Attracting and Retaining Teens On a Health-Focused Online Social Network: What Works?

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 well-care visit, even though this is a standard health insurance benefit. Because 73% of American teens use social networking sites, this project seeks to reach low income teens via an online social network to influence their health care utilization decisions.

Program background: This project, funded by an NIH research grant, tests whether an intervention using an online social network can 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.  Our partner, a large health insurance company, manages the health care of thousands of adolescents who have public health insurance. The Teen2xtreme website offers a teens-only community of users, teen- and professionally produced content, transmedia storytelling, 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. The process of recruiting teen participants into the study, attracting the intervention sample to register on the site and retaining site members who return regularly has been one of trial and error, with many lessons learned along the way about what works and what does not work.

Evaluation Methods and Results:  Evaluation of the project uses a Randomized Controlled Trial to test intervention impact, comparing our social media intervention and ‘usual care’ among the Medi-Cal and Healthy Families teens served. A 2-wave comparison groups design uses self-report questionnaires as well as HMO 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.

Conclusions:  While the final evaluation has not been conducted yet, ongoing process evaluation and monitoring during the recruitment and intervention period have provided insight into the methods that work with teens and those that do not. The methods that have been most effective in getting the teen participants onto the site have included the use of incentives, text messages, mailed holiday cards and other direct contact. To keep them coming back, fun and engaging content and activities such as contests, online chats, and transmedia storytelling that they cannot find on other sites is critical.

Implications for research and/or practice:  Because social media is gaining such widespread adoption, it holds great promise for influencing health-related behaviors. However, we must keep in mind that our audience has many competing sites to choose from, and anything we offer them must be unique and compelling to earn their time and attention.