key: cord-0263665-1yeejnq5 authors: Morse, H.; Brown, A. title: Using Facebook groups to support families: midwives perceptions and experiences of professional social media use date: 2022-04-16 journal: nan DOI: 10.1101/2022.04.12.22273813 sha: c7529c286a4507ce93c8a48fc90f4c1ff5cae407 doc_id: 263665 cord_uid: 1yeejnq5 Seeking support from Facebook groups during pregnancy is now widespread and social media has been widely used by maternity services during the COVID-19 pandemic. Despite this, little is currently known about midwives attitudes towards, and experiences of social media in practice. Research is needed to understand barriers and solutions to meeting mothers expectations of online support and to improve services. This study explored midwife involvement in Facebook groups, exploring experiences and perceptions of its use to communicate with and support mothers. 719 midwives and student midwives completed an online survey during August- September 2020 and their numerical and free-text responses analysed descriptively. Few participants were involved in providing Facebook support, and most of these were unpaid. There was a consensus on a range of benefits for mothers, but widespread concern that engaging with mothers online was a personal and professional risk, underpinned by a lack of support. Experience of being involved in midwife moderation increased belief in its benefits and reduced fear of engaging online, despite a lack of renumeration and resources. Midwives and students felt they were discouraged from offering Facebook support and sought further training, guidance and support. Although limited, experiences of providing Facebook group support are positive. Perceptions of risk and a lack of support are significant barriers to midwives involvement in using Facebook groups to support mothers. Midwives seek support and training to safely and effectively engage with mothers using Facebook. Engaging with mothers via social media is embedded in national policy and digital strategy, and progress is needed to fulfil these, to improve services and meet mothers expectations. Midwives experiences suggest extending opportunities to provide Facebook support would benefit midwives, services and families. Consultation to revise local policy to support midwives and students in line with strategic goals is recommended. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint 133 134 Participants were asked to provide details of how long they had been qualified as a midwife 135 (or were currently a student) and to indicate their current role. At the time of survey 136 completion, over a third (36.2%, n = 260) were student midwives. For qualified midwives (n 137 = 459), time since registration ranged from 0-20+ years, with 63.1% having been qualified 10 138 years or less. Overall, twice as many qualified midwives were based in hospital (30.2%) as 139 were based in a community setting (clinic/home based care) (14.7%). Those with specialist 140 roles (16.4%) were asked to give details, with infant feeding being the most commonly 141 specified role (13.6%). A chi square found that those in specialist roles were significantly 142 more likely to be providing Facebook support than those who were not in specialist roles [X 2 143 = 20.067, p = .000]. 180 provided specialist support e.g. for NICU or parents of multiples and 13 (14.8%) were 181 breastfeeding support groups. In relation to responsibilities, contributing to discussion by 182 posting and responding to women's posts alone was the most common (27.3%) followed by 183 involvement in setting up the group, moderating discussion and responding to posts 184 (22.7%). Overall, 18.2% (n = 16) were involved in discussion and moderation alone and 185 20.5% (n = 18) specified other responsibilities using a free text box. These included 186 responsibility for promotion of their NHS or independent services using Facebook pages 187 (rather than support groups), running support groups for professionals/students and 188 involvement in digital intervention projects. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint 256 257 Participants were asked whether they felt any of a list of professional and managerial 258 sources were supportive of midwives providing Facebook support to mothers (Table 5) . 259 Overall, work colleagues were seen as supportive most often and NHS health board/trust 260 management the least. Those involved in providing support reported greater perceptions of 261 support for the role, than the personal/social group. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 453 Groups that offer support to mothers located within specific geographic areas enable 'real 454 life' connections to be built, fostering relationships that create social opportunities for 455 mothers and babies and facilitating signposting to face to face support when needed [11] . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint 459 but also the impact of negative interactions, particularly in the context of changes related to 460 COVID-19 [24] . Faced with inaccuracies, judgement or criticism about maternity care or 461 services on Facebook midwives felt disempowered, and that they were did not have the 462 guidance or support to engage constructively. These negative experiences on Facebook in 463 general impacted midwives' attitudes towards Facebook support, despite not being seen in 464 midwife-moderated groups [10] . Previous research found access to midwife moderated 465 groups improved perceptions of midwifery support, improving feedback and experiences, 466 including during the pandemic [25] . [26] , and the standards they must uphold to register, and remain registered, with the NMC 474 [27] . This extends to online behaviours and interactions [28] , and although midwives felt 475 they were confident in staying professional online, they were less so about maintaining 476 boundaries and how to ensure confidentiality. This underpinned midwives' fears that 477 engaging online could prompt complaints and referral to their employer or the NMC, 478 despite this being highly infrequent [18] . Universities were also seen as unsupportive; 479 student midwives reported being warned against social media use during their education 480 and felt frustration at defensive rather than proactive approaches. Previous research has 481 noted resistance to introducing digital professionalism to the midwifery curriculum [18] . . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint 482 These findings are a concern, highlighting that midwives are often not receiving the support 483 or training needed, pre-or post-registration, to meet digital transformation goals. were less likely to perceive these benefits, or the potential for engaging online to support . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint 506 continuing professional development. Findings suggest this may be a missed opportunity 507 and that widening access to midwife moderator roles would benefit individuals and services. 508 509 Midwives expressed fears for their own privacy, security and a desire to avoid blurring 510 boundaries between personal and professional online space. Social media use requires 511 energy and cognitive processing that can cause overload and fatigue [33] , and additional 512 professional use may increase these risks, creating anxiety, stress and rumination [34, 35] . 