Participants’ characteristics
Subjects were recruited from a university in Turkey where the principal investigator was based and also from a European Dietetics student network. The number of participants from Amasya University was 143, that was 85 from the Division of Nursing and 58 from the Division of Midwifery. The number of dietetic students from European countries was 54. The majority of the participants were female with 78.8% from nursing, 100% from midwifery and 83.3% from dietetics. Majority of the participants aged between 20-24 years old, with 67.1% from nursing, 87.9% from midwifery and 64.8% from dietetics. Whilst 100% of nursing and midwifery students from Turkey, the majority of the dietetic students were from Spain (48.8%), Turkey (16.7%) and Greece (7.4%).
Digital competences
In terms of the trainings at university to enable students to become a digitally component student at placement once they graduated, majority of nursing (43.5%) and midwifery (55.2%) students agreed that “students should receive training at university about digital technologies in healthcare practice”. However, majority of those disagreed that they had received sufficient training about digital technologies in clinical practice at university. Main trainings about digital means they received at university included finding trustable health information online, using social media to communicate health information and e-mail usage. Regarding source of information, most students reported that academic classes and lectures were the main source of information (Table 1).
The majority of the nursing and midwifery students reported that they would like to able to identify and install software, programs, applications for better healthcare practice (57.6% of nursing students and 69.0% of midwifery students) and to improve their competences on evidence-based implementation of digital tools in healthcare practice (56.5% of nursing students and 67.2% of midwifery students). Only 17.6% of nursing students and 15.5% of midwifery students reported that they would like to develop skills to be able to create infographics.
The dietetic students reported that they would like to receive training on Google Analytics (n=15, 27.8%), communication strategies and digital collaborations with other experts (n=14, 25.9%) and professional standards for dietitians in the digital environment (n=12, 22.2%).
Table 1. Main source of information for students of nursing (n=85), midwifery (n=58) and dietetics (n=54)
|
Nursing (n=85)
N (%)
|
Midwifery (n=58)
N (%)
|
Dietetics (n=54)
N (%)
|
Academic classes / lectures
|
49 (57.6)
|
31 (53.4)
|
20 (37.0)
|
Research publications
|
27 (31.8)
|
18 (31.0)
|
15 (27.8)
|
Conferences
|
10 (11.8)
|
9 (15.5)
|
10 (18.5)
|
Seminars/webinars
|
16 (18.8)
|
12 (20.7)
|
13 (24.1)
|
Media (TV, podcasts)
|
33 (38.8)
|
26 (44.8)
|
5 (9.3)
|
Social media / blogs
|
43 (50.6)
|
27 (46.6)
|
6 (11.1)
|
Representatives from companies
|
0 (0)
|
0 (0)
|
0
|
Never informed before
|
9 (10.6)
|
8 (13.8)
|
0 (0)
|
Digital communication channels for communicating healthcare/nutrition information Forty three percent of nursing students reported that they occasionally use digital communication channels for communication healthcare information. 55.2% of midwifery and 11.1% of dietetics students reported that they use digital communication channels for communication healthcare/nutrition information. Main reasons not to communicate healthcare/nutrition information online included limited internet connection (20.0% of nursing students and 22.4% of midwifery students), lack of technical knowledge (17.6% of nursing students and 31.0% of midwifery students) and lack of time (10.6% of nursing students, 12.1% of midwifery students and 5.6% of dietetics students).
In terms of digital communication channels, Instagram was the most popular. Thirty one percent of nursing and 7% of dietetics students reported to have moderate posting activities, while 59% of midwifery students reported low posting activities on Instagram. Whilst majority of nursing and midwifery students used personal Instagram account, dietetics students used professional Instagram account to share healthcare / nutrition information (Table 2).
Dietetics students were asked to provide the reasons why they use digital platforms to communicate nutrition information. The most frequent drivers were “to share evidence-based nutrition information” (n=9,16.6%), “to make nutrition information actionable for the public” (n=8, 14.8%) and “to improve my personnel branding/promotion” (n=7, 13.0%) and “to keep myself up to date” (n=7, 13.0%).
