DISCUSSION PAPER: ACCESS TO SOCIAL NETWORKING SITES FOR SEXUAL HEALTH PROFESSIONALS

Discussion Paper: Access to Social Networking Sites for Sexual Health Professionals

May 2011 Written by Leng Boonwaat. NSW STI Programs Unit Sydney Hospital Level 3 Nightingale Wing Macquarie Street Sydney GPO Box 1614 Sydney T +61 2 9382 7440 F +61 2 9382 7475
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Discussion Paper: Access to Social Networking Sites for Sexual Health Professionals

Contents
Acronyms ............................................................................................................. 4

1. Purpose ....................................................................................................................................... 5 2. Introduction ................................................................................................................................ 5 3. What are social networking sites? ............................................................................................. 5 4. What is social media? ................................................................................................................. 5 5. Why Provide Access? .................................................................................................................. 5 5.1. Ottawa Charter for Health Promotion ................................................................................ 5 5.2. The International Union of Health Promotion and Education ............................................ 5 5.3. Growth in the use of communication technology .............................................................. 6 5.4. Use of social media to support NSW Government objectives ............................................ 7 5.5. Use of social media to support other Australian state government objectives ................. 8 5.6. Organisations that have lifted the ban on social networking sites..................................... 9 5.7. Social media use by health professionals - examples ......................................................... 9 5.8. Social media based interventions in Australia - examples.................................................. 9 6. Guidelines for conducting internet based interventions .......................................................... 10 7. Risks to clinicians from use of social media sites...................................................................... 11 8. Conclusion ................................................................................................................................. 12 9. Recommendations .................................................................................................................... 12 10. References............................................................................................................................... 14 11. Bibliography ............................................................................................................................ 17 12. Appendix ................................................................................................................................. 18 12.1. Suggestions of possible social media tools for health promotion staff ......................... 18 12.2. Suggestions of possible social media tools for medical officers .................................... 19 12.3. Suggestions of possible social media tools for nurses ................................................... 20 12.4. Suggestions of possible social media tools for sexual health counsellors ..................... 21

Acronyms
AIDB AIDS AMACDT ARCSHS CDC CNC CNS DET EEN EN HIV ICT IPS IUHPE MSM NCSTDD NP NSW NUM NZMADITC NZMSA PD RN SMS STD STI AIDS and Infectious Diseases Branch of NSW Health Acquired Immune Deficiency Syndrome Australian Medical Association Council of Doctors-in-Training Australian Research Centre in Sex, Health and Society Centers for Disease Control and Prevention Clinical Nurse Consultant Clinical Nurse Specialist Department of Education and Training Endorsed Enrolled Nurse Enrolled Nurse Human Immunodeficiency Virus Internet and communication technology Internet based partner services International Union of Health Promotion & Education Men who have sex with men National Coalition of STD Directors Nurse Practitioner New South Wales Nursing Unit Manager New Zealand Medical Association Doctors-in-Training Council New Zealand Medical Students Association Policy Directive Registered Nurse Short Message Service Sexually transmissible diseases Sexually transmissible infections

Discussion Paper: Access to Social Networking Sites for Sexual Health Professionals
1. Purpose
This documents purpose is to discuss and provide recommendations for the provision of access to social networking sites for NSW Health Sexual Health professionals.

2. Introduction
NSW Health Policy Directive PD2009_076 states that access by staff members to certain internet sites can lead to large amounts of time being spent on unproductive non-workrelated purposes.1 There are also concerns that use of social media can damage personal integrity, health care provider-patient relationships and future employment opportunities.2 Consequently, access to social networking sites is routinely blocked within NSW Health facilities. Access may be granted if a genuine work related reason can be established.1 The case for the provision of work related access is supported by the settings based approach to health promotion. Support for this can also be found within Australian Government Policy. The settings based approach asserts that health promotion is more effectively conducted in the settings where people live their everyday lives. It was given credence by the Ottawa Charter for Health Promotion3 in 1986 and continues to be highly relevant to 21st century public health.4 Risks related to social media use can also be mitigated through the use of guidelines related to how health professionals should conduct themselves online. 2,5, 6

3. What are social networking sites?

The Australian Governments Office of the Australian Information Commissioner provides the following definition: Social networking sites are websites that let people socialise online, send messages to one another, share interests and information, chat, meet people, and post information, photos and videos about themselves for others to look at. 7

4. What is social media?

Social media are primarily internet and mobile-based tools for sharing and discussing information among human beings. The term most often refers to activities that integrate technology, telecommunications and social interaction, and the construction of words, pictures, videos and audio. 8

5. Why Provide Access?

5.1. Ottawa Charter for Health Promotion
Since 1986, the Ottawa Charter for Health Promotion3 advocated that health promotion should take place in the settings where people create, love and live their everyday lives. Since this charter, settings based health promotion has become a central feature in the efforts to promote health that recognise the significance of context. These settings should therefore be accessible to health care professionals.

