Teenage clicks

Winner – NHS Choices: New media sexual health initiative in the Humber region

At last year’s BT e-Health Insider awards, NHS Choices won the best use of ICT in patient and citizen involvement, sponsored by Fujitsu, for a new media sexual health initiative in the Humber region. It teamed up with local primary care trusts to explore how new media and social marketing could be used to improve access to sexual health services for 14-21 year olds.

The outcomes included a microsite with localised information about sexual health services and magazine-style information about sexual health issues, and the experimental use of Bluetooth messaging for people in high risk areas such as night clubs. Sandra Hempel reports.

The Humber sexual health programme grew out of an NHS Choices invitation to primary care trusts to help evaluate digital technology. The aim was to test new ways of delivering health messages and information about services to particular groups in the community.

Among those to pitch was a cluster of primary care trusts in the Humber area: Hull, North East Lincolnshire, North Lincolnshire and East Riding. It wasn’t only their geographical cohesion that made this group an interesting proposition, but their contrasting social conditions. The patch included, for example, Hull city, isolated rural communities in East Riding and some pockets of considerable deprivation in Bridlington and Grimsby.

Both the NHS and the Humber PCTs had identified sexual health as being of key importance. Hull, in particular, faced some big challenges, but also had the resources to tackle them. It had second highest rate of Chlamydia in the country, but it also had a skilled and committed team delivering some innovative services.

Another reason for choosing sexual health was that young people were a natural target its messages and they, in turn, offered the best opportunity to investigate the potential of mobile phones and texting, which the project organisers were particularly keen to explore.

“We knew this was going to involve more than a website and, as we wanted to use the mobile phone as a channel, we thought that young people would be a good group to start with,” explains former pilot programme lead for NHS Choices, Gita Mendis. “We were making some assumptions, though, about young people and their use of digital technology. We didn’t really know at that point.”

Mobile phones were seen as particularly suitable. Not only are they most young people’s preferred method of communication, but they also offer a degree of discretion, which is particularly important in this health area. Teenagers are also less likely than adults to have unsupervised access to the internet.

Clued up or hopelessly confused?

The project began in 2007 with focus groups. Service providers discussed what messages they wanted to get across and how they thought young people accessed information. Young people aged 14-17 from across all four PCTs talked about what they knew about sexual health and how they wanted to receive information.

“One key message to come out of this was that young people had problems talking about sex with authority figures such as school nurses and GPs,” says Mendis. “That meant that they didn’t know what services were available or where to get them. They preferred to get their information from their peers and they also said they wanted basic facts, delivered simply and straight, not in a patronising way.”

The findings also showed that levels of knowledge varied widely, with some young people extremely clued up but others left hopelessly confused by some classic playground myths.

The IT team set about pulling together all the messages about sexual health education and services that the PCTs were putting out and making these available by mobile phone. Collating the data and making sure that it was up to date proved a hard task. All the PCTs were delivering information in complex ways that varied from one to another.

The end result, however, was that young people could access the information they needed through text messaging. They were also able to access information from a website through their mobile phone. By typing in their post-code, they could see the services closest to them, including details of where to get emergency contraception. They could also get some basic facts, for example about when to take the morning-after pill. The website itself had more information, including videos created by young people alongside interviews with those providing local services.

To publicise the service, groups of young people working with local youth clubs were trained in how to approach their peers and sent to places where teenagers were known to congregate. They carried leaflets promoting the mobile phone service and encouraged young people to ‘buy into’ what was on offer by taking part in a competition. Ensuring that the whole area was covered was quite a logistical feat, Mendis says.

Ahead of its time

In December 2007, the service went live with promotions on local radio stations across the Humber region. An evaluation found that the service was seen as easy to use and about 50% of those questioned said that they would use it. Yet to some extent, the project was slightly ahead of its time, Mendis believes.

“At that time, not so many people could access the internet from their phone. Now this is changing fast, particularly with the iPhone,” she says. And new applications are coming online that will enable further developments, such as allowing people to calculate their alcohol intake and to use the phone as a Sat Nav to find the fastest route to local services.

Less successful in getting the message across were Bluetoothanimations sent from a laptop to mobile phones. The technology’s 100 yard range was too limited. Take-up was reasonable in places such as student canteens and clubs where young people were together in some numbers for a period of time, but not so good in other locations, such as shopping centres, where people were on the move.

However, the cartoons have enjoyed a longer shelf life than anyone envisaged. “Because they were funny, people have been forwarding them to their friends,” Mendis explains. “In the end though, Bluetooth proved not really practical, but we were right to try it.”

Following the launch, Hull’s sexual health centre has seen an increase in the use of its services, while Chlamydia screening among 15-24 year olds is up by 10% on the previous year. This makes Hull among the best performing trusts in the country. The results can be sent by mobile phone.

“This project has had a massive impact on our services and made a real physical difference to the way we deliver them,” says Jo Cole, public health manager of NHS Hull. “The partnership with NHS Choices gave us the chance to try out something cutting edge, and we learnt a huge amount about social marketing.

“It isn’t enough just to open a clinic: we have to use the right communication channels to reach young people and provide the service that they want, on their terms.” The PCT is now looking at other projects, including making the NHS Choices online teenage health checks available on mobile phones.

“This is all about understanding what information people really want and making that information relevant to local communities,” Ms Mendis says. “PCTs are key to this. We don’t want to add to their administration – and ensuring the information is kept up to date involves a lot of work – but they are keen to do it. “

“Peer to peer messaging was really important in this project and the reason it was successful was that we involved young people all the way along,” Mendis adds. “This sounds an obvious thing to do but it’s not always done. The challenge was first to get all this information in and then to ensure it was kept up to date – get it wrong, give someone the wrong information, and you lose that person’s trust forever.”

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