Monthly Archives: June 2013

Thinking Health Communication? Think Mobile.

Uptake of mobile phones is pretty extraordinary in Australia. Our population has recently topped 23,000,000 (ABS) yet we have over 30,000,000 (ACMA) mobile phones in use. Are our health agencies keeping up with this?

This video above and blog post below explain the rationale for using SMS for health communication, and provides examples drawn from clinical practice.

IMG_1910Why Use SMS?

Many health agencies block the number on outgoing calls. From my experience in a role where I made phone contact with everyone who was referred to the service, I estimate that only one in every three or four calls are answered from a blocked number. From the same role, I found voice-to-text messaging for unanswered calls more common than voicemail by a similar factor – three or four to one. Although voice-to-text accuracy has improved remarkably over the last couple of years it’s still prone to muddling words. The other thing about voice-to-text is that it is difficult to confer detail or convey tone – both of which are important when addressing people who have been referred to a mental health service.

SMS1To get around this problem I made a number of template messages on the work mobile phone (a hideously clunky-to-use Nokiasaurus), and used these template messages as an adjunct/alternative to voicemail and voice-to-text. Most of the templates included my name, position, the name of the service, and a shortened URL. The rationale was to use the SMS as an introduction.

The wording of the SMS templates was done with input from a very skilled and passionate Consumer Consultant. Nevertheless, when i first started using them I was wondering whether we had got the tone and/or language wrong. There were very few prompt replies.

In my personal life SMS conversations have a pretty quick tempo: I send a message, you reply within a minute or so; I send a photo, you send an emoticon straight back.  A snappy way to communicate.

My Australian accent and this man's Japanese accent made verbal communication difficult and imprecise. SMS solved that.

My Australian accent and this man’s Japanese accent made verbal communication difficult and imprecise. SMS solved that.

Using the SMS template above rarely yielded a quick reply. People returned contact sometimes within a few hours, but more typically a day or so later. I imagine (guess) that they were waiting until they were in a place and a head-space where they would feel comfortable (or less uncomfortable?) talking to a mental health nurse they’ve never met. Fair enough – I’d do the exact same thing if the tables were turned.

The slowest return contact from a SMS was six weeks. That lady introduced herself by saying, “I was hoping I wouldn’t have to make this call, but things have changed now. I need some help please…”

Why use a short URL?

Simply, so that those with smartphones can easily visit the web site to see what we’re on about. The web presence and short URL are important, I think – it puts information about your service, alternative services, and other resources directly into someone’s hands.

Each SMS is only 160 characters long (why is a Tweet only 140?), and the full URL at 76 characters long would take-up nearly half the message: http://www.health.qld.gov.au/cairns_hinterland/html/pmh_referral_pathway.asp whereas by using a URL shortener we only use 17 characters http://qld.so/pmh

What is lost in corporate branding is made-up for in practicality.

Is it that big a deal – do people actually access the internet from their phone? You betcha! As you can see below, the market penetration of smartphones is highest amongst the age groups most associated with childbearing (i.e.: the perinatal mental health target demographic).

Mobile phone, smartphone and tablet usage. Source: Australian Communications and Media Authority (2013) Communications report 2011–12 series Report 3: Smartphones and tablets: Take-up and use in Australia. Commonwealth of Australia

Mobile phone, smartphone and tablet usage.
Source: Australian Communications and Media Authority (2013) Communications report 2011–12 series Report 3: Smartphones and tablets: Take-up and use in Australia. Commonwealth of Australia

Is This All a Bit White & Middle-Class?

Put the info where it's always handy: on your client's phone.  Brochures are so last century.

Put the info where it’s always handy: on your client’s phone.
Brochures are so last century.

This is a question us whitefellas who live in parts of Australia where there are a lot of first-nation people need to be checking on all the time. We don’t want to bugger-up an opportunity to do our bit towards closing the gap in health outcomes. So, in regards to mobile phone/internet use, it was interesting to see these three observations in the Joint Select Committee on Cyber-Safety report on the inquiry into Issues Surrounding Cyber-safety for Indigenous Australians (which was released last week):

  • “As for other young people in the community, mobile phones are a valuable communication tool for Indigenous youth who are enthusiastic adopters of the technology.” (3.5)
  • “Research shows that mobile phones, where coverage is available, are the preferred communications device for many Aboriginal and Torres Strait Islander peoples.” (3.8)
  • “Smartphones have emerged as the preferred online platform, given limited household internet connectivity and the life circumstances of many Indigenous Australians.” (3.2)

referralThis information together with my clinical experience makes me feel pretty confident to say that mobile phones are not just a middle-class whitefella thing.

In 2011-2012 19% of perinatal mental health referrals I received were for Aboriginal and Torres Strait Islander women, and 99% of all people referred had a mobile phone number cited on their referral.

