Use of Social Media and Internet to Obtain Health Information by Rural Adolescent Mothers M. Cynthia Logsdon, Meghan Mittelberg, John Myers PII: DOI: Reference:
S0897-1897(14)00087-1 doi: 10.1016/j.apnr.2014.04.006 YAPNR 50580
To appear in:
Applied Nursing Research
Received date: Revised date: Accepted date:
19 March 2014 22 April 2014 30 April 2014
Please cite this article as: Logsdon, M.C., Mittelberg, M. & Myers, J., Use of Social Media and Internet to Obtain Health Information by Rural Adolescent Mothers, Applied Nursing Research (2014), doi: 10.1016/j.apnr.2014.04.006
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Rural teen moms
1
Use of Social Media and Internet to Obtain Health Information by Rural Adolescent Mothers
SC
RI P
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M. Cynthia Logsdon, PhD, WHNP-BC, FAAN Professor, School of Nursing, University of Louisville; Associate Chief of Nursing for Research, University of Louisville Hospital/Brown Cancer Center Louisville, Kentucky [email protected] 502-852-5825 Phone 502-852-8783 FAX
MA
NU
Meghan Mittelberg, BSN School of Nursing University of Louisville Louisville, Kentucky [email protected]
CE
PT
ED
John Myers, PhD, MPH Associate Professor, Department of Pediatrics, School of Medicine University of Louisville Louisville, Kentucky [email protected]
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The authors acknowledge funding from the Improved Health Outcome Project/Passport Health Services/University of Louisville Hospital Foundation. The authors report no conflict of interest. Acknowledgment of Funding: The project was supported by a research grant from the Improved Health Outcome Program, Passport Health Services.
ACCEPTED MANUSCRIPT Rural teen moms
2
Searching the Internet for information is ubiquitous in adolescents (Madden, Lenhart, Cortesi, & Gasser, 2013), including adolescents residing in rural areas. In addition, the various functions of
T
cell phones (text messages, searching Internet, Facebook) are becoming increasingly important
RI P
to rural adolescents in addition to their use as a communication tool (Foundation for Rural
information by rural adolescents are not known.
SC
Service, 2013). However, use of social media and the Internet (and cell phones) to obtain health
NU
The health of adolescents residing in rural counties is a concern. Rural adolescents are more likely to smoke cigarettes (Eberhardt, Ingram, & Maku, 2001), to use alcohol and cannabis
MA
and to use prescription drugs nonmedically (Havens, Young, & Havens, 2011) compared to their urban counterparts. Research has demonstrated a relationship between substance abuse and early
ED
initiation of sexual activity in rural adolescents (Dunn et al, 2008) as well as a high incidence of
PT
risky sexual behavior (Rew, Carver, & Liu, 2011) leading to a higher rate of adolescent births in rural adolescents.
CE
The culture of rural communities can support risky behaviors and serve as a perceived barrier to
AC
needed health care (Gordon, Ettaro, Rodriguez, Mocik, & Clark, 2011; Moreland, Raup-Krieger, Hecht, & Miller-Day, 2013). Lack of access and concerns about confidentiality may lead to foregoing health care (Elliott & Larson, 2004). Technology can assist to overcome these barriers (Mikulec, Goniu, & Moreno, 2013). Adolescent mothers that reside in rural areas are in particular need of accurate health information to care for themselves and their baby. Health information on the Internet overcomes barriers to health care related to travel and access to care. The purpose of this study was to determine use of social media and Internet by adolescent mothers residing in rural areas, particularly in regards to obtaining health information.
ACCEPTED MANUSCRIPT Rural teen moms
3
Methods
T
Using a cross-sectional design, a convenience sample of adolescent mothers who lived in a rural
RI P
county in a state located in the southern United States (n=15) were invited to participate in a research study about the use of social media to obtain health information. Eligibility criteria
SC
included the following: lives in rural county, 13-18 years of age, delivered live child, and child lives with adolescent mother. The study was approved by the health care organization and by the
NU
university institutional review board.