5.2. The International Union of Health Promotion and Education

In 2010 the International Union of Health Promotion & Education (IUHPE) passed a resolution calling for the inclusion of new and emergent settings within settings based health promotion. This resolution supported a commitment to the development of web based technologies to facilitate knowledge exchange and interaction.9 For this to happen, those

involved in health promotion will also require access to these new web based technologies in their work places.

5.3. Growth in the use of communication technology

Mc Nab (2009)11 states that access to information and communication technology (ICT) is growing every year and globally one in four people now use the internet. There is also rapid growth in the use of mobile phones and other devices which access the internet with more than four billion mobile phones subscribed globally.12&13 In Australia, young people, aged between 15 to 24 years, have the highest percentage of internet usage than any other age demographic, at 76.5% of the population.14 Social networking sites such as My Space or Facebook have appealed to millions of users since their inception. Social Bakers (2011) provides the latest user statistics for Facebook on line and provides the following figures for Australia.15 There is an increasing trend in the total number of Facebook users in Australia. There were 10 041 860 users reported in April 2011 compared with 9 million reported in March 2010.

Table 1. Number of Facebook users January 2011 to 30 April 2011 in Australia. Source: http://www.socialbakers.com/facebook-statistics/australia Table 1 shows an increasing trend over four months in total numbers of Facebook users from 9.3 to 10 million in Australia.

Figure 1 User age distribution on Facebook in Australia January 2011 to 30 April 2011

Figure 1 shows that the highest proportions of Facebook users in Australia are between 18 to 34 years old. Source: http://www.socialbakers.com/facebook-statistics/australia Social messaging service Twitter provides an instant stream of information between people around the world. Users can follow health conferences, a developing health story, search for information or share web links instantly. The World Health Organisation used Twitter during the 2009 influenza A (H1N1) pandemic and had more than 11700 followers.11

Figure: 2. Growth in Twitter users 2006 to 2010 in Australia. Source: http://www.sysomos.com/insidetwitter/twitter-stats-2010/ Figure 2 shows that from January, 2010 until mid-August, 2010, new users accounted for nearly 44% of the total Twitter population in Australia. People who created a profile before January 2009 only accounted for 4.7% of the total Twitter population in Australia.16

5.4. Use of social media to support NSW Government objectives

Use of social media is encouraged by the NSW Government as evidenced by the following statement in the NSW Government advertising guidelines. The NSW Government encourages the use of social media technologies to enhance communication, collaboration, and information exchange in support of NSW Government objectives. By openly sharing knowledge, best practices, and lessons learned, more effective solutions and efficiencies to enhance excellence in the business of government can be provided.

The use of social media technology follows the same standards of professional practice and conduct associated with all communication activities in the public sector. Common sense and sound judgment are vital in avoiding contentious issues. 17

5.4.1. Support for using Social Media by NSW Health AIDS & Infectious Diseases Branch
The Mid Term Review of the NSW HIV/AIDS, Sexually Transmissible Infections and Hepatitis C Strategies, 2006 2010, and the Implementation Plan for Aboriginal People, 2006 2010 was conducted in 2009. Emerging technologies and new media were frequently mentioned as needing to be embraced to transmit prevention, screening and treatment messages, with the following specific actions: establish a new technology group to plan a strategy run a new technology forum to share ideas, experiences and strategy appoint a policy officer position in the AIDS and Infectious Diseases Branch (AIDB) to work on this area build an evidence base on the use of new technologies in STI screening18

These actions were subsequently supported by NSW Health as indicated below in NSW Health Departments AIDB response. 19

5.4.2. Support for using Social Media in NSW Youth Health Policy 2011-2010
An action item on pg. 5 of the NSW Youth Health Policy 2011-2016 Implementation Plan states that advisory group should be convened to develop an e-technology strategy for youth health. 20 An expected outcome from this action is that NSW Health or NSW Health Funded Services meet young people where they are through creative approaches, including multi-media to engage and work with them. NSW Health will also find new ways of providing health information to young people in places where they are: on the internet; in schools; youth centres and in community organisations.20

