Fact Not Fiction's (Re)Design and Launch: A Case Study in Using Social Media to Enhance Teen's Access to Sexual and Reproductive Health Education

Background: Inadequate access to comprehensive sexual and reproductive health education (also referred to as abstinence-plus education) in public schools has been linked to adolescent childbearing in the U.S., which has the highest teen birth rate among comparable developed nations as well as disproportionately high rates of sexually transmitted infections (STIs) among youth and young adults. Resource-limited states such as Mississippi experience high rates of adolescent childbearing and STIs. For example, at 42.6 births per 1,000 teen girls, Mississippi has the third highest adolescent birth rate in the nation. Although 58% of the state’s high school students are sexually active, the delivery of comprehensive sex education in public schools faces a number of issues in Mississippi (e.g., a ban on condom use demonstrations).

Program background: In order to fill the critical gap in comprehensive sexual and reproductive health education in Mississippi public schools, FactNotFiction (http://factnotfiction.com/) was launched in 2012 to provide medically accurate sexual health information to Mississippi teens (and their parents). However, six months after FactNotFiction’s launch, a review of online analytics indicated the bounce rate among mobile phone users was unacceptably high and that first-time visitors were not returning to the site. Based on these findings, our research questions became: 1) How do we reduce the bounce rate among teens using mobile phones to visit FactNotFiction?, and 2) How do we encourage teens to make repeat visits to the site?

Evaluation Methods and Results: After re-examining the initial developer’s assumption that Mississippi teens don’t have smart phones, we redesigned site to be mobile-responsive and converted the static website into a dynamic Tumblr site and Facebook page, which we launched in April 2013. A review of online analytics from April-December 2013 following FactNotFiction’s redesign and launch indicated that: 1) visits to the site increased from 8,848 to 34,160; 2) return visits increased from 12% to 26%; 3) monthly visits averaged 3,700; 4) average time on the site increased from 0.47 to 1.03 minutes; 5) 69% of visitors were from within Mississippi.

Conclusions: FactNotFiction’s redesign and launch was successful in driving teens seeking sexual and reproductive health information to the site and in retaining repeat visitors. Our findings suggest that paying close attention to early results from online analytics and responding to these early results can play an important role in increasing the effectiveness of online public health promotion initiatives. Indeed, responsiveness to such early results can be crucial to sustaining the viability of eHealth initiatives.

Implications for research and/or practice: We describe challenges associated with FactNotFiction’s initial development and launch and its successful redesign. Lessons learned from this case study have implications for other eHealth and social media initiatives for public health promotion—especially those targeting teens or other hard-to-reach audiences.