Peer-to-peer sharing of sexual health social media messages in a school-based intervention: Opportunities and Challenges Identified in the STASH Feasibility Trial (Preprint)

Background:There is strong interest in the use of social media to spread positive sexual health messages through young people’s social networks. However, research suggests this potential may be limited by a reluctance to be visibly associated with sexual health content online, and by a lack of trust in the veracity of peer sources.Objective:To investigate the opportunities and challenges of using social media to facilitate peer-to-peer sharing of sexual health messages within the context of a secondary school-based and peer-led sexual health intervention (STASH; Sexually Transmitted infections And Sexual Health).Methods:Following training, and as part of their role, student-nominated peer supporters (aged 14-16) invited school friends to STASH trainer-monitored, private Facebook groups. They posted curated educational sex and relationships content within these groups. Data come from a feasibility study of the STASH intervention implemented in 6 UK schools. To understand student experiences of the social media component we used data from: 11 semi-structured paired and group interviews with peer supporters and their friends (collectively, ‘students’; n=41; aged 14-16); a web-based post-intervention questionnaire to peer supporters (n=88); and baseline and follow-up questionnaires to students in the intervention year group (n=680 and 603 respectively). We carried out thematic analysis of qualitative data and descriptive analysis of quantitative data.Results:Message-sharing by peer supporters was hindered by variable engagement with Facebook. The trainer-monitored and private Facebook groups were acceptable to student members (peer supporters and their friends), and reassuring to peer supporters, but led to engagement that ran parallel to – rather than embedded in –their routine social media use. The offline context of a school-based intervention helped legitimate and augment the Facebook posts; but even where friends were receptive to STASH messages, they did not necessarily engage visibly. Preferences for content design varied, but humor, color and text brevity were important. Preferences for online versus offline message-sharing varied.Conclusions:Invitation-only social media groups formed around peer supporters’ existing friendship networks hold potential in peer-based sexual health interventions. Ideally, interactive opportunities should not be limited to single social media platforms and should run alongside offline conversations. There are tensions between offering young people autonomy to engage flexibly and authentically, and the need for adult-oversight of activities for information accuracy and safeguarding. Clinical Trial: ISRCTN97369178