5.4.3. Support for using Social Media by the NSW Department of Education and Training
The NSW Department of Education and Training (DET) supports its employees participation in social media online applications such as social networking sites, wikis, blogs, micro-blogs, video and audio sharing sites and message boards that allow people to easily publish, share and discuss content. DET have developed a policy to provide department employees with standards of use as they engage in conversations or interactions using digital media for official, professional and personal use. 21

5.5. Use of social media to support other Australian state government objectives
Use of social media in health is well established in Victoria as evidenced by the policies and guidelines published on the Victorian Governments Social Media in Health website. This policy states that social media can be a powerful engagement tool that enables people to 8

engage and communicate with each other and the broader community in an empowering and innovative way.22

5.6. Organisations that have lifted the ban on social networking sites
Shachtman (2009) describes an account of the US Army ordering its network managers to give soldiers access to social media sites. Army public affairs managers had worked hard to share the services stories through social sites. Yet the people presumably most interested in these sites, the troops, were banned from seeing the material. All domestic Directors of Information Management have since been ordered to lift the ban. The reason provided for this order was to enable the army to leverage social media to tell the Army story and to disseminate strategic unclassified information.23 The new policy says supervisors may still restrict the use of these sites. Previous restrictions will also still apply to sites with adult, racist or illegal content.24

5.7. Social media use by health professionals - examples

Ms Zena Jones is a nurse who specialises in sexual health and contraception and was appointed to make access to advice about sex and contraception easier for women in Rotherham, UK. To promote an awareness of her service, Ms Jones maintains a presence on Facebook and Twitter. Visitors to her site are advised to send her a private message to protect their privacy.25 Some suggestions are provided by the author of Medicine for Change Blog on how to use Twitter more effectively to promote health services. 26 Dr. Petra Boyton is a lecturer in International Health Services. Her research interests include the modernisation of sexual health services. Her blog and Twitter presence provides examples of how sexual health issues are effectively communicated.27 Boucher (2010) states that blogs, tweets, and other forms of social networking can be used just like telephone calls or e-mail messages to enhance between-visit care and help physicians have deeper, more engaged relationships with their patients. 28 Medichat.MD is an innovative site that offers users a plethora of factual information, along with advice and support that they can receive by interacting with other users through chat rooms and realtime video streaming. If they choose to, users can also interact with doctors. The site provides users with informational databases on doctors, nursing homes, pharmaceutical, and insurance companies. 29 In 2008, a Sydney based sexual health service implemented a short message service (SMS) reminder system to improve re-testing rates for HIV and sexually transmissible infections (STIs) in men who have sex with men (MSM). SMS reminders were found to more than double HIV/STI re-testing rates. SMS offers a cost-efficient system and has great potential value in increasing HIV/STI re-testing in clinical settings.
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Diagrams showing examples of how various social media might be used by sexual health professionals are provided in the appendix.

5.8. Social media based interventions in Australia - examples

In 2009 and 2010 the Burnet Institute in Melbourne delivered two interventions using social networking sites (primarily Facebook). The Face Space Project targeted young people and Queer as F**k targeted gay men. Both interventions used fictional characters to deliver health promotion messages, via online videos and social networking sites. Evaluation of these interventions integrated tools from the health (questionnaires, diaries, focus groups) and the information technology (user testing, expert review) sectors. Queer as F**k reached over 1,700 users, and the intervention has been continued by a local community organisation.31

Slipping through the NET was an internet education and research strategy on HIV and gonorrhoea transmission conducted in 2002. It was developed to reach men who have sex with men, who utilise internet chat rooms to meet other men to chat, talk about sex and seek sexual encounters. The project aimed to increase awareness about sexually transmitted infections and the increased risk of HIV transmission associated with co-infection. It also aimed to provide the men with an opportunity to ask questions about sexual health in private. The strategy was managed, designed and conducted by The Alfred Health Education Service, Victorian HIV Service, Infectious Diseases Unit, The Alfred. The evaluation component was designed and conducted by the Australian Research Centre in Sex, Health and Society (ARCSHS) at La Trobe University.32 The strengths of this health strategy were: Men were exposed to the health messages in their own environments. They could access the health educators immediately. Support, advice and referral were provided anonymously which allowed for open discussion of behaviour concerns. The private conversations with health educators facilitated referral to a local doctor experienced in sexual health, sexual health service or the Victorian AIDS Council/Gay Mens Health Centre along with other services. Men were provided with specific information about protected sex in a relevant environment, Men who responded by privately messaging were motivated to seek out information. 32

