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The use of social media in health education has witnessed a revolution within the past decade. Students have already adopted social media informally to share information and supplement their lecture-based learning. Although studies show comparable efficacy and improved engagement when social media is used as a teaching tool, broad-based adoption has been slow and the data on barriers to uptake have not been well documented.
The objective of this study was to assess attitudes of health educators toward social media use in education, examine differences between faculty members who do and do not use social media in teaching practice, and determine contributing factors for an increase in the uptake of social media.
A cross-sectional Web-based survey was disseminated to the faculty of health professional education departments at 8 global institutions. Respondents were categorized based on the frequency of social media use in teaching as “users” and “nonusers.” Users sometimes, often, or always used social media, whereas nonusers never or rarely used social media.
A total of 270 health educators (52.9%, n=143 users and 47.0%, n=127 nonusers) were included in the survey. Users and nonusers demonstrated significant differences on perceived barriers and potential benefits to the use of social media. Users were more motivated by learner satisfaction and deterred by lack of technology compatibility, whereas nonusers reported the need for departmental and skill development support. Both shared concerns of professionalism and lack of evidence showing enhanced learning.
The majority of educators are open-minded to incorporating social media into their teaching practice. However, both users and nonusers have unique perceived challenges and needs, and engaging them to adapt social media into their educational practice will require previously unreported approaches. Identification of these differences and areas of overlap presents opportunities to determine a strategy to increase adoption.
Social media is an inexpensive, powerful, and influential way of using Internet-based tools to facilitate easy and broad communication and the sharing of information and opinions [
Currently, up to 70% of the general public seeks health care information and advice from Internet sources, and they continue to use Web-based resources to strengthen their capacity to communicate about their health needs [
A recent study demonstrated that medical students engaged in a course about social media and e-professionalism aided in the awareness of positive and negative uses of social media in a professional and educational environment [
Adapting to new technologies and demands on time were identified as challenges to social media integration into education by educators and students [
We conducted a global cross-sectional Web-based survey of 8 member institutions (see
The research team included a faculty and student representative from each participating university, and they jointly developed a 24-question survey. Content for the first draft of the survey instrument was derived from the existing literature [
The site-specific faculty representative disseminated the survey to the members of their university community through electronic mailing lists targeting faculty, staff, and students. Although this survey was distributed to students and faculty, given the purpose of this study, only faculty responses were used. Response to the survey was accepted as informed consent, and responses were anonymous. Respondents were allowed to select more than one choice for nondemographic questions, where applicable. The survey was administered from July to December 2014. Inclusion criteria for the study required respondents to have identified as educators and reported their frequency of social media use. Respondents who only filled out demographic data were excluded.
Data were downloaded from the Fluid Surveys platform into a Microsoft Excel spreadsheet and transferred to Stata/SE version 13 for analysis. Survey questions with an option for open text responses were coded into existing categories where applicable, or a new category was created as needed. Descriptive statistics were conducted on demographic data with continuous variables (age) expressed as a mean and standard deviation and categorical variables (gender and university affiliation) expressed as frequencies and percentages. Differences in the distributions of demographic variables were examined using a chi-square test (or Fisher exact test) for categorical variables or a
The chi-square test (or Fisher exact test where appropriate) was also applied and a
Health educators from 8 global institutions and a variety of health disciplines, including nursing, public health, medicine, pharmacy, dentistry, and physiotherapy, responded to the survey. The survey response rate was reported individually by each university and ranged from 4% to 46%, with data from some institutions missing. Respondents were divided into two groups, users and nonusers, based on the frequency of social media use in educational practice. Of the 270 respondents, 143 (52.9%) were users, and 127 (47.0%) were nonusers. There was a statistically significant difference in the mean age of users compared with nonusers (43.8 vs 46.3 years;
Demographics.