513 There was concern about differentiating between being 'on' and 'off' duty when an online 514 workplace is accessible around the clock and carried in a pocket. They feared becoming 515 emotionally involved and overstepping boundaries. Some shared experiences of midwives 516 being identified or targeted on Facebook, or having information they had shared taken out 517 of context, creating fear this would occur in a group setting. However, these concerns were 544 These findings are a concern, demonstrating a failure to support, safeguard and renumerate 545 midwives who provide a service that mothers seek and services benefit from [11] . In 546 addition to the potential personal and professional risks being shouldered by midwives, this 547 situation also prevents effective auditing of any midwife-led online support to ensure its 548 quality, efficacy, safety and accessibility. Being able to identify who is moderating a group is 549 key to how mothers engage with and perceive its reliability [10, 11] . It is therefore vital that 550 services ensure midwife moderated groups are part of a robust, professional and 551 accountable digital service [2]. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint 553 While midwives in the sample often presented binary views of Facebook support as a 554 benefit or a threat to care and services, they were aware that women's expectations in 555 relation to digital communication are changing. However, concerns were expressed that 556 social media support would be relied upon to replace and justifying reduced resourcing of 557 face-to-face services. Clearly new approaches to offering support will be needed, but these 558 must be based on evidence, meet mothers' needs and be integrated with care into the role 559 of the midwife. The findings support wider research, highlighting a desire to understand 560 'cybercivility' [appropriate online engagement] and develop skills in digital professionalism 561 [39] . This need has been brought into focus by the rapid digitalisation of services during 562 COVID-19 [24] . Overall, findings highlight that further training is needed, and that midwives 563 are eager to engage where guidance exists, and where policy supports practice. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint 577 [5] . It is unsurprising therefore that almost all participants were active Facebook users, that 578 95.1% find the platform convenient and easy to use and that 77.6% also used other social 579 media such as Twitter or Instagram. Limitations of data collection methods aside, these 580 findings suggest that much of the midwifery workforce is familiar with using social media for 581 personal use, potentially providing a strong foundation for developing skills for the 582 midwifery moderator role. However, many participants also expressed strongly held views 598 Limitations aside, this study has demonstrated that there are significant perceived personal 599 and professional barriers to the integration of Facebook as a tool for supporting mothers . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint Maternity Direct. British journal of midwifery. 2017;25(7):458-64. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 16, 2022. ; https://doi.org/10.1101/2022.04.12.22273813 doi: medRxiv preprint Participants were asked to indicate whether they were required to offer Facebook support 191 as part of their employed role as a midwife. Overall 31.0% (n = 27) did so within their role, 192 and (62.1%, n = 54) chose to do so outside of their employed role . The remainder (n = 7) 193 were student midwives Two to 195 four hours was the most common weekly time spent on the role (35.1%, n = 26) with 4.1% had been doing this role between 1-3 years (37.5%, n = 33), with 12.5% (n = 11) 202 having started within the previous three months (during the pandemic), and 27.5% (n= 22) 203 for over three years. Of those offering support as part of their employed role These statements focused on elements of knowledge acquisition and 211 social capital. These responses were compared for the two types of Facebook use 600 into midwifery practice. Despite strategic goals encouraging social media interaction and the 601 impact of the COVID-19 pandemic on delivering digital communication, progress in 602 maternity services remains slow. Mixed messages between local and national policies and 603 defensive social media policies are causing fear amongst midwives. A lack of support from 604 employers and resistance from midwifery educators is preventing creative approaches to 605 overcoming the complexities of using Facebook to support families. It is clear midwife 606 moderated Facebook support has the potential to support skill development, improve 607 communication and meet women's needs. However, the application of the knowledge, skill 608 and passion of midwives to delivering support via social media needs wider exploration to 609 ensure access is equitable, appropriately resourced and midwives are supported, protected 610 and renumerated. Further research also needs to establish how appropriate digital 611 professionalism training can be developed and implemented to reduce fear and improve 612 engagement Inclusion criteria were: aged over 18 or over, a registered midwife or 619 student midwife in the UK and who gave consent to participate in the survey in English Responses were received from regions across the UK. Ethical approval was granted by a All participants gave informed consent to take part in 622 the study The questionnaire was piloted prior to sharing more widely. It was completed by 3 midwives 645 and five student midwives Facebook groups aimed at midwives and students [such 651 as 'Beyond Midwifery UK' and 'Midwives in the making'] were identified via a Facebook 652 search, with permission sought from group administrators for posting study information to were interested in taking part, they clicked on the link where the participant 657 information sheet and consent questions loaded Participants were asked to indicate whether they used Facebook [Not at all, personal/social 664 use Non-users were directed only to questions 665 on views, omitting use and experiences. As the research questions focus on understanding 666 the experiences of Facebook users [and the non-user sample very small], non-user 667 responses were excluded from some analyses. Where non-users are included Chi square tests were carried out to compute associations between type of Facebook use 671 [personal/social use, professional support use] and age range, specialist role, group 672 recommendations and receipt of training. T tests were performed to compare attitudes to 673 mothers and midwives' use of Facebook support groups and level of concern about their use 674 for the two Facebook use groups. County area data were analysed for distribution frequency 675 using Google My Maps After familiarisation with the data, initial codes were produced, identifying themes 679 which were reviewed in relation to the coded extracts, defined and named. These were 680 reviewed by a second researcher and discussed until agreement reached [42]. A reflexive 681 journal was used to reflect on methodological decisions and the researcher's midwifery 682 background. 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