6. Guidelines for conducting internet based interventions

In 2008, The USA based National Coalition of STD Directors (NCSTDD)5 produced a guide to conducting internet outreach targeting men who have sex with men. The guidelines focus on the following areas. Internet-based partner services (IPS) Internet-based outreach Health Communications

6.1. Internet-based Partner Services (IPS)

These guidelines describe internet based partner services as the process of using the internet to notify a person of their potential exposure to an infectious disease. As trends in sex-seeking opportunities adapt to new technological advances, the NCSTDD state that IPS is particularly useful in contacting individuals that may otherwise be unreachable except via screen names, e-mail addresses, or other internet aliases. Measures to ensure confidentiality, ethics, and computer security are essential precursors to conducting IPS. The Guidelines present several issues, and possible solutions, to consider prior to attempting IPS.5 These guidelines can be adapted to encompass the use of smart phones and text messaging.

6.2. Internet-based Outreach

The authors state that careful observation of the culture of the online community is crucial for online outreach. Each internet community may have different clientele with unique STD/HIV risk behaviours, or varying standards for permitting health educators and health messages on their website or online community. As such, it is important to create guidelines for online outreach specific to an individual program or agency to ensure consistency in

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approach. The guidelines offer tips on creating an online identity and suggests elements to be included in agency-specific guidelines.5

6.3. Health Communications

The authors state that STD/HIV-related health communications on the internet should be a complementary activity to IPS and outreach. Every agency should at least have a website. Passive health-information seekers may be more inclined to view health information on a website than to engage in dialogue with an actual person. Having a well developed website can also add credibility to other online activities. In addition to tips on developing a website, the guidelines also cover traditional health communications tools, such as banner ads, mobile devices audio and video.5

6.4. Adapting to changes in the virtual environment

The authors of the above guidelines acknowledge that the virtual environment constantly changes. Websites popular today may lose their core audience and become clich tomorrow. However, the authors assert that equipped with the basic elements outlined in the guidelines, agencies will have the necessary skills to remain relevant in the realm of internet-based STD/HIV prevention activities.5 Grindr is an example of how the virtual environment has recently evolved. Grindr is a socialnetworking application that uses a global positioning system. It allows the user to contact gay and bisexual men who are nearby via a smart phone. Through a simple user interface, pictures of men, arranged from nearest to farthest away are displayed. There are options to chat, send pictures, and share one's location.33 Over 1000,000 men in 180 countries are part of the Grindr network.34 Sexual health services can potentially link into this network and remind those within the vicinity to drop-in for a sexual health check up.

6.5. Social networking sites and USA government agencies

On his first full day in office, Obama signed an Executive Order calling for all departments and agencies to "establish a system of transparency, public participation and collaboration." At the same time, White House lawyers, working with other federal agencies, sought to create new "terms of use" agreements with private companies to allow government to sign up for social networking sites. What was once the sole domain of adventurous government agencies has now become standard USA government policy.35 Additionally, social media guidelines developed by an extensive list of USA government agencies can now be accessed via an online Social Governance Database.36 While several USA government agencies still struggle to free themselves from bureaucratic restraints, the Center for Disease Control (CDC) has successfully used a wide array of social media tools.35 The CDC has also produced a comprehensive guide to using social media. This guide has been designed to improve the reach of health messages, increase access to information about service providers, increase further participation with audiences and advance transparency to improve health communication efforts. 6

7. Risks to clinicians from use of social media sites.

Although doctors and medical students are increasingly participating in online social media, evidence is emerging from studies, legal cases, and media reports that the use of these media can pose risks for medical professionals. These risks relate to confidentiality, defamation and professional boundaries. Inappropriate online behaviour can potentially damage personal integrity, doctor-patient and doctor-colleague relationships, and future employment opportunities. The Australian Medical Association advises that, rather than ban social networking sites, perceptions and regulations regarding professional behaviour must 11