Dietetics students were also asked how they think dietitians could act against misleading information published online. The most frequent responses were “dietitians could provide evidenced-based facts” (n=18, 33.3%) and “dietitians could educate the public on how to find trustable nutrition information” (n=18, 33.3%).
Table 2. Digital platforms, posting frequency and account types to share healthcare/nutrition information (nursing students, n=85; midwifery students, n=58; dietetics students, n=54)
|
Posting Frequency
N (%)
|
Account Type
N (%)
|
|
High
|
Moderate
|
Low
|
Professional
|
Personal
|
Mix
|
Facebook
|
|
|
|
|
|
|
Nursing
|
6 (7.1)
|
13 (15.3)
|
25 (29.4)
|
-
|
54 (63.5)
|
2 (2.4)
|
Midwifery
|
2 (3.4)
|
2 (3.4)
|
24 (28.2)
|
1 (1.7)
|
36 (62.1)
|
2 (3.4)
|
Dietetics
|
-
|
1 (1.9)
|
1 (1.9)
|
-
|
3 (5.6)
|
-
|
Instagram
|
|
|
|
|
|
|
Nursing
|
10 (11.8)
|
27 (31.7)
|
22 (25.9)
|
2 (2.4)
|
67 (78.8)
|
3 (3.5)
|
Midwifery
|
3 (5.2)
|
10 (17.2)
|
34 (58.7)
|
1 (1.7)
|
45 (77.6)
|
3 (5.2)
|
Dietetics
|
2 (3.7)
|
4 (7.4)
|
1 (1.9)
|
4 (7.4)
|
3 (5.6)
|
1 (1.9)
|
Linked In
|
|
|
|
|
|
|
Nursing
|
-
|
-
|
7 (8.2)
|
-
|
12 (14.1)
|
-
|
Midwifery
|
1 (1.7)
|
-
|
3 (5.2)
|
-
|
11 (19.0)
|
-
|
Dietetics
|
-
|
-
|
1 (1.9)
|
2 (3.7)
|
1 (1.9)
|
-
|
YouTube
|
|
|
|
|
|
|
Nursing
|
4 (4.7)
|
2 (2.4)
|
9 (10.6)
|
1 (1.2)
|
26 (30.6)
|
1 (1.2)
|
Midwifery
|
1 (1.7)
|
-
|
12 (20.7)
|
-
|
17 (29.3)
|
2 (3.4)
|
Dietetics
|
-
|
-
|
-
|
-
|
-
|
-
|
Research Gate
|
|
|
|
|
|
|
Nursing
|
-
|
-
|
5 (5.9)
|
-
|
6 (7.1)
|
1 (1.2)
|
Midwifery
|
3 (5.2)
|
-
|
3 (5.2)
|
-
|
7 (12.1)
|
1 (1.7)
|
Dietetics
|
-
|
-
|
-
|
-
|
-
|
-
|
Twitter
|
|
|
|
|
|
|
Nursing
|
4 (4.7)
|
4 (4.7)
|
18 (21.2)
|
-
|
6 (7.1)
|
1 (1.2)
|
Midwifery
|
3 (5.2)
|
3 (5.2)
|
17 (29.3)
|
-
|
7 (12.1)
|
1 (1.7)
|
Dietetics
|
-
|
-
|
-
|
-
|
-
|
-
|
Focus groups
Two online focus groups were run using the Zoom Meeting Application. The first focus group was carried out with nursing (n=4) and midwifery (n=4) students. There was one male and seven female students. The discussion lasted for 45 minutes.
The second focus group was carried out with only dietetic students (n=5) lasting 55 min. One student was male, the others were female. One student was in her second year of dietetics education, two were in third year and two were in the final year (fourth) of the dietetics programme.
Transcripts of these two focus groups analysed together and three broad themes emerged from the data: virtual consultations, social media, and strategies to improve digital competences of healthcare workers/dietitians.
