  Facebook becomes the place where they are hanging out and being there is how you are seen as relevant and someone who understands them.”

Schroeder adds that her organization supports unfettered access to sexuality education, and the Internet is one of the most important tools for providing it: 

“We still know that it’s best when sexuality education is provided to young people by trained adults but there are still far too many adults who are invested in keeping that from happening. In some cases we need to eliminate the middle person and access young people directly.”

I use Facebook and have a Twitter account, but as a sexuality educator, I need to get more comfortable with the ways in which new technologies can help reach young people—but only if I can also admit that I kind of miss designing tri-fold brochures.

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