evolve_to_encompass_these_new_forms_of_media.2 The Australian Medical Association Council of Doctors-in-Training (AMACDT), the New Zealand Medical Association Doctors-in-Training Council (NZMADITC), the New Zealand Medical Students Association (NZMSA), and the Australian Medical Students Association (AMSA) stated they are committed to upholding the principles of medical professionalism. As such, they have created some practical guidelines to assist doctors and medical students to continue to enjoy the online world, while maintaining professional standards.2 Saver (2010) reports that McCormack, a USA based nurse attorney cautions against nurses giving health advice on social media sites as they are not covered by insurance when they do this. McCormack also refers to an instance where nurses were dismissed after a patients xrays were posted on Facebook even though the patients identity was not disclosed. However, Saver suggests that as social media is rapidly becoming the primary means of electronic communication, rather than ban access, it is best to educate staff and to have a social media 37 policy.

8. Conclusion
The settings based approach provides a compelling case for providing sexual health professionals with access to social networking sites. Support for this can also be found within Australian Government policy. Successful interventions conducted via social networking sites are well documented. Well established guidelines also exist to mitigate the risks of interacting within the social media setting. As more people use social media, it has become increasingly relevant for health professionals to join social media based conversations to, not only pass on health related information, but also to help correct rumours and provide feedback.11 Social networking sites can provide an avenue for collaboration and open discussion between patients and health care providers. In these settings, everyone can contribute and be heard. Clear information and an opportunity to discuss treatment options can also be provided. The provision of access to social networking sites can thus be demonstrated to be consistent with NSW Healths core values of Collaboration, Openness, Respect and Empowerment.38

9. Recommendations
1. Establish a social media working group to plan a strategy. 2. Hold a social media forum to share ideas, experiences and contributions to the strategy. 3. Establish a dedicated position to coordinate the strategy 4. Adapt existing social media related policies to meet local requirements and develop a clinical governance framework. 5. Organisations providing sexual health services should incorporate social media in their strategic action plans. 6. Build an evidence base on the use of new technologies in sexual health service provision. To build this evidence base, access to social networking sites should be provided to sexual health staff whose responsibilities include: Health promotion Promoting awareness of services to consumers Contact tracing Scheduling appointments Patient consultation including follow up and monitoring of chronic conditions Re-orientation of services to improve access for priority groups 12

 Networking with other colleagues. Developing partnerships with other organisations 7. Provide training in: use of specific social media tools how to interact with specific social networking sites, and responsible use of social media and the application of social media and health related policy to practice

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10. References
1. NSW Health Policy Directive Communications - Use & Management of Misuse of NSW Health Communications Systems 19-Nov-2009 http://www.health.nsw.gov.au/policies/pd/2009/pdf/PD2009_076.pdf Accessed 6 May 2011. Australian Medical Association. Social media and the medical profession: A guide to online professionalism for medical practitioners and medical students, 30 November2010.http://ama.com.au/system/files/node/6231/Social+Media+and+the+Me dical+Profession_FINAL+with+links.pdf. Accessed 1 May 2011. World Health Organisation, Ottawa Charter for Health Promotion (1986), Charter adopted at International Conference: The move towards a new public health, November 17-21, 1986 Ottawa, Ontario, Canada http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf. Accessed 1 May 2011. Dooris, M. Holistic and sustainable health improvement: the contribution of the settingsbased approach to health promotion. Perspectives in Public Health 2009 Vol. 129 No. 1 pp. 29-36 http://rsh.sagepub.com/content/129/1/29.abstract. Accessed 28 April 2011. National Coalition of STD Directors. (2008, March). National Guidelines for Internet-based STD and HIV Prevention: Accessing the Power of the Internet for Public Health. Washington, DC: Author. http://www.ncsddc.org/upload/wysiwyg/documents/IGE.pdf. Accessed 1 April 2011. Centers for Disease Control and Prevention, Office of the Associate Director for Communications. The Health Communicators Social Media Toolkit http://www.cdc.gov/healthcommunication/ToolsTemplates/SocialMediaToolkit_BM.pdf Accessed 5 May 2011 Department of Services, Technology & Administration for NSW Government. NSW Government Advertising Guidelines December 2010. http://advertising.nsw.gov.au/sites/default/files/nswgovernmentguidelinesdec.pdf Accessed 23 April 2011 Creative Media Farm Information Glossary. Website: http://www.creativemediafarm.com/information/glossary. Accessed 2 May 2011. International Union of Health Promotion and Education. Resolution paper on settings based health promotion 2010. http://www.iuhpe.org/uploaded/Activities/Scientific_Affairs/Settings_resolution.pdf. Accessed 27 April 2011

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10. Australian Government Office of the Australian Information Commissioner What are social networking sites? Website: http://www.privacy.gov.au/faq/individuals/sn-q1. Accessed 27 April 2011. 11. Mc Nab, C. What social media offers to health professionals and citizens. Bulletin of the World Health Organisation 2009. http://www.who.int/bulletin/volumes/87/8/09066712/en/. Accessed 26 April 2011.