Theme1: Virtual consultations
Majority of students found virtual consultations useful for some critical processes such as palliative care and pregnancy. The comment below illustrates possible advantage of virtual consultation which is not conducted currently as party of palliative care in a state hospital. A dietetics student who underwent placement in a state hospital expressed:
“When the patient from palliative care refers to us (dietetic department), dietitian plans his diet based on the information on his folder without seeing the patient and gives it (diet list) to the patient’s companion. We (dietitians) explain the diet to the patient’s companion and ask him (the patient’s companion) to explain it (diet list) to the patient…… I think it would be much better if we could communicate directly (virtually) with the patients who could not access in person.” Dietetics student, year 3
Another student considered virtual consultation for pregnant women to be useful.
“There were pregnant women who could not come to the clinic from time to time, we were communicating with them via WhatsApp, and it was useful.” Dietetics student, year 4.
Nursing and midwifery students’ views on virtual consultation were different from the dietetics students. As a midwifery student said:
“Online events are very useful during this period; we can even participate in international events without travelling. However, I do not find distance education and consultancy services effective. For example, we provide breastfeeding counselling to pregnant women, but when we do this online, it is not effective. In-person counselling is more beneficial.” Midwifery student, year 4.
Theme 2: social media
Opinions about the use of social media by healthcare workers and dietitians included-
High-quality posts
Characteristics of high-quality social media posts were identified by the students as follows:
“If it (social media post) includes a reference or is based on a scientific fact, it seems reliable to me.” Dietetics student, year 3.
“The posts by a dietitian should not go beyond general healthy eating recommendation such as water intake, consumption of fresh fruits and vegs etc.” Dietetics student, year 4.
“I think the harmony of visual and post caption is important. If a sleezy image uses, what the caption is not very important to me…. Attracting people’s attention with a good image is significant.” Dietetics student, year 4.
Low-quality posts
The following characteristics of low-quality social media posts were identified by the students.
-
Before/after posts
-
Shock and very-low calorie diets and detox recipes
-
Posts with irrelevant hashtags
-
Long and too much information
-
Posts with irrelevant images
-
Personal posts over professional account
“‘This shock diet makes you lose 10 kilos in 2 days!’ This is done by a dietitian! We may encounter very strange and absurd titles and content just to increase the number of followers and interaction.” Dietetics student, year 3.
“They (dietitians) constantly share low-calorie recipes. This seems strange to me. They are sharing low-calorie recipes by constantly adding honey or dates instead of refined sugar into things. I found many dietitians’ post useless especially on Instagram.” Dietetics student, year 3.
“If a dietitian uses irrelevant hashtags to become more popular and gain more followers, the post seems low quality to me.” Dietetics student, year 4.
“I see that some dietitians share their photos and their private lives in order to reach more followers on their professional accounts. From time to time, they give information about nutrition under their own photos. I think that the personal account and the professional account should be separated.” Dietetics student, year 3.
Theme 3: Strategies to improve digital competences
Having recognized inappropriate and low-quality social media posts by dietitians, the students provided some recommendations that could improve digital competences of healthcare workers and dietitians. The majority of students agreed with the statement that digital technologies content should be included into the university curriculum.
“In fact, it should be included as a course (module) in nutrition and dietetics undergraduate education to increase this competence (digital) and use social media more accurately.” Dietetics student, year 4.
This view was echoed by another student.
“The subject of rhetoric, ethical rules and digital competences such as video editing should be included in this module.” Dietetics student, year 3.
A nursing student’s comment was about electronic patient registration system:
“There is an electronic registration system used in hospitals and we spend a lot of time learning this registration system after we are appointed. There is a computer module at university, but I am still very bad at computer because I do not think that computer education is enough. I especially think that electronic patient record system should be taught in school. I worked at the hospital for a while since I graduated from a medical career collage and I spent at least two weeks to learn this system, and I had to constantly consult someone while learning.” Dietetic student, year 1.