Peer-to-Peer Sharing of Social Media Messages on Sexual Health in a School-Based Intervention: Opportunities and Challenges Identified in the STASH Feasibility Trial

Abstract

Background There is a strong interest in the use of social media to spread positive sexual health messages through social networks of young people. However, research suggests that this potential may be limited by a reluctance to be visibly associated with sexual health content on the web or social media and by the lack of trust in the veracity of peer sources. Objective The aim of this study was to investigate opportunities and challenges of using social media to facilitate peer-to-peer sharing of sexual health messages within the context of STASH (Sexually Transmitted Infections and Sexual Health), a secondary school-based and peer-led sexual health intervention. Methods Following training, and as a part of their role, student-nominated peer supporters (aged 14-16 years) invited school friends to trainer-monitored, private Facebook groups. Peer supporters posted curated educational sex and relationship content within these groups. Data came from a feasibility study of the STASH intervention in 6 UK schools. To understand student experiences of the social media component, we used data from 11 semistructured paired and group interviews with peer supporters and their friends (collectively termed students; n=42, aged 14-16 years), a web-based postintervention questionnaire administered to peer supporters (n=88), and baseline and follow-up questionnaires administered to students in the intervention year group (n=680 and n=603, respectively). We carried out a thematic analysis of qualitative data and a descriptive analysis of quantitative data. Results Message sharing by peer supporters was hindered by variable engagement with Facebook. The trainer-monitored and private Facebook groups were acceptable to student members (peer supporters and their friends) and reassuring to peer supporters but led to engagement that ran parallel to—rather than embedded in—their routine social media use. The offline context of a school-based intervention helped legitimate and augment Facebook posts; however, even where friends were receptive to STASH messages, they did not necessarily engage visibly on social media. Preferences for content design varied; however, humor, color, and text brevity were important. Preferences for social media versus offline message sharing varied. Conclusions Invitation-only social media groups formed around peer supporters’ existing friendship networks hold potential for diffusing messages in peer-based sexual health interventions. Ideally, interactive opportunities should not be limited to single social media platforms and should run alongside offline conversations. There are tensions between offering young people autonomy to engage flexibly and authentically and the need for adult oversight of activities for information accuracy and safeguarding.

Social Network Research contribution to evaluating process in a feasibility study of a peer-led and school-based sexual health intervention

“…For example, we might suggest that overall, joining a Facebook group was a fairly accepted behaviour and students were receptive to the idea. Other findings of the STASH process evaluation reported elsewhere 36 , also confirm different levels of engagement in STASH FB groups in different schools (e.g., school 3 presented the highest prevalence of face-to-face interactions because FB was a less popular platform among their school year group) and that their online engagement in STASH was mostly in parallel with their habitual use of social media. These results highlighted the challenge of engaging youth in social media interventions in sexual health.…”

“…By exploring the relational aspects of these processes with MERGMs we aimed at understanding: how the presence of friendship ties between students at one level (node set A) is associated with the presence of affiliation ties on FB groups at another level (node set B). In this way, we sought to assess whether the creation of online communities on FB mirrored the offline adolescent groups that we expected to be aligned as per STASH instructions and delivery, and provide an understanding of the use of FB social media in disseminating prevention messages on sexual health among friends 36 . In order to evaluate the potential mechanisms of impact and the contextual processes related to the STASH intervention, we focused on how student-to-student relationships were shaped and formed, taking into account students’ characteristics and the role of PS.…”

Open Communication About Reproductive Health Is Associated With Comprehensive HIV Knowledge and a Non-stigmatising Attitude Among Indonesian Youth: A Cross-sectional Study

“…Moreover, Internet and social media could be utilised to provide safe spaces for peer-to-peer discussion regarding sexuality and sexual health. This method could be especially effective with the involvement of trained peer-supporters to guide the discussion and clarify misinformation [ 36 ].…”

Feasibility study of peer-led and school-based social network Intervention (STASH) to promote adolescent sexual health

“…The most likely explanation was the presence of a STASH trainer in the online groups. Although close monitoring by trainers allayed fears and possibly prevented such incidents, it may also have stifled 'natural' engagement with STASH Facebook messages (see also Hirvonen et al [43]).…”