Demographics | Users | Nonusers | Total | ||
.045 | |||||
Age in years | 43.8 (9.3) | 46.3 (10.3) | 45.0 (9.8) | ||
.07 | |||||
Male | 44 (31.2) | 53 (42.4) | 97 (36.5) | ||
Female | 97 (68.8) | 72 (57.6) | 169 (63.5) | ||
<.001 | |||||
Fudan University, Shanghai, China | 27 (67.5) | 13 (32.5) | 40 (14.9) | ||
Instituto Tecnológico de Monterrey, Nuevo Leon, Mexico | 17 (85.0) | 3 (15.0) | 20 (7.5) | ||
University of Birmingham, West Midlands, United Kingdom | 9 (26.5) | 25 (73.5) | 34 (12.7) | ||
University of British Columbia, Vancouver, Canada | 23 (62.2) | 14 (37.9) | 37 (13.8) | ||
University College of Dublin, Dublin, Ireland | 5 (71.4) | 2 (28.6) | 7 (2.6) | ||
University of Hong Kong, Pokfulam, Hong Kong | 18 (75.0) | 6 (25.0) | 24 (9.0) | ||
University of Melbourne, Victoria, Australia | 8 (38.1) | 13 (61.9) | 21 (7.8) | ||
University of Nottingham, Nottingham, United Kingdom | 35 (41.2) | 50 (58.8) | 85 (31.7) |
aNote: Denominator varies slightly because of missing data.
bSD: standard deviation.
Barriers to the use of social media for health professionals’ education (in descending order of “Nonuser” group responses).
Factors | Users |
Nonusers |
|
Do not understand how to incorporate social media into teaching/ learning | 35 (24.5) | 91 (71.7) | <.001 |
Concerns about professionalism | 70 (49.0) | 73 (57.5) | .18 |
Unsure about department’s policies related to the use of social media | 54 (37.8) | 71 (55.9) | .005 |
Lack the technical skills to use social media tools | 42 (29.4) | 71 (55.9) | <.001 |
Department does not offer support for the use of social media in health education | 59 (41.3) | 69 (54.3) | .01 |
Do not see the value of using social media in health education | 7 (4.9) | 41 (32.3) | <.001 |
Department prohibits or actively discourages the use of social media in health education | 5 (3.5) | 14 (11.0) | .02 |
Factors influencing decisions to use social media in teaching/learning practice (in descending order of “Nonuser” group responses).
Influencing factor | Users |
Nonusers |
|
Evidence that learning is enhanced through the use of social media tools | 96 (67.1) | 73 (57.5) | .13 |
Ability and knowledge in the use of social media tools | 78 (54.5) | 65 (51.2) | .63 |
Support from experts in the use of social media to design teaching strategies/modules | 52 (36.4) | 62 (48.8) | .048 |
Fit of social media tools to the style of teaching/learning | 65 (45.5) | 61 (48.0) | .72 |
Improved learner satisfaction with the course | 97 (67.8) | 50 (39.4) | <.001 |
Peers using social media technologies in their classrooms | 65 (45.5) | 47 (37.0) | .18 |
Improved student evaluations of the course | 56 (39.2) | 44 (34.6) | .45 |
Course/Department coordinator suggesting the use of social media technologies in the classroom | 45 (31.5) | 40 (31.5) | >.99 |
Compatibility of social media technologies with the devices in use within classroom | 65 (45.5) | 33 (26.0) | .001 |
Meanwhile, users have also rated supportive evidence to illustrate the enhanced learning from the use of social media as an important influencing factor (96/143, 67.1%). However, in stark contrast to nonusers, they were significantly more likely to be influenced by improved learner satisfaction (97/143, 67.8% vs 50 out of 127, 39.4%;
Finally, users agreed that social media has the capacity to positively impact educational practices, whereas nonusers were significantly more skeptical of its ability to improve student learning (116/136, 85.3% vs 70/125, 56.0%;
Both users and nonusers reported not being trained on social media–related policies and guidelines, with only 11.5% (16/139) and 5.8% (7/120), respectively, having been provided prior training (
Our survey found that almost three-quarters of educators only used social media as an educational tool “sometimes” or less often. Students’ use of social media for health education is overwhelmingly higher, with almost the same proportion using social media often or always [
Our findings suggest that the differences in mean age of the user and nonuser groups are statistically significant. In practicality, the 2.6-year difference in mean age and range of ages in each group may not be contextually relevant. Hence, unlike previous studies that suggested age and gender as major factors for the lack of broad-based adoption, our sample does not demonstrate strong demographic differences between users and nonusers [
Nonusers perceived their greatest barrier to be a lack of comfort and technical skills. Therefore, evidence-based recommendations on principles, best practices, and successful strategies can be helpful to nonusers who are not confident in educational social media usage [
By comparison, users strongly believe in the capacity of social media to improve student learning and faculty and peer interactions with students, highlighting the importance of providing them with new evidence-based ways to increase engagement and supporting their efforts to incorporate innovative methods into their educational practice [