MA
If the adolescent mother was interested in study participation, she then read a preamble indicating that completion of a survey related to use of social media implied consent. The
ED
adolescent mother completed the one- time survey. Recruitment and study participation occurred during home visits with nurses employed by a state funded program to promote parenting.
PT
Adolescent mothers completed the Pew Internet Survey. The survey was used with
CE
permission and consists of 37 questions related to use of social media and internet, particularly in regards to obtaining health information. The survey was developed by Pew Corporation Senior
AC
Researchers for use in the Pew Internet and American Life Project with teens. It has previously been used in telephone interviews with samples of 800 nationally representative teens (Lehnart, Purcell, Smith, & Zickuhr, 2010; Madden, Lenhart, Duggan, Cortesi, & Gasser, 2013). Results Adolescent mothers were primarily Caucasian (73%) and lived with one of her parents (40%). A majority of the adolescent mothers were in the 11th grade (n=9, 60.0%), the rest were either in the 10th grade (n=4, 26.7%) or 12th grade (n=2, 13.3%), with a mean age of 16.9 years. The mothers of the adolescent mothers were most likely to be high school graduates
ACCEPTED MANUSCRIPT Rural teen moms
4
(n=8,53.3%), while their fathers were either a high school graduate (n=4, 26.7%), had attended some college (n=3, 20.0%), or were a college graduate (n=3, 20.0%).
T
All adolescent mothers had access to a computer and had gone online to search for
RI P
information. They had access to the Internet at a variety of locations and mainly used cell phones (93%) or desktop/laptop computers (100%) to go online. Many adolescent mothers sent or
SC
received over 50 text messages per day. See Table 1. Sixty seven percent of adolescent mothers
NU
spent from 1-10 hours online each week. Thirteen percent of adolescent mothers spent greater than 10 hours per week online. Most adolescent mothers used the search engine Google (73%),
MA
and did not check the sponsor of websites (60%).
The Internet served as one source of health information for adolescent mothers.
ED
Adolescent mothers received the most health information from the following: Parents (60 %);
PT
Doctors/Nurses (73 %); health class (40 %); parents of friends (33 %); Facebook (20%); and Internet (20%). Preferences for sources of health information included parents (60 %),
CE
Internet (33%), health class (60%), and health care professionals (80 %). Adolescent mothers
AC
believed that the Internet was a better source of information than newspapers and television (60%), magazines (60%), and radio (60%) but a worse source of information than friends/family (23%), library (47%), and health care provider office (87%). Thirty three percent of adolescent mothers searched for health information on the Internet every few weeks; 27% had received health information from Facebook. After receiving health information from a website, most adolescent mothers shared the information with parents or another adult (80%). Several adolescent mothers visited a healthcare provider as a result of the information obtained from a website (27%). Other adolescent mothers changed their health behaviors because of information found on a website (46%).
ACCEPTED MANUSCRIPT Rural teen moms
5
Discussion Rural adolescents have a high incidence of risky and unhealthy behaviors. It is
T
important for adolescent mothers that reside in rural areas to have accurate health information
RI P
and to avoid risky health behaviors. Technology can serve as an important vehicle to promote healthy behaviors and to impact the health of the adolescent mother and her baby.