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12. Internet world statistics: usage and population statistics [Internet site]. Available from: www.internetworldstats.com 13. Measuring the internet society: the ICT Development Index. Geneva: International Telecommunications Union; 2009. 14. Australian Bureau of Statistics 2008, Australian Social Trends: Internet Access at Home, catalogue number 4210.0, ABS, Canberra. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Chapter10002008 15. Social Bakers, Heart of Facebook Statistics. Website: http://www.socialbakers.com/facebook-statistics/australia. Accessed 26 April 2011. 16. Sysomos Twitter Statistics for 2010: An in-depth report at Twitters Growth 2010, compared with 2009. Website: http://www.sysomos.com/insidetwitter/twitter-stats2010/ Accessed 25 April 2011. 17. NSW Government Advertising Guidelines December 2010. Strategic Communications &
Government Advertising, a division of the Department of Services, Technology & Administration.

http://advertising.nsw.gov.au/sites/default/files/nswgovernmentguidelinesdec.pdf 18. Report of the Mid Term Review Forum of the NSW HIV/AIDS, Sexually Transmissible Infections and Hepatitis C Strategies, 2006 2010, and the Implementation Plan for Aboriginal People, 2006 2010; 14 and 15 May 2009. Internal Report. NSW Health AIDB. 19. NSW Health AIDS & Infectious Diseases Branch Response to the Recommendations of the Mid Term Review of the NSW HIV/AIDS, Sexually Transmissible Infections and Hepatitis C Strategies, 2006 2010, and the Implementation Plan for Aboriginal People, 2006 2010. Internal report, October 2009. 20. NSW Department of Health, 2010, NSW Youth Health Policy 2011-2016: Healthy bodies, healthy minds, vibrant futures. NSW Department of Health, North Sydney. 21. NSW Government Department of Education and Training Social Media Policy. https://www.det.nsw.edu.au/policies/technology/communication/PD20110418.shtml Accessed 6 May 2011. 22. Department of Health Victoria - Social Media Action Plan - Part 1: Policy: Acceptable use policy, code of conduct, governance and approval. Website: http://www.egov.vic.gov.au/victorian-government-resources/website-practicevictoria/web-2-0-victoria/department-of-health-social-media-action-plan-part-1policy.html. Accessed 28 April 2011. 23. Shachtman N., (2009) Army Orders Bases to Stop Blocking Twitter, Facebook, Flickr. Wired. Website. http://www.wired.com/dangerroom/2009/06/army-orders-bases-stopblocking-twitter-facebook-flickr/ Accessed 3 April 2011. 24. Peace W. (2010). Marines lift social media ban. Stars and Stripes March 31, 2010. Website: http://www.stripes.com/news/marines-lift-social-media-ban-1.100410. Accessed 30 April 2011.

