messaging young people in school nursing focus groups summer 2012

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2.1. Data on included schools . .... 3.2.2.1 Key messages and reservations . ... guidelines encouraged the use of messag
MESSAGING YOUNG PEOPLE IN SCHOOL NURSING FOCUS GROUPS SUMMER 2012

MESSAGING YOUNG PEOPLE IN SCHOOL NURSING FOCUS GROUPS SUMMER 2012 Contents 1.

SECTION 1 .................................................................................................................................................... 3

1.1.

Introduction ............................................................................................................................................. 3

1.1.1.

Methodology ....................................................................................................................................... 3

1.1.2.

Aim of the focus groups ...................................................................................................................... 3

2.

SECTION 2 .................................................................................................................................................... 4

2.1.

Data on included schools......................................................................................................................... 4

2.2.

Demographics of included schools [%].................................................................................................... 5

3.

SECTION 3 .................................................................................................................................................... 6

3.1.

Focus group data ..................................................................................................................................... 6

3.1.1.

Focus groups by gender and age ......................................................................................................... 6

3.1.2.

School nurse knowledge and use ........................................................................................................ 6

3.1.3.

Mobile phone use in school................................................................................................................. 6

3.1.3.1.

Data on mobile phone use in school ............................................................................................... 6

3.1.3.2.

Mobile phone use by model/operating system .............................................................................. 7

3.1.3.3.

School mobile phone policies .......................................................................................................... 8

3.2.

Summary of key themes from focus groups ........................................................................................... 8

3.2.1.

Perceptions and behaviours ................................................................................................................ 9

3.2.1.1.

Knowledge of the school nurse role and responsibilities................................................................ 9

3.2.1.2

Sources of confidential health advice ............................................................................................ 10

3.2.1.3

Communicating with family and friends ........................................................................................ 10

3.2.2

Messaging service design and delivery ............................................................................................. 12

3.2.2.1

Key messages and reservations ..................................................................................................... 12

3.2.2.2

Technical considerations................................................................................................................ 13

3.2.2.3

Promotion of a messaging service ................................................................................................. 13

4 4.2

SECTION 4 .................................................................................................................................................. 15 Summary................................................................................................................................................ 15

FOCUS GROUPS: SUMMER 2012

Messaging young people in school nursing

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1. SECTION 1 1.1.

Introduction

During 2012 anecdotal feedback from school nurses and other community health clinicians indicated they were feeling increasing pressure from service users to be contactable via messaging. Meanwhile national guidelines encouraged the use of messaging and apps to improve timeliness and efficiency of service delivery. These reports included “Getting it right for children and young people” (the school nurse vision and call to action) and “Digital First – the delivery choice for England’s population” (the Department of Health initiative to incorporate technology into interactions between service users and clinicians). Leicestershire Partnership NHS Trust Division of Families, Young People and Children’s Services identified that an SMS messing service or app based instant messaging service which enables young people to speak with a school nurse safely and securely, might make it easier for young people to access a school nurse and more likely that young people will access a school nurse. The trust began to consult with young people to test the hypothesis with a view to creating and piloting a new robust messaging system.

1.1.1.

Methodology

Focus groups were conducted at four schools. The sites were chosen because of the differences between them in the age and socio ethnic makeup of the students on roll. Groups included students of varying ages, some of whom had and some of whom hadn’t used the school nursing service before. The groups were conducted by an interviewer following key prompts on a focus group schedule.

1.1.2.

Aim of the focus groups a. b. c. d. e.

Assessing existing awareness and perception of the school nursing service Testing general appetite for a school nurse messaging service Identifying key issues that would encourage or discourage use of a messaging service Better understanding mobile device prevalence and use in schools To inform themes for a quantitative surveying exercise which would take place at a later date

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2. SECTION 2 2.1.

Data on included schools

Ofsted rating

Location College Type Student ages Students on roll

FOCUS GROUPS: SUMMER 2012

Colleges Charnwood Formerly Garendon Outstanding 2010

Formerly Burleigh Satisfactory 2012

Outstanding 2011

Leicester County Academy (Secondary school with sixth form) 14 – 19 years

Leicester County Secondary community college / high school 11 – 14 years

Leicester County Secondary / foundation with sixth form 14 – 19 years

Leicester County Secondary school with sixth form 14-19 years

1896

1195

Judgemeadow Community Outstanding 2010

Lutterworth

Leicester City Secondary high school 11 – 16 years 1204

Good 2008 Sustained 2012

Messaging young people in school nursing

Oadby Beauchamp

2079

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2.2.