SC
As in a nationally representative telephone survey of adolescents in the United States
NU
conducted by the Pew Corporation (Madden et al, 2013), this study demonstrated that adolescent mothers who reside in a rural area of a state in the southern United States have access to the
MA
Internet and that they search for health information on the Internet and social media. Study findings indicate that health information found on the Internet can drive an adolescent mother to
ED
see a health care provider as well as the change her behavior. Thus, targeted health intervention
PT
strategies delivered by the Internet have the potential to be effective with adolescent mothers that reside in rural areas, as has been recommended for other groups of adolescents (Mikulec et al,
CE
2013). National resources are available to guide clinical nurses and nurse researchers in the
AC
development of such interventions (CDC, 2011). Over half of study participants sent more than 50 text messages per day. Text messages have become the preferred method of communication for adolescents. Eighty eight percent of adolescent cell phone users send text messages (Lenhart, Ling, Campbell, & Purcell, 2010). Agencies such as the Center for Disease Control have capitalized on widespread cell phone use to reach underserved groups with evidence based, non-commercial information in Text4Baby. Further programs should be considered. The study is limited by a small sample size recruited from one site. Findings may not generalize to other populations or settings.
ACCEPTED MANUSCRIPT Rural teen moms
6
References Center for Disease Control. (2011). The health communicator’s social media toolkit.
T
www.cdc.gov/social media/
RI P
Eberhardt, M.S., Ingram, D.O., & Maku, D. Urban and Rural Health Chartbook. Health, United States, 2001. Hyattsville, Md.: National Center for Health Statistics, 2001.
SC
Elliott, B.A. & Larson, J.T. (2004). Adolescents in mid-sized and rural communities:
NU
Forgone care, perceived barriers, and risk factors. Journal of Adolescent Health, 35(4), 303-309.
MA
Foundation for Rural Service. (2013). 2013 rural youth telecommunications survey. www.frs.org/youth-programs/rural-youth-survey.
ED
Gordon, A.J., Ettaro, L., Rodriguez, K., Mocik, J., & Clark, D. (2011). Provider, patient,
PT
and family perspectives of adolescent alcohol use and treatment in rural settings. Journal of Rural Health, 27(1), 81-90.
CE
Havens, J., Young, A., & Havens, C. (2011). Nonmedical prescription drug use in a nationally
AC
representative sample of adolescents. Archives of Adolescent Medicine, 165 (3), 250-255. Lenhart, A., Ling, R., Campbell, S. & Purcell, K. (2010). Text messaging explodes as teens embrace it as the center of their communication strategies with friends. http://www. Pewinternet.org/2010/04/20/teens-ad-mobile-phones. Lenhart, A., Purcell, K., Smith, A. & Zickuhr, K. (2010). Social media & mobile internet use among teens and young adults. http://pewinternet.org/Reports/2010/Social0Media-and-young-adults.aspz Madden, M., Lenhart, A., Duggan, M., Cortesi, S., & Gasser, U. (2013). Teens and technology 2013. Pew Research Center’s Internet & American Life Project.
ACCEPTED MANUSCRIPT Rural teen moms http://youthandmedia.org/publications/papers/all Mikulec, E., Goniu, N. & Moreno, M. (2013). Urban, suburban, and rural: Adolescents
T
use and preferences for fitness promotion technologies across communities. ISRN
RI P
Obesity, Vol. 2013, Article 324259 4 pages, 2013. doi 10.1155/2013/324259. Moreland, J.L., Raup-Krieger, J.L., Hecht, M.L., & Miller-Day, M.M. (2013). The
SC
conceptualization and communication of risk among rural Appalachian adolescents.
NU
Journal of Health Communication, 18, 668-685.
Rew, L., Carver, T., & Li, Chia-Chun. (2011). Early and risky sexual behavior in a
MA
sample of rural adolescents. Issues in Comprehensive Pediatric Nursing, 34(40,
AC
CE
PT
ED
189-204.