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25. Cunningham A. M. (2010). Health Professionals and Social Media http://www.slideshare.net/amcunningham/health-professionals-and-social-media Accessed 5 May 2010. 26. Lu (2010). Medicine for Change. Blog. http://www.medicineforchange.com/how-to-sexed-twitter/ Accessed 5 May 2010 27. Dr Petra Boynton, Sex educator, Agony Aunt, Academic. Website http://www.drpetra.co.uk/blog/ Accessed 5 May 2011. 28. Boucher J.L. (2010) Technology and Patient-Provider Interactions: Improving Quality of Care, But is it improving Communication and Collaboration? http://spectrum.diabetesjournals.org/content/23/3/142.full.pdf+html 29. Medichat.MD Website: http://www.medichatmd.com/aboutmedichatmd Accessed 9 May 2011. 30. Bourne C, Knight V, Guy R, Wand, H, Lu H, McNulty A (2011). Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with men. http://sti.bmj.com/content/early/2011/02/03/sti.2010.048397.full.pdf Accessed June 2011. 31. Gold J, Pedrana A, Stoove M, Chang S, Howard S, Asselin J, Ilic O, Batrouney C, Hellard M. Developing Health Promotion Interventions on Social Networking Sites: Recommendations from The FaceSpace Project http://wwwdev.burnet.edu.au/freestyler/gui/files/CPH%20Comm%20Tech%20Summary.pdf. Accessed 2 April 2011. 32. Rosey Cummings R., Hillier, L. Price, B. (2002). Slipping through the NET: An innovative HIV and gonorrhoea education, research and evaluation strategy. Victorian HIV/AIDS Service, Infectious Diseases Unit, The Alfred & Australian Research Centre in Sex, Health and Society http://www.dhs.vic.gov.au/health/researchprograms/downloads/slipping.pdf Accessed March 2011. 33. Wikipedia (2011). Grindr. http://en.wikipedia.org/wiki/Grindr. Acessed 17 April 2011. 34. Apple Apps (2011) Website: http://itunes.apple.com/au/app/grindr-gay-bi-curiousguy/id308956623?mt=8. Accessed 3 May 2011. 35. Scherer M. Obama and Twitter: White House Social-Networking. Time in partnership with CNN. Politics. http://www.time.com/time/politics/article/0,8599,1896482,00.html Accessed 12 May 2011. 36. Boudreaux C. Social Media Governance. Database on USA, Australian, UK and New Zealand Social Media Policies from government and non-government agencies, 2009 2011. http://socialmediagovernance.com/policies.php

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37. Saver C (2010) Social Responsibility: Social Media Opportunities and Pitfalls. Nursing Spectrum/NurseWeek Website. http://news.nurse.com/article/20100809/NATIONAL01/108090045/-1/frontpage Accessed 4 May 2011. 38. NSW Liberals & Nationals Plan to Provide Timely, Quality Health Care 2011. http://amansw.com.au/media/File/Plan_to_Provide_Timely_Quality_Health_Care_FINAL. pdf?forceDownload Accessed 3 May 2011.

11. Bibliography
1. Aids.Gov http://aids.gov/using-new-media/tools/, accessed 5 May 2011. 2. Nielsen Wire: Australia Getting More Social Online as Facebook Leads and Twitter Grows http://blog.nielsen.com/nielsenwire/global/australia-getting-more-social-online-asfacebook-leads-and-twitter-grows/ Accessed 6 May 2011 3. Sterling, G. 50 % of those exposed to mobile ads took action. Search Engine land. Website. http://searchengineland.com/google-50-percent-of-smartphone-users-exposedto-ads-took-action-74760 Accessed 9 May 2011. 4. Levine, D. Using new media to promote adolescent sexual health: Examples from the field. prACTice Matters. Ithaca, NY: ACT for Youth Center of Excellence October 2009. http://www.actforyouth.net/resources/pm/pm_media_1009.pdf 5. Medical Observer Social Networking: Facing the Facts. 14 May 2010. Website. http://www.medicalobserver.com.au/news/social-networking-facing-the-facts Human Capital Institute and Saba: Social Networking in Government: Opportunities and Challenges, 2010. http://www.hci.org/files/field_content_file/SNGovt_SummaryFINAL.pdf Accessed 12 May 2011. Newman B. (2009) Government / Non-profit Policy: Use of Social Media. Why government and non profit organizations should set up Social Media profiles. http://www.inqbation.com/government-policy-on-the-use-of-social-media/ Accessed 12 May 2011.

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12. Appendix
12.1. Suggestions of possible social media tools for health promotion staff i

This diagram suggests how social media tools may be used to respond to and facilitate conversations (as opposed to aiming messages at target audiences). Social media tools have multiple functions. More activities than those represented here may apply to each social media tool. There are also other social media tools with similar functions. 18

12.2. Suggestions of possible social media tools for medical officers ii

ii

Suggestions are provided on how medical officers can interact with patients via social media. Social media tools have multiple functions. More activities than those listed here may apply to the social media tools listed here.

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12.3. Suggestions of possible social media tools for nurses iii

The diagram suggests how nurses can interact with their patients. More activities than those shown here may apply to each social media tool. Other social media tools not listed here may be used instead. Access requirement to social media for different grades of nursing staff may vary according to their responsibilities. 20

iii

12.4. Suggestions of possible social media tools for sexual health counsellors iv

iv

This diagram suggests how social media tools can facilitate conversations between clients and counselling staff. Social media tools have multiple functions. More activities than those represented here may apply to each social media tool. Other social media tools not listed here may be used instead. 21