Demographics of included schools [%]

100 90

86.2

80 70 National average

57.6

60

Judgemeadow 49.2

50

Lutterworth Charnwood (Garendon) 37.5

40

Oadby Beauchamp

29.1

30

20.7

20.3 20

Charnwood (Burleigh)

35.1

20.6

17.4

16

14.2

11.611.1

9.9 9.2

10 2.8

3.6

11.1

11.4

9.4

6.4 6.4

9.6

7.1

7.7

7.5 7.2 6.6

2.9

0 Eligible for school meals

FOCUS GROUPS: SUMMER 2012

From deprived areas

Engligh NOT first Language

Messaging young people in school nursing

International minorities

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Gifted/talented

3. SECTION 3 3.1. Focus group data

3.1.1.

Focus groups by gender and age

Colleges Judgmeadow Community Lutterworth Charnwood Oadby Beauchamp WHOLE SAMPLE

3.1.2.

No. male students 3 2 2 7 14

No. female students 3 4 6 6 19

No. all students

Age

6 6 8 13 33

11 – 15 14 – 17 11 – 15 16 – 17 11 - 17

School nurse knowledge and use

All [100%] students said that they were aware of school nurses and the school nursing service. 7 [21%] students volunteered information about having accessed a school nurse.

3.1.3. 3.1.3.1.

Mobile phone use in school Data on mobile phone use in school

32 [97%] students said they had a mobile phone. 1 [3%] student said they did not have a mobile phone 31 [94%] students said they brought their mobile phone to school. 8 [24%] students said their phone was usually on during lessons and breaks. 22 [67%] students said their phone was usually on and in silent mode during lessons and breaks. 1 [3%] said their phone was usually switched off during lessons (but may be on during breaks).

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Mobile phone use in school

1 1 8 Phone ON at school Phone OFF at school Phone ON & SILENT at school

1

No phone at school No phone 22

3.1.3.2.

Mobile phone use by model/operating system

All [100%] students who said they had a mobile phone reported owning a model of phone that is compliant with use of SMS text messaging and apps (i.e. “smartphones”). Model iPhone Blackberry Android Other/not specified Total

Number 7 13 10 2 32

% 22% 41% 31% 6% 100%

Mobile phone use by model/operating system [%]

45

41

40 35

31

30 25

22

20 15 10

6

5 0 iPhone

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Blackberry

Android

Other

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3.1.3.3.

School mobile phone policies

Whilst all schools had formal or informal restrictive phone use policies in place, all students reported experiencing varied degrees of tolerance towards phone use during lessons, breaks and lesson changeovers. Students reported teachers in one school accepting non-policy use of phones during breaks “if it was done discreetly”. In another school, students reported that sometimes they might be allowed “to leave the classroom to answer a call” if it is a call that is deemed “important” such as “from a parent or GP”. Lutterworth students in particular described staff being tolerant of phone use that breached policy. But, there was a general feeling across all schools that different teachers/staff may respond in different ways to non-policy use of mobile phones during lessons, breaks and lesson changeovers. Students also reported varying degrees of “punishments” associated with inappropriate phones use. In Oadby Beauchamp, punishment included confiscation of the phone but, in spite of this, students suggested they were not concerned that their phone might ring aloud in class if it wasn’t switched off or in silent mode.

Phone Policy – Charnwood College Phones must only be used at break and lunch times.

Phone Policy – Lutterworth College Phones must only be used during social time, not during lessons and lesson changeover.

Phone Policy – Judgemeadow Community College No phones allowed on site - if seen by staff they will be confiscated and require a letter signed by a parents to be returned.

Phone Policy – Oadby Beauchamp College Phones are to be switched off and away during lessons unless specifically directed otherwise teaching staff (i.e. some departments encourage the use of phones to take photos of work on the board or monitor homework through the college's app). Misuse can result in confiscation.

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3.2. Summary of key themes from focus groups

3.2.1.

3.2.1.1.