7
ACCEPTED MANUSCRIPT Rural teen moms
Web Use
MA
T
NU
Text Use
RI P
Library Home School Phone Go Online Go Online Several Times a Day Daily Sent more than 50 a Day Receives more than 50 a Day Visit a Chat Room
Computer Access
Rural Teen Moms (n=15) Number/Percent 15 (100) 13 (87) 14 (93) 12 (80) 15 (100) 9 (60)
SC
Table 1 Use of Electronic Communication Variable
AC
CE
PT
ED
Chat Room Use
2 (13) 8 (53) 8 (53) 2 (13)
8
S0897-1897(14)00087-1 doi: 10.1016/j.apnr.2014.04.006 YAPNR 50580
To appear in:
Applied Nursing Research
Received date: Revised date: Accepted date:
19 March 2014 22 April 2014 30 April 2014
Please cite this article as: Logsdon, M.C., Mittelberg, M. & Myers, J., Use of Social Media and Internet to Obtain Health Information by Rural Adolescent Mothers, Applied Nursing Research (2014), doi: 10.1016/j.apnr.2014.04.006
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Rural teen moms
1
Use of Social Media and Internet to Obtain Health Information by Rural Adolescent Mothers
SC
RI P
T
M. Cynthia Logsdon, PhD, WHNP-BC, FAAN Professor, School of Nursing, University of Louisville; Associate Chief of Nursing for Research, University of Louisville Hospital/Brown Cancer Center Louisville, Kentucky [email protected] 502-852-5825 Phone 502-852-8783 FAX
MA
NU
Meghan Mittelberg, BSN School of Nursing University of Louisville Louisville, Kentucky [email protected]
CE
PT
ED
John Myers, PhD, MPH Associate Professor, Department of Pediatrics, School of Medicine University of Louisville Louisville, Kentucky [email protected]
AC
The authors acknowledge funding from the Improved Health Outcome Project/Passport Health Services/University of Louisville Hospital Foundation. The authors report no conflict of interest. Acknowledgment of Funding: The project was supported by a research grant from the Improved Health Outcome Program, Passport Health Services.
ACCEPTED MANUSCRIPT Rural teen moms
2
Searching the Internet for information is ubiquitous in adolescents (Madden, Lenhart, Cortesi, & Gasser, 2013), including adolescents residing in rural areas. In addition, the various functions of
T
cell phones (text messages, searching Internet, Facebook) are becoming increasingly important
RI P
to rural adolescents in addition to their use as a communication tool (Foundation for Rural
information by rural adolescents are not known.
SC
Service, 2013). However, use of social media and the Internet (and cell phones) to obtain health
NU
The health of adolescents residing in rural counties is a concern. Rural adolescents are more likely to smoke cigarettes (Eberhardt, Ingram, & Maku, 2001), to use alcohol and cannabis
MA
and to use prescription drugs nonmedically (Havens, Young, & Havens, 2011) compared to their urban counterparts. Research has demonstrated a relationship between substance abuse and early
ED
initiation of sexual activity in rural adolescents (Dunn et al, 2008) as well as a high incidence of
PT
risky sexual behavior (Rew, Carver, & Liu, 2011) leading to a higher rate of adolescent births in rural adolescents.
CE
The culture of rural communities can support risky behaviors and serve as a perceived barrier to
AC
needed health care (Gordon, Ettaro, Rodriguez, Mocik, & Clark, 2011; Moreland, Raup-Krieger, Hecht, & Miller-Day, 2013). Lack of access and concerns about confidentiality may lead to foregoing health care (Elliott & Larson, 2004). Technology can assist to overcome these barriers (Mikulec, Goniu, & Moreno, 2013). Adolescent mothers that reside in rural areas are in particular need of accurate health information to care for themselves and their baby. Health information on the Internet overcomes barriers to health care related to travel and access to care. The purpose of this study was to determine use of social media and Internet by adolescent mothers residing in rural areas, particularly in regards to obtaining health information.
ACCEPTED MANUSCRIPT Rural teen moms
3
Methods
T
Using a cross-sectional design, a convenience sample of adolescent mothers who lived in a rural
RI P
county in a state located in the southern United States (n=15) were invited to participate in a research study about the use of social media to obtain health information. Eligibility criteria
SC
included the following: lives in rural county, 13-18 years of age, delivered live child, and child lives with adolescent mother. The study was approved by the health care organization and by the
NU
university institutional review board.