However, I was less successful in engaging Indigenous than non-Indigenous women via phone. I recognise and accept that my gender and cultural background are barriers for some, but it may also be that the template SMS messages might not be user-friendly across cultures. It’s not for me to say really, cultural safety is “an outcome of nursing and midwifery education that enables safe service to be defined by those that receive the service” (Ramsden 2002). With that in mind, it would be a good idea to revisit the wording of the SMS templates with some Indigenous health professionals and service users before replicating/adapting this communication strategy .

The Small Print

IMG_1906Please do not phone the numbers used in the screenshots as a way to access perinatal mental health or me. The funding period for that role was 23/08/10 – 30/06/13 (more info here).

The screenshots with text in green blocks used on this page and in the video are all of fair-dinkum exchanges of communication, but were manipulated via my personal smartphone to capture the way the conversation flowed (forwarded the actual SMS messages to my personal phone from the work Nokiasaurus).

The screenshots with text in blue blocks are completely fictional, made only for illustrative, artistic and/or comic affect.

It should be obvious that I am not representing any organisation here; if you’re still wondering please visit meta4RN.com/about and see Q13.

References

Australian Communications and Media Authority (2013) Communications report 2011–12 series Report 3: Smartphones and tablets: Take-up and use in Australia. Commonwealth of Australia

Image: International Morse Code, from Page 96 of Radio Receiving for Beginners. Rhey T. Snodgrass and Victor F. Camp (copyright 1922 by The MacMillan Company, New York), sourced via http://commons.wikimedia.org/wiki/File:International_Morse_code.png

Joint Select Committee on Cyber-Safety (June 2013) Issues Surrounding Cyber-Safety for Indigenous Australians. The Parliament of the Commonwealth of Australia: Canberra

Ramsden, I. (2002) Cultural Safety: Kawa Whakaruruhau, Massey.

End

As always, your comments/feedback are welcome.

Paul McNamara, 29th June 2013

#HCSMANZ: be unafraid, speak up, join in (letter in the TQN)

My letter to the editor was published in the current issue of TQN, the journal published six times a year for Queensland nurses and midwives by the Queensland Nurses Union. Below is the content of the letter:

IMG_0236QNU Secretary Beth Mohle wrote an inspiring article (TQN April, p3) urging nurses and midwives to be unafraid, to speak up, and to remember that our community supports us even when our government doesn’t. This was in stark juxtaposition to the case study and reflective exercise on using social media (p36-38), which completely overlooked the benefits of nurses and midwives speaking up, being unafraid, and interacting with others in the community.

The April TQN case study cited an instance of racist, sexist and other derogatory comments getting an employee into trouble. This is not a social media problem; this is a racist, sexist, derogatory comment problem.

Let’s make the assumption that most nurses and midwives are wise enough to behave as ethically online as they do elsewhere. There is a worldwide community of health professionals using social media in constructive, creative, collegial ways. Queensland midwives and nurses should not be discouraged from joining this community.

The risks of using social media are often overstated, the benefits are frequently underestimated. Participate, be generous, be sensible, enjoy.

IMG_0235Citation

McNamara, P. (2013) Behave online as you would in real life (letter to the editor), TQN: The Queensland Nurse, June 2013, Volume 32, Number 3, Page 4.

Quick Comment

The title given to the letter, “Behave online as you would in real life” bugs me a bit. Being online is part of everyday real life; it is not, as the title implies, completely separate from real life.

Maybe the letter’s title could have been, “#HCSMANZ (Healthcare Social Media in Australia & New Zealand): be unafraid, speak up, join in”

End

As always, your comments and feedback are welcome.

Paul McNamara, 21st June 2013

#ACMHN Looking back at the 2013 Consultation Liaison / Perinatal Infant Conference through a Social Media Lens

Context

The 2013 ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses Annual Conference was held on June 6th and 7th, in Noosa – on Queensland’s Sunshine Coast. It is a boutique conference: these two subspecialties account for a tiny fraction of the total mental health nursing workforce. Given the size of these subspecialties, the conference organisers were pleased with the attendance of about 70 nurses, who gathered together from New Zealand and most states/territories in Australia. 70 is probably about par for the course.

IMG_1850The theme of the conference was “Present and Available” – an exploration of the process of presence, being with and affecting change in the variety of settings that we work. This post explores whether social media can also help mental health nurses and their conference content be present and available to others via social media, specifically: via twitter.