Perceptions and behaviours

Knowledge of the School Nurse Role and Responsibilities

a. Confidentiality Confidentiality was universally important to students. They understood that school nurses offer a confidential service although those who had not accessed the school nursing service were unclear about the detail of confidentiality arrangements. Some Lutterworth students felt that promises of confidentiality may not be honoured by NHS staff - this was as a result of one member of the group’s previous experience in which they felt their confidentiality had been breached to a parent by a member of NHS staff (who was not a school nurse). Other students in the group supported the perception, suggesting that sharing of confidential information is unrestricted amongst NHS staff within NHS networks. Speaking about sharing personal information, one male student felt that he “didn’t want anyone else ‘knowing his business’…and wouldn’t trust a school nurse unless she/he could earn [his] trust”. However, students declaring that they had seen a school nurse said they were glad that they had done so. Anonymity when contacting a school nurse was seen as being desirable, particularly by adolescent males, who suggested it enhanced confidentiality. It was also suggested that anonymity, and the opportunity to put a message in writing, can make it easier to reveal certain kinds of information, “sometimes it’s difficult to say something in words to someone’s face”. This was deemed to be one benefit of a proposed messaging service between students and school nurses.

b. Roles and Responsibilities Students provided accurate suggestions about the types of support school nurses could provide, such as sexual health support (“sex education” or “free condoms and lube”), advice about family issues, skin conditions and minor illness, general health and diet, bullying, smoking cessation or other “things you don’t want to talk to your parents about”. The majority of students described providing support around sex and sexual health as a primary function of the school nurse role. Some students provided inaccurate examples of the kind of support school nurses would be likely to provide, such as first aid and genital examinations. There was a general consensus that school nurses could help with all aspects of health and wellbeing albeit in a suggested “low level” way compared with GPs. GPs were suggested to be “different” in that they are “medical” and “can prescribe medicines”. GPs were described as being “formal” where school nurses were

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described as being “informal”. Informality was described as constituting a personable and friendly service, usually accessible on a drop-in basis, “it’s someone to talk to about your problems”. In some cases there was almost a sense of a parallel with soft or talking therapy.

c. Awareness and access All students were aware of school nurses and the school nurse service, “everyone knows about school nurses”. Participants identified that school nurses were accessed through a “clinic” in some cases accurately quoting specific clinic times and locations. Awareness about how to access the service was high and students suggested that it was more accessible than sources of help which are off-site, “school nursing is available here in school where we are all of the time”. Other students recognised that school nurses could be access through pastoral or reception staff in school and mentioned how access was promoted through posters and information in tutorials. In the schools with highly utilised first aid and pastoral staff employed by the school, there was lack of distinction between the school first aid and pastoral staff and NHS school nurses. There was little understanding of the specific differences between the roles and little kudos was associated with whether the staff were provided by the school or by the NHS. More females than males mentioned having used the school nursing service. Students over 13 years of age were more likely to decide for themselves that they wanted to see a school nurse, whereas 11 and 12 year olds were more likely to involve their parents in the decision or have their parents initiate the decision.

3.2.1.2

Sources of confidential health advice

The majority of students described the internet as their initial source of confidential health advice, “I’d look it up on Google”. GPs were cited as the second example in the majority of cases. School nurses were also cited and described as being quicker to access than GPs and “better to see about certain kind of problems”.

3.2.1.3

Communicating with family and friends

Young people described text messaging as the primary way of communicating with family and friends. SMS text messaging was specifically referred to as “most used” although instant messaging apps were described as being used similarly. The majority of young people presumed to list mobile communications media first when asked about communicating with family and friends. Face to face contact and talking was categorised differently and not usually cited in their list of examples even though it was described as being critically important when prompted. Talking on the phone (voice calls) was categorised alongside other mobile communications media examples and ranked third after text messaging and contact through online social networking sites. Email was not described as a primary method of communication, “I can’t even access my email – I haven’t been able to for ages”. Direct messaging through Facebook and Twitter were being used as alternatives to

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email. Myspace, BeBo and MSN messanger were also considered to be unfashionable or outdated, with BeBo and MSN in particular being described as “more for children”. The most cited methods of communicating with family and friends in order of preference were:

a. SMS text messaging and instant messaging provided by free to use services like WhatsApp and Blackberry Messenger (BBM). b. Online social networking sites like Twitter and Facebook c. Voice calls d. Video/internet calling like Skype and Facetime, for family and friends geographically further away.

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3.2.2

Messaging service design and delivery

When asked about whether a messaging service would make it easier for students to access a school nurse and more likely that students would access a school nurse, 29 [88%] students said it would make access easier and more likely. 4 [12%] students said it would make no difference, or expressed a caveat such as “it would only help if it was well promoted in school”. No students [0%] said a messaging service would make access more difficult or less likely. Charnwood College already had an SMS contact number for school nurses in operation and students there cited this as a familiar method of accessing a school nurse. In other schools, some students spontaneously suggested instant messaging and SMS messaging as “a good new way to get in touch with a nurse” without being prompted. No students referred to or enquired about the likely cost of SMS messaging.