MA
If the adolescent mother was interested in study participation, she then read a preamble indicating that completion of a survey related to use of social media implied consent. The
ED
adolescent mother completed the one- time survey. Recruitment and study participation occurred during home visits with nurses employed by a state funded program to promote parenting.
PT
Adolescent mothers completed the Pew Internet Survey. The survey was used with
CE
permission and consists of 37 questions related to use of social media and internet, particularly in regards to obtaining health information. The survey was developed by Pew Corporation Senior
AC
Researchers for use in the Pew Internet and American Life Project with teens. It has previously been used in telephone interviews with samples of 800 nationally representative teens (Lehnart, Purcell, Smith, & Zickuhr, 2010; Madden, Lenhart, Duggan, Cortesi, & Gasser, 2013). Results Adolescent mothers were primarily Caucasian (73%) and lived with one of her parents (40%). A majority of the adolescent mothers were in the 11th grade (n=9, 60.0%), the rest were either in the 10th grade (n=4, 26.7%) or 12th grade (n=2, 13.3%), with a mean age of 16.9 years. The mothers of the adolescent mothers were most likely to be high school graduates
ACCEPTED MANUSCRIPT Rural teen moms
4
(n=8,53.3%), while their fathers were either a high school graduate (n=4, 26.7%), had attended some college (n=3, 20.0%), or were a college graduate (n=3, 20.0%).
T
All adolescent mothers had access to a computer and had gone online to search for
RI P
information. They had access to the Internet at a variety of locations and mainly used cell phones (93%) or desktop/laptop computers (100%) to go online. Many adolescent mothers sent or
SC
received over 50 text messages per day. See Table 1. Sixty seven percent of adolescent mothers
NU
spent from 1-10 hours online each week. Thirteen percent of adolescent mothers spent greater than 10 hours per week online. Most adolescent mothers used the search engine Google (73%),
MA
and did not check the sponsor of websites (60%).
The Internet served as one source of health information for adolescent mothers.
ED
Adolescent mothers received the most health information from the following: Parents (60 %);
PT
Doctors/Nurses (73 %); health class (40 %); parents of friends (33 %); Facebook (20%); and Internet (20%). Preferences for sources of health information included parents (60 %),
CE
Internet (33%), health class (60%), and health care professionals (80 %). Adolescent mothers
AC
believed that the Internet was a better source of information than newspapers and television (60%), magazines (60%), and radio (60%) but a worse source of information than friends/family (23%), library (47%), and health care provider office (87%). Thirty three percent of adolescent mothers searched for health information on the Internet every few weeks; 27% had received health information from Facebook. After receiving health information from a website, most adolescent mothers shared the information with parents or another adult (80%). Several adolescent mothers visited a healthcare provider as a result of the information obtained from a website (27%). Other adolescent mothers changed their health behaviors because of information found on a website (46%).
ACCEPTED MANUSCRIPT Rural teen moms
5
Discussion Rural adolescents have a high incidence of risky and unhealthy behaviors. It is
T
important for adolescent mothers that reside in rural areas to have accurate health information
RI P
and to avoid risky health behaviors. Technology can serve as an important vehicle to promote healthy behaviors and to impact the health of the adolescent mother and her baby.
SC
As in a nationally representative telephone survey of adolescents in the United States
NU
conducted by the Pew Corporation (Madden et al, 2013), this study demonstrated that adolescent mothers who reside in a rural area of a state in the southern United States have access to the
MA
Internet and that they search for health information on the Internet and social media. Study findings indicate that health information found on the Internet can drive an adolescent mother to
ED
see a health care provider as well as the change her behavior. Thus, targeted health intervention
PT
strategies delivered by the Internet have the potential to be effective with adolescent mothers that reside in rural areas, as has been recommended for other groups of adolescents (Mikulec et al,
CE
2013). National resources are available to guide clinical nurses and nurse researchers in the
AC
development of such interventions (CDC, 2011). Over half of study participants sent more than 50 text messages per day. Text messages have become the preferred method of communication for adolescents. Eighty eight percent of adolescent cell phone users send text messages (Lenhart, Ling, Campbell, & Purcell, 2010). Agencies such as the Center for Disease Control have capitalized on widespread cell phone use to reach underserved groups with evidence based, non-commercial information in Text4Baby. Further programs should be considered. The study is limited by a small sample size recruited from one site. Findings may not generalize to other populations or settings.
