Providers’ demographic characteristics and use of social media
Of the AYA oncology providers, 72% were women, 35% worked in the pediatric oncology setting, 51% in a university hospital, and 44% were nurses, and 40% physicians. Almost all providers used SM for private reasons and on a daily basis. Only half of them used SM professionally and the majority did so only rarely. It has to be noted that some participants did not answer all items resulting in missing values which, in turn, lead to different sample sizes for some of the variables and analyses respectively. Further demographic and SM use related information are presented in table 1.
Providers’ assessments of usefulness of social media
Only a small majority of HCPs (37 out of 66) felt skillful in using SM (56.1% either agreed or strongly agreed, 21.2% either disagreed or strongly disagreed, 22.7% were uncertain). Moreover, providers assessed the usefulness of SM for various professional purposes on a five-point Likert scale (range: 1-5; fig. 1). Overall, they tended towards assessing SM as useful for all five professional purposes (N=66; figure 1): professional life (M=3.6, SD=0.9), educational purposes (M=3.8, SD=0.8), networking (M=4.0, SD=0.7), engagements with patients (M=3.6, SD=0.9), and clinical trial recruitment (M=3.4, SD=1.0).
We evaluated factors associated with providers’ usefulness assessments (dependent variable) using multiple linear regression. For this purpose, we calculated a usefulness assessment sum score, composed of the five usefulness assessments. This sum score was reliable (Cronbach’s alpha: α=.812) and normally distributed (Shapiro-Wilk: p=.141, M=18.4, SD=3.2, Mdn=19, Mo=20). Based on a priori theoretical [15] and sample size/predictor ratio considerations [25] we checked the linearity (scatter plots) of the relationships between the dependent variable and the following five predictor variables: providers’ skillfulness in using SM (5 point Likert-item: “Do you feel skillful in using social media?”), Covid-19 impact on attitudes towards SM use in AYA oncology (dichotomous item: “Did the COVID-19 emergency have any impact on your attitudes towards the usefulness of social media in your professional life?”), language region (German or Romance), work experience (in years), oncology setting (pediatric or adult). Since the relationship between work experience and the usefulness assessment was not linear, we did not include it in the model. In addition to linearity, the remaining assumptions were checked before interpreting the multiple linear regression model. All assumptions were met: no multicollinearity (VIF and tolerance), independent residuals (Durbin-Watson test), homoscedasticity (plotting the standardized values the model predicts against the standardized residuals obtained), normally distributed residuals (P-P plot), no relevant outliers (Cook’s distance). Finally, F-test was conducted to test for the statistical significance of the overall model fit, indicating that the predictors included in the model significantly contributed to the explanation of the usefulness assessment (F (4, 57) = 5.45, p = 0.001, R2=.276). Adjusted R2 was 0.226, indicating that 22.6% of variance was explained by the multiple regression model.
Regression analysis revealed that self-assessed skillfulness with social media, the Covid-19 impact on attitudes, and the oncology setting significantly predicted assessment of the usefulness of SM in AYA oncology. In particular, the more skillful a provider was in using SM, the stronger the impact of Covid-19 on attitudes towards SM use in AYA oncology, and the “more pediatric” the oncology setting, the greater was the usefulness assessment (table 2).
[Fig.1]
Finally, analysis of variance between the three occupational groups (nurses, physicians, other) was conducted for the usefulness assessment, revealing that there were no significant effects of occupational groups on the usefulness assessment, F(2,63) = .363, p = 697.
[Tab.2]
Covid-19 impact on providers’ professional social media attitudes and use
Only a minority of AYA oncology providers reported an impact of Covid-19 on their attitudes towards the use of SM in their professional lives (16/64), on the frequency of professional SM use (17/63), on how they use SM professionally (12/64), and on how patients approached providers via SM (4/64). Figure 2 depicts these four variables in more detail. Participants who responded that the frequency of their professional SM use had increased due to Covid-19 were asked to specify the increase in percentages. Out of 17 providers whose professional SM use had increased (27%), 15 specified the respective increase: M=28.3%, SD=16.0%, Mdn=30%, Mo=30%. In open items in which HCPs could elucidate their change in SM attitudes and use, exchange of information and experiences with colleagues and timely responses to patient and family queries were most often cited as important reasons for increased use. One participant tried to combat misinformation: «It happened that on Twitter I argued with some "fake news spreaders”.
[Fig.2]
Institutional use of SM and guidelines on social media use
With respect to the question whether their institution has SM channels (N=61), more than a third of AYA oncology providers reported that they did not know (34.4%). More than a third stated that their institution has at least one SM channel (36.1%). In the open comments, Facebook (in 12 out of 18 responses) was most frequently cited as institutional SM platform, followed by Instagram (in 7 out of 18 responses) and Twitter in 5 out of 18 responses). Almost 30 percent (29.5%) of providers reported that their institution has no SM channel.
With respect to the question whether their institution provides guidelines on how to use SM (N=61), half of HCPs did not know (50.8%). Almost 30 percent reported that their institution provides guidelines (27.9%) and one fifth stated that their institution does not provide any guidelines (21.3%). Those who declared that institutional guidelines were in place most often referred to a code of conduct or privacy guidelines but did not report specific SM guidelines.
Challenges, benefits, and facilitation of social media use
HCPs most frequently perceived the following barriers to an implementation of SM in AYA oncology care: legal and ethical issues (43/59), professional boundary violations (27/59), and lack of institutional account and of time (each 22/59). Moreover, the most frequently perceived benefits of implementation of SM were: professional networking (35/58), staying up to date (31/58), patient education (29/58).
In answer to open items, improved training and education of medical staff and clear ethical guidelines were most frequently cited to facilitate the implementation of SM. Two HCPs reported the need for more funding. Two other participants suggested to experiment with telemedicine once or twice per week or to have a specific HCP who is an expert in that field. In the same vein, one provider reported that it requires dedicated professionals as doctors are no communication experts.
[Fig.3]