The users and nonusers did share commonalities; both were greatly influenced by evidence that learning is enhanced through social media integration and resources to aid educators increase their abilities and knowledge of social media–based teaching tools. As the body of evidence is continuously growing, the need for further high-quality literature is underscored by the need for effective dissemination of results [
We also found that both groups shared similar concerns on the impact that integrating social media in health education would have on professionalism. In the new media age, the distinction between personal and professional Web-based content is blurry, and the definition of appropriate behavior remains uncertain. Within the health care context, patients are likely to judge health professionals on their Web-based persona, which may in turn affect trust and adherence to advice [
Compared with the existing literature that largely comprises postulated barriers, our study substantiated some but not others. Although, professionalism, legal implications, and time investment are all important issues, they are of secondary importance to technological support, learner engagement, and clarity of institutional policies and guidelines. Hence, our study demonstrates an unreported set of issues to consider and the practical nature of educators’ priorities when approaching social media in health education.
This study has several limitations. As with most survey-based studies, our results may be subject to construct bias. However, an extensive review process was carried out a priori to minimize risk. Additionally, because faculty representatives at each institution disseminated the survey, there may have been inconsistencies leading to difficulties in determining the response rate and introducing potential bias.
The sample size was small and derived from voluntary participation; hence, it may have been limited by faculty population size, institutional stance on social media use, and strength of interest or opinion, thereby leading to potential type 2 error or insufficient power. Finally, the institutions self-selected to be participants; hence, our results are likely not generalizable to all health professional programs.
In conclusion, our survey results have demonstrated that adoption of social media as a teaching tool is not uniform for all faculty members but necessitates targeted strategies for current users and nonusers. The two groups have unique attitudes, needs, and motivations that need to be addressed. Furthermore, both groups need clear evidence that demonstrate effectiveness of social media as an educational strategy and thorough understanding of the institutional boundaries of social media use. Therefore, institutions need to discern the mix of users and nonusers that exists in their faculty population before instituting change management strategies to engage them in social media use in health professional education.
With health education moving away from the conventional approach of didactic knowledge transmission, social media could be an effective modality to employ a Socratic methodology where students and educators jointly collaborate to facilitate enhanced learning. Our findings suggest that the majority of users and nonusers are open-minded to incorporating social media into their teaching practice, and so they should be encouraged to do so, in accordance to their respective needs.
The ethics application was submitted to the University of British Columbia, and each of the other 7 participating institutions (Fudan University, China; Instituto Tecnológico de Monterrey, Mexico; University of Birmingham, the United Kingdom; University College of Dublin, Ireland; University of Hong Kong, Hong Kong; University of Melbourne, Australia; and University of Nottingham, the United Kingdom) used the approval to receive institutional departmental authorization before the administration of the survey.
standard deviation
The authors would like to acknowledge the members of the Universitas 21 Health Sciences Social Media for Health Professional Education Group for their dissemination of this paper’s survey to their respective schools and their participation in the verbal discussion and feedback to the content of this paper and Ms Jodi Siever for assistance with statistical analysis. The study was funded through a grant from Universitas 21 Health Sciences. The grant funding supported student travel to annual meetings, forum planning, executive and administration support, print and travel budget, and manuscript publication.
Drs Ho and Last had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors were involved in the study concept and design. D’Souza, O’Sullivan, Last, and Ho worked on the acquisition, analysis, or interpretation of data. D’Souza, Henningham, Zou, Huang, and Ho were involved in the drafting of the manuscript, whereas all the authors were involved in the critical revision of the manuscript for important intellectual content. D’Souza, Last, and Ho were involved in statistical analysis. Administrative, technical, or material support was provided by D’Souza and Ho. D’Souza, O’Sullivan, Last, and Ho were involved in study supervision. D’Souza and Ho were involved in the final approval of the version to be published.
None declared.