Quantitative Data

There were 26 twitter participants using the #ACMHN hashtag over four days (the two conference days being in the middle of this period). Interestingly, only 3 of the 26 #ACMHN participants were delegates (ie: only 12% of those tweeting about the conference were actually at the conference). Let’s look at the make-up of all #ACMHN participants:

  • 3 conference delegates (each of them Australian mental health nurses)
  • 4 Australian mental health nurses, across three states (Victoria, South Australia & Queensland)
  • 2 European mental health nurses (Germany & Netherlands)
  • 2 Australian general nurses (New South Wales & Australian Capital Territory)
  • 2 Australian nurse/midwife academics (both in Queensland)
  • 1 UK nurse academic
  • 1 Australian psychologist
  • 6 Australian health-related agencies
  • 1 Australian health service manager
  • 1 USA physician
  • 2 non-clinicians from the USA
  • 1 mental health clinician?/consumer advocate? from Scotland

It’s surprising and enthusing (to me, anyway), that a boutique conference being held in a small regional Australian city attracted such an eclectic, geographically widespread group of social media participants. The 26 #ACMHN hashtag participants sent 141 Tweets in the timeframe being examined. The three delegates generated 90 #ACMHN tweets, being 64% of the total during the examined period.

Use of the #ACMHN by those away from the conference was almost entirely in the form of retweets – a simple process where one twitter user shares the content of another twitter user, thereby spreading information quickly and widely. Through this compounding, amplifying effect that social media activity has, during the 96 hours being examined the #ACMHN hashtag had a potential reach of over 94,000 (source). Two specific examples of this will be examined below under Twitter is an Amplifier.

Qualitative Data

The qualitative data is the content of the tweets.

I recommend that you scan through the curated (ordered, edited and quite readable) version of the transcript here: http://storify.com/meta4RN/noosa

Also available is the un-curated (asynchronous and jumbled to read, but complete) transcript here: http://qld.so/tweets 

Twitter is an Amplifier

IMG_1841IMG_1840Assuming that a key purpose of a health care conference is to share information, it would be foolish to overlook the amplifying effect of social media. This first example of a simple statement in a presentation on anorexia nervosa, shows how a message reached beyond the 70 people at the conference to a potential audience of over 20,000.

Let me show the maths on that:

579 = the number of people following the @meta4RN Twitter account. So that one Tweet could have been seen by up to 579 people/organisations. I doubt very much that it was seen by that many. Believe it or not, people have better things to do with their time than read every single one of my tweets. Nevertheless there is a very good chance that many dozens, maybe as high as a couple of hundred or so, people see any single tweet sent. That single Tweet was retweeted (ie: shared/passed-on) by five other Twitter accounts, each with their own group of followers, thus:

Let’s add those numbers up: 579 + 9712 + 8433 + 1969 + 178 + 1403 = 22,274. (source)

So, the potential (not actual) audience for that one message delivered to 70 conference delegates suddenly becomes a message that would have been seen by thousands of people. How many exactly? No idea. As long as you pick a number less than 22,274 your guess will be as good as mine.

IMG_1848IMG_1849Another example of Twitter being used as an amplifier is with this Tweet regarding the publications of one of the conference presenters. The bit at the end that reads “Ping #nswiopCS13” can be interpreted as “You people following the Advances in Clinical Supervision conference may also be interested in this”.

One of those in attendance at the Clinical Supervision conference retweeted, as did two Professors of Nursing: one with James Cook University in Cairns, the other with City University in London. So, while the numbers of people exposed to the presenter’s publications via a tweeted internet link is more limited than the previous example, they were also more targeted… nobody values peer-reviewed journal publications more than an academic. It’s good for Chris Dawber’s professional profile to have nursing academics on either side of the world to be aware of his papers and sharing them with their Twitter followers. It is also useful that Chris had his papers bought to the attention of those at/following a Clinical Supervision conference that was being held in Sydney at the same time as our conference. The link to Chris’s papers is here.

Danger Will Robinson!

This amplifying effect of Twitter comes with a cautionary note… what if I misquoted or inadvertently misrepresented what Catherine Roberts said?

Easily could have.

I don’t doubt that I’ve captured the essence of what Catherine said as I heard/understood it. However, by using quotation marks I have attributed it as a direct quote from Catherine. Now, a few days after the conference, I’m not 100% confident that I have used Catherine’s exact words.

Naturally, I’ll pass-on a genuine and contrite apology to Catherine if I have got it wrong and caused any offence or embarrassment. However, in practical terms, it’s too late – the horse has bolted. For better or worse, there are probably thousands of people who now think that’s what Catherine said.

Another point of risk: all the way through the conference I tweeted out the take-home message from sessions as I understood it (as seen by scrolling through here). What if I’ve missed the point that speaker wanted emphasised? What if I got it wrong?

Does that make social media too scary and dangerous to use professionally? Of course not.

