Teen2Xtreme: Using Social Media to Improve Adolescents' Health Literacy

Background: In California 88% of teens are insured, however they often don’t use their health insurance effectively. We define this broadly as a health literacy issue. In California, only 32% of disadvantaged adolescents receive an annual Adolescent Wellness Visit, even though this is a standard health insurance benefit. Surveys show that during these visits, while physicians and other health providers adequately address reproductive health, physical health and substance abuse issues, they may not ask about mental health, violence, and nutrition issues. In addition, many teens continue to use the emergency room for routine care.

Program background: This intervention research tests whether a social media intervention can encourage adolescents ages 13 – 17 to better utilize their health insurance benefits. Our objectives are to increase teens' capacity to access and use their insurance, become more engaged in their health care and health behavior decisions, and develop pro-health attitudes.  We are partnering with a large health insurance company, Health Net of California, who manages the health care of thousands of adolescents who have public health insurance. The Teen2Xtreme social media website includes forming a community of users, development of teen and professionally produced content, storytelling formats, competitions, games, quizzes, blogs, video sharing and other interactive and participatory communication methods. Rather than focusing on health, per se, the site covers lifestyle issues for teens to help them live life to the fullest and accomplish their goals, including how to access their health benefits to accomplish this.

Evaluation Methods and Results:  We are using a Randomized Controlled Trial to test intervention impact, comparing our social media intervention and ‘usual care’.  Our initial sample is 8,000 Health Net enrollees out of 155,000 Medi-Cal and Healthy Families teens served. A 2-wave comparison groups design uses self report questionnaires as well as administrative data to assess changes in adolescents’ utilization patterns, understanding of health insurance benefits, rights and responsibilities, primary care provider encounters, health information seeking, attitudes and health behaviors. Of particular interest is increasing the use of the annual Adolescent Wellness Visit from 36% to 45%.

Conclusions:  Our initial sample of adolescents know they have health insurance, however they do not have a clear understanding of their benefits, a relationship with their primary care provider, or know where to go to get appropriate care when they get sick. Moreover, while most understand some aspects of prevention, they do not perceive their primary care physician as someone who they can talk to about these issues.  We will report on formative research, describe the development of the social media website and give initial results from the baseline survey,  as well as results to-date of the social media site recruitment and initial community response.

Implications for research and/or practice:  As health insurance coverage becomes more prevalent, we need to find ways to help people access and utilize their benefits most effectively to positively impact their health. Because social media is gaining such widespread adoption, it holds great promise for influencing health-related behaviors among populations that use it most.