3.2.2.1

Key messages and reservations

The key overriding message was that the service would need to ensure confidentiality in order to be a positive initiative overall. Whilst the majority of students were happy to use a message based service to book appointments, their willingness to send a message including more personal information would be influenced by their confidence in: a. The identity of the recipient Some students needed to specifically know and trust the nurse who would read their message whilst other were happy not to know exactly which nurse would open their message and were happy if they had not met the nurse before. b. Guaranteed safe arrival Some students suggested they would need immediate acknowledgement that their message had been received by the school nursing service in order to feel confident that it had not “ended up in the wrong hands”. There was also a suggestion that a further acknowledgement should be sent when the message had been read by a school nurse. c. The timeliness of the response A quick and prompt response was important to students. The majority of students defined a timely response as immediate (i.e. within a few minutes). In order to feel confident about using the service students said they would need to know when to expect a response. d. Whether anonymity is accepted Anonymity was less critical than confidentiality but the option of remaining anonymous was desirable, described as being likely to increase use of any messaging service.

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e. The security of their messages Students were aware that mobile phones are not secure devices and some acknowledged the potential that a third party might see messages on their handset. They were encouraged by the possibility of an instant messaging app that requires the user to input login details. They recognised how this would increase the security of their messages. They added that the need for a young person to create a user account when registering with an app, may reduce the likelihood of them sending hoax messages.

3.2.2.2

Technical considerations

Some students described issues connecting to the internet via personal mobile devices in school because of poor 3G or WiFi availability. This was highlighted most predominantly at Judgemeadow. Online access was generally available in school through shared resources, “I can book some time on a computer in the library”, although access on such resources was restricted, and certain sites were blocked. This could impede students’ ability to access an instant messaging app within the school premises via personal mobile devices and may require that special arrangements are put in place with the school in order that young people could access an alternative version of an app online. Students expressed concern for peers who may not be able to access an instant messaging app because they do not have an app compliant phone (i.e. “smartphone”) and added that SMS messaging should also be available to ensure universal access. They did not express concerns about students who might be excluded because they do not have any kind of mobile phone. Another technological issue that might impede the use of SMS messaging is poor network coverage. Poor network coverage was not highlighted by students in any session.

3.2.2.3

Promotion of a messaging service

Methods to promote a messaging service suggested by young people were: a. b. c. d. e. f. g. h.

Assemblies/school announcement systems Tutor group/personal and social education sessions Posters in toilets, around school or in places where students might socialise TV screens in schools where available QR codes on marketing resources Business cards in schools Twitter/social networks Marketing on the room of a door where drop in clinics happen

There was some discussion about branding and whether an NHS logo would be seen as a positive or negative attribute on marketing material. Some students felt that this would be reassuring, indicating national/professional standards, whereas others brought up the question of confidentiality suggesting an NHS logo indicated increased likelihood that personal information would be shared between colleagues or departments.

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Students also suggested there was a need for discretion in marketing material. Key messages on posters would need to be clear and easy consume quickly, as students suggested they “might not want to be seen looking at posters” by peers. Key messages in any marketing strategy would have to emphasise: a. b. c. d.

Confidentiality and/or anonymity and what is meant by this How and when will a response be sent – “within minutes not hours”. Who will send the response and whether it is a real person The types of queries that the service can be used for – students expected to see specific examples. There was some debate about whether “self-harm” was an appropriate example to give and students concluded that it was, suggesting it might encourage more discourse around self-harm which was thought to be prevalent but taboo or at least difficult to talk about.

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4 SECTION 4 4.2

Summary

In general, all students were aware of the school nursing service and had a reasonable understanding of school nurse roles and responsibilities. Young people were highly aware of confidentiality issues and were concerned about the preservation of confidentiality. A school nurse messaging service was viewed to be a good idea on the whole. Students felt a messaging service would make it easier for students to contact a school nurse and more likely that students would access a school nurse – particularly if the option to make anonymous enquiries was available. Access to technology was good with use of high spec smartphones being prevalent in school. Although antiphone use policies were in place in all schools, students who felt they applied discretion and respect around phone use, expected to experience tolerance from teaching staff. More possible technical difficulties were highlighted in relation to an instant messaging app than SMS messaging. However young people also recognised some information security risks relating to SMS messaging and that those risks could be overcome by the use of an app – students suggested the need for both options. The theme of confidentiality was suggested to be critical to the success of a service. In order for a service to work it would need to be well promoted and the terms of confidentiality would need to be well explained and upheld. Marketing materials would need to explain the parameters of the service and be disseminated through a variety of channels. A messaging service would need to ensure a personable and timely response to enquiries in order to retain the trust of young people and deliver satisfaction.

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