For me, there’s three strategies that these reflections suggest:

  1. Be careful with what you Tweet if you’re attributing it to others. For example, only use quotation marks when you’re sure you have the presenter’s exact phrasing correct. Also, try to make it clear whether the take home message is the presenter’s words, or your own understanding/interpretation.
  2. Encourage more social media conference participation. As with this example from a keynote presentation at the International Council of Nurses 25th Quadrennial Congress, it’s more interesting to have multiple people using social media rather than just one. Multiple participants also makes it less likely that a single participant’s misunderstanding will be read in isolation… a safety in numbers thing.
  3. For presenters: take control of your social media presence – don’t leave it to chance. That’s what I did with my presentation at the conference (see example below).

1

2As you can see above,  rather than take the risk of being misunderstood and/or misquoted by a conference delegate tweeting, I did the tweeting myself via scheduled tweets in the lead-up and during my presentation. As I did, you can include links to websites that are relevant to your presentation. This is a good way to keep control over your message. (BTW: a summary of my presentation is online: meta4RN.com/twit)

For presenters, the alternative way to take control of your social media impact from a conference is to announce, “No Live Tweeting Please”. That’s fine – it should be the presenter’s prerogative. However, what you’re actually saying is either, “What I Have To Say Is Too Precious For People Like You To Share” (in which case, should you be talking about it at a conference?), or “I Do Not Understand or Trust Social Media” (which sounds a bit like, “I do not understand or trust traffic lights” – charmingly quaint, but oddly old-fashioned).

Finishing-Up

For those familiar with my web site, you’ll notice that this post is an obvious companion piece to three previous posts:

Looking Back at a Nursing Conference through a Social Media Lens

Looking Back at Postnatal Depression Awareness Week through a Social Media Lens

Looking Back at a Mental Health Nursing Conference through a Social Media Lens

Through examining and reflecting on this collection of data, I am gathering confidence and understanding of professional use of social media. By sharing it online, hopefully other health professionals will do likewise: more the merrier.

References/Data

That’s it. As always, your comments/feedback are welcome.

Paul McNamara, 12th June 2013

Omnipresent and always available: a mental health nurse on Twitter

or “Four Examples of Twitter being useful for Health Professionals”

twitter

The original (embarrassingly self-agrandiasing) title of this post matches the title of a presentation at the ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses 2013 Annual Conference – the theme of which is “Present and Available”. As stated in the conference publicity, this theme offers an opportunity for these sub-specialities of the mental health nursing community to create conversations and explore the process of presence, of being with.  At the conference we hope to improve our understanding what constitutes being present and available in the variety of settings and ways that we work.

The presentation is a blatant hard-sell to mental health nurses regarding professional use of social media. Examples of Twitter being used to augment education, conferences, health promotion, and the profile of mental health nursing are cited. Turbo-charging the conference theme, the argument will be made that mental health nurses can go beyond being “present and available”. Through professional use of social media mental health nurses can create the impression of being “omnipresent and always available”.

It wasn’t really until I started putting the presentation together that I realised what I had in mind was mostly a summary of stuff I have already presented online. So, for those interested in the content of the presentation, here are four examples of Twitter being useful for health professionals (click the links for more info):

View from the podium at the opening session of the ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses Annual Conference 2012

View from the podium at the opening session of the ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses Annual Conference 2012 – I will update with a picture from the podium of the closing session for the 2013 conference ASAP

That’s it for this post. Thanks for dropping-by – please feel free to comment below.

Paul McNamara, 7th June 2013*

* Actually written on June 1st. The presentation is scheduled for 3:30pm on the last day of the conference: Friday 7th June. I’ve scheduled this blog post to be published and publicised via Twitter, Facebook & LinkedIn at 3:50pm – about the time my presentation should be winding-up (tip for conference presenters: the best way to ingratiate yourself to an audience at the end of a conference is to be quicker than expected).

Perinatal and Infant Mental Health Nurse eNetwork

At the 2nd Annual General Meeting (AGM) of the Perinatal Infant Special Interest Group (PI SIG) of the Australian College of Mental Health Nurses (ACMHN), a report will be given on the Perinatal and Infant Mental Health Nurse eNetwork.

There’s over 200 more people on the eNetwork than who will be at the AGM, so this very brief post and 5 minute-long video are for those who are interested in the eNetwork but won’t have a chance to be in Noosa when the report is given.

In short, the eNetwork is growing, thus:

Slide06

Activity on the eNetwork is humming-along, like this:

Slide12

And the place to subscribe/unsubscribe is here:

If you want more info please visit this page and/or have a look at the video.

Two last things.

[1] I’m not representing the Australian College of Mental Health Nurses, or anyone else for that matter (see Q13 here). This video/blog post have come about because I had a bit to do with getting the eNetwork up and running, so am interested in looking-at and reporting-on its development. That’s it.

[2] This is a scheduled blog post. So, although written on 03/06/13, it’s scheduled to go public at about the same time the ACMHN PI SIG AGM ends.

Paul McNamara, 6th June 2013