ACCEPTED MANUSCRIPT Rural teen moms
6
References Center for Disease Control. (2011). The health communicator’s social media toolkit.
T
www.cdc.gov/social media/
RI P
Eberhardt, M.S., Ingram, D.O., & Maku, D. Urban and Rural Health Chartbook. Health, United States, 2001. Hyattsville, Md.: National Center for Health Statistics, 2001.
SC
Elliott, B.A. & Larson, J.T. (2004). Adolescents in mid-sized and rural communities:
NU
Forgone care, perceived barriers, and risk factors. Journal of Adolescent Health, 35(4), 303-309.
MA
Foundation for Rural Service. (2013). 2013 rural youth telecommunications survey. www.frs.org/youth-programs/rural-youth-survey.
ED
Gordon, A.J., Ettaro, L., Rodriguez, K., Mocik, J., & Clark, D. (2011). Provider, patient,
PT
and family perspectives of adolescent alcohol use and treatment in rural settings. Journal of Rural Health, 27(1), 81-90.
CE
Havens, J., Young, A., & Havens, C. (2011). Nonmedical prescription drug use in a nationally
AC
representative sample of adolescents. Archives of Adolescent Medicine, 165 (3), 250-255. Lenhart, A., Ling, R., Campbell, S. & Purcell, K. (2010). Text messaging explodes as teens embrace it as the center of their communication strategies with friends. http://www. Pewinternet.org/2010/04/20/teens-ad-mobile-phones. Lenhart, A., Purcell, K., Smith, A. & Zickuhr, K. (2010). Social media & mobile internet use among teens and young adults. http://pewinternet.org/Reports/2010/Social0Media-and-young-adults.aspz Madden, M., Lenhart, A., Duggan, M., Cortesi, S., & Gasser, U. (2013). Teens and technology 2013. Pew Research Center’s Internet & American Life Project.
ACCEPTED MANUSCRIPT Rural teen moms http://youthandmedia.org/publications/papers/all Mikulec, E., Goniu, N. & Moreno, M. (2013). Urban, suburban, and rural: Adolescents
T
use and preferences for fitness promotion technologies across communities. ISRN
RI P
Obesity, Vol. 2013, Article 324259 4 pages, 2013. doi 10.1155/2013/324259. Moreland, J.L., Raup-Krieger, J.L., Hecht, M.L., & Miller-Day, M.M. (2013). The
SC
conceptualization and communication of risk among rural Appalachian adolescents.
NU
Journal of Health Communication, 18, 668-685.
Rew, L., Carver, T., & Li, Chia-Chun. (2011). Early and risky sexual behavior in a
MA
sample of rural adolescents. Issues in Comprehensive Pediatric Nursing, 34(40,
AC
CE
PT
ED
189-204.
7
ACCEPTED MANUSCRIPT Rural teen moms
Web Use
MA
T
NU
Text Use
RI P
Library Home School Phone Go Online Go Online Several Times a Day Daily Sent more than 50 a Day Receives more than 50 a Day Visit a Chat Room
Computer Access
Rural Teen Moms (n=15) Number/Percent 15 (100) 13 (87) 14 (93) 12 (80) 15 (100) 9 (60)
SC
Table 1 Use of Electronic Communication Variable
AC
CE
PT
ED
Chat Room Use
2 (13) 8 (53) 8 (53) 2 (13)
8
