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Introduction

Rationale

The Reproductive and Child Health team, one of the teams within the Family Health Division, delivers programs and services in accordance with the Reproductive& Child Health standards of the Ontario Public Health Standards (OPHS). One of these programs is the Child & Babytalk Phone Line, which the team has operated for over a decade. A Public Health Nurse (PHN) answers the Phone Line Monday to Friday between 8:30am to 4:30pm, and connects parents, parents-to-be, caregivers, and professionals in KFL&A with up to date information on reproductive and child health topics, programs, and services.

In recent years, the number of calls to the Phone Line has decreased. In 2012, the lead PHN investigated alternative methods for connecting with the target audience, specifically one that was: easy to update, current, and already being used by the target population to obtain information. For example, a previous evaluation of the phone line suggested one third of callers would have referred to the internet to find health information.

Internet Usage Statistics:

In 2012, of residents 16 and older in the City of Kingston, South Frontenac, Loyalist and the Frontenac Islands (4):

83% had access to the internet at home. Access decreased with decreasing income level (from 99% to 61%).
82% used the internet for personal non-business use in the past year. Use was highest among 16 to 44 year olds and lower among older low income residents.

In 2012, of Canadian personal internet users 16 and older:

70% to 89% (by decreasing age) go online at least once per day (5).
50% of 16 to 24 years olds spent 10 or more hours a week online (6).
67% used social networking sites such as Facebook and Twitter. Use decreased with age (from 92% to 32%) (6).

In a non-random poll in January 2015, 70% of Canadian mothers with children under the age of 18 used Facebook. Canadian Facebook users averaged visiting Facebook slightly more than once a day (7).

In KFL&A residents aged 18 years or older in 2010 (8):

79% used the internet to access health-related information.
Females (84%) searched for health-related information more often than males (72%) and those aged 65 or older searched less than younger ages.

Web 2.0 and Social Media: rely on the engagement of users and are unique in that they allow users to generate content that is broadly accessible to other users. Social networking sites, a type of social media, are websites that facilitate the formation of online communities. Information on these sites involves multiple users, and flows in multiple directions.

Facebook 101

Facebook is one of the most popular social networking sites in Canada, with 19 million users (7). Since it was opened to the public in 2006, it has evolved to capitalize on its large reach and marketing potential.

Currently, users set up accounts and form networks by 'friending' friends, acquaintances and family members with accounts. Each user has a profile; the main page of a user's profile is their timeline where they can create posts. Posts can be 'status updates' (text), or can contain embedded photos, links or videos. They can also interact with their friends by posting on their friends timelines, or by commenting on, liking or sharing their friend's posts. Posts and interactions by friends are seen on a user's newsfeed (which is their Facebook home page). Targeted ads are displayed directly in the newsfeed as well as on timelines.

Facebook allows businesses, organizations and institutions to join by setting up a Facebook page. The page contains many of the same features of individual accounts, but instead of 'friending', users must the 'like' the page (at which point they are called 'fans'). Once they do this, users receive new content from the organization's timeline in their newsfeed. However, both fans and non-fans of a page can like, comment on, or share content posted by the organization. A fan's interactions with the page may appear on their friends' newsfeeds.

Note on Newsfeeds: For the majority of Facebook users, there is too much content generated by their friends and liked pages to display everything on their newsfeed. Instead a highly-advanced and regularly changing, automated algorithm is used to determine what is shown on each user's newsfeed. Included in the algorithm's decision-making process is: how often a user has interacted with the friend/Page before, the type of posts the user has previously interacted with, and how popular a post is with other users (i.e., how many other users have commented on, liked or shared the post). (9)

The Child & Babytalk in KFL&A Facebook Page

Based on the widespread use of the internet and social media by women of child-bearing age and the potential benefits of using social media to improve delivery of public health messaging, the Reproductive & Child Health Team launched the Child & Babytalk Facebook (CBFB) Page on April 1, 2014. The intention was that the CBFB Page would serve as a pilot project for KFL&A Public Health, in order to test Facebook as a potential medium for knowledge exchange and health promotion. The purpose of the Page is to enable the healthy development of all children in KFL&A from preconception to age six, by increasing the proportion of the target population (men and women planning to have children, pregnant women and their partners, and families with children zero to six) who have access to evidence-based information on best practices for healthy child development.

The CBFB Page is maintained Monday to Friday during regular business hours by one staff member from the team. The majority of days this is the lead public health nurse (PHN) for the program. When she is unavailable, it is covered by another PHN or Registered Dietitian who has received Page-specific training. Each day, an appropriate topic is determined and posts within that topic are made throughout the day by the staff member. Additionally, the Page is monitored throughout the day, and comments, questions and messages from the public are replied to promptly. Documentation of posts and interactions with the public occurs within a database created for the Page.

As part of the launch of the pilot project, and based on the literature, an evaluation was conducted for the Page's first year (April 1, 2014 to March 31, 2015). The primary purpose of this process evaluation was to detail what went on in the program in an attempt to determine its strengths and weaknesses, challenges and opportunities, and possible explanations for why things occurred the way it did. The underlying goal was continuous monitoring to improve quality and effectiveness of the implementation, maintenance, and monitoring of the Page. It investigated the inputs, activities and outputs of the Page, such as timing and content of posts, and reach and engagement by users, often using novel techniques. Additionally, the evaluation included the monitoring of staff resources and any additional costs incurred during the development, implementation and evaluation of the Page.

Over the course of the pilot year, three quarterly reports were prepared for the purposes of continuous monitoring. These reports used data from Facebook and the documentation database to provide recommendations to program staff and management. The final report, conducted at the end of the pilot year, investigated the entire pilot year and development period. This document serves as a summary of the salient results, and all of the recommendations from the full final report (available on request). Additionally, given the novelty of the analyses conducted as part of this evaluation, the full methodology will be released, allowing other local public health agencies to efficiently reproduce the analyses for their own evaluations. This will support the building of a collective body of knowledge on the use of social media for knowledge exchange and health promotion.