1. Knowsley Teenage Heath and Opinion Project “The Knowsley Project”

2. Partnership Delivered by North West Regional Youth Work Unit and The Cheshire and Merseyside Child Health Development Programme (CYP1) working in Partnership with yougn people from the THinK Steering group and Knowsley Youth Service Commissioned by Knowsley Health and Wellbeing to Gain Greater insight to inform and improve services for children and young people to work alongside Linked-UP (young peoples LINKS)

3. Purpose The aim of “The Knowsley Project” was identify if it was possible to substantially improve young people’s engagement with health services and health publicity information using existing online tools and a young person led approach to health engagement. Being “young person led” is a loosely used term; in this project we refer to it to mean that decision were made by young people in partnership with adults/professionals. The techniques employed to enable this were based on youth work and youth participation. A small group of young people from the ThinK project were directly involved in making decisions about the delivery and design of this project, and at a strategic level young people who participate in the Cheshire and Merseyside Child Health Development Programme Board approved its initial development by the programme.

4. Purpose The online tools were selected on the basis that they were identified by CHDP’s networks as being tools currently being explored or developed by the health community in Cheshire and Merseyside that it would be useful to gain further information about in relation to young people’s usage. They were:- http://www.birdsbeesandteens.nhs.uk/ A website aimed at young people providing links to health passed information that has been verified by medical professionals http://www.patientopinion.org.uk A website aimed at the public to enable two feedback and dialogue on NHS services between patients and services http://www.yourchildshealth.nhs.uk A website “aimed at introducing you to the best Web page on any particular child health related topic. It is aimed at parents, patients and doctors” Talk to Me About – a downloadable pdf resource initially developed for professionals working with young people. A draft version adapted directly for young people was used for this project and placed on the Get Lays Site

5. Process An Initial research aim was developed by CHDP Stakeholder Board Members. They also identified 4 health promotion and patient involvement existing Webtools for the research A Project plan was developed by CHDB, NWRYWU and Knowsley Youth Service. This included the “Web portal” concept and a commitment involving young people in additional marketing of the webtools within Knowsley CHDB Board contains professionals from a wide variety of backgrounds working to resolve cross –profesional issues.; Young People are also an active part of this group. The initial need for research in to the effectiveness of existing online health promotion and involvement for young people was identified by this group,.Involving young people in marketing the webtools would provide information about the effectiveness of youth led marketing. The Webportal is a single web page which links to the 4 web tools. By Marketing the Webportal to young people instead of the web tools themselves the impact of the marketing could be directly measured.

6. Process The Project was commission from Knowsley PCT and a steering group was established Young people from the Think Steering Group worked with NWRYWU and Knowsley Youth Service to create a brand and market a webportal, which would direct young people to the 4 web tools The steering group group was established by the project commissioner to ensure the project was complimentary to the existing Links strategy within Knowlsey Young Peoples involvement is in project delivery central principle of the organisations involved in the project. It supports the rights of children and young people to be heard, creates learning and empowerment opportunities for young people and leads to more effective service delivery and new ideas.

7. Process A private PR firm was chosen by the young people as most effectively able to deliver the strategy they developed, due to the nature of the strategy they designed. A variety of other options were considered including public and voluntary sector orgs and young people themselves.. As the webportal was not promoted in any other context, the internet traffic passing through it to access the webtools could be directly attributed to the marketing strategy. This provided information about the effectiveness of youth led marketing. The Marketing Strategy was delivered by a PR firm based on commission from ThinK steering group The Web Portal was used to measure the number of young people in Knowsley using the webtools as a result of the marketing strategy

8. Process This provided information about the levels of awareness of Get Lays created by the marketing strategy, the extent to which young people wanted online health information, and young peoples opinion of the webtools. A participatory approach to research with young people as researchers enables a greater understanding of the issue, from the young peoples perspective Before conducting the Questionnaire young people from the Think group were concerned it would not provide enough information about young peoples opinions of the webtools. Consequently a series of workshops were designed by the group that would guarantee this information being captured. Young People form the Think steering group designed and conducted a questionnaire to asses the impact of the marketing strategy Young People from the Think Steering Group designed workshops to provide qualitative information about the web tools. Workshops were conducted with groups from the Knowsley areas by NWRYWU.

9. Outcomes Young people want to access online health information about both health services and health issues The results from questionnaire indicate that just under half of young people would like to access online information about health services and just over half would like to access online information about health issues. As a large proportion of respondents replied don’t know, this outweighed those who didn’t in both cases. Peer led approaches to the marketing and branding are incredible effective method of promoting online health tools to young people The web monitoring indicates that the number of website (1700+) “unique visitors” was higher than expected (1500) for the allocated marketing budget The levels of awareness of the get lays brand (33% of questionnaire respondents) demonstrated by the questionnaire, indicate that the number of people accessing the web portal may be significantly higher than the hits received. Of the questionnaire respondents who were aware of Get lays 77% said they had visited the site

10. Outcomes The range of health tools trialled in this programme require significant and substantial improvement if they are to engage with young people who have not already actively looking for health information online. Workshop participants, who were all asked to look at the sites on behalf of an adult reacted incredibly negatively to all of the tools. There were very few positive comments and the tools failed to engage the young people during the workshops Poor design of the web tools is a significant barrier to accessing content to young people who are not already actively looking for health information online. The vast majority of feedback during the workshops was based around design and look of sites. During the workshops young people were so put off by the look and feel of the sites, it prevented them wanting to look at the content. It was felt content should be more graphical, with less words, and more interactive. Positive comments during the workshops were focused around the few graphical elements present, such as the birds bees and teens “clock” and Birds bees and teens faired most favourable on questionnaire feedback The current online tools do provide some use to young people who have actively chosen to look for health based information online. By contrast to the workshops questionnaire respondents scored all of the tools as 3.9 out of 5 or above (with five being “Good” and one being “Bad”) Questionnaire respondents were not asked to look at the website prior to completing the questionnaire and will have chosen to do so as a result of the Get Lays marketing, presumably indicating they may well have been looking for specific health information. This is one possible explanation for the differing results from workshop and questionnaire respondents. Young people will research health information online with a person centred approach rather than the condition centred approach used on some of the sites During workshops when asked to think of a topic on which look for health information, young people’s starting point is more likely to be “I have a rash/pains/concerns about my head/arm/genitals etc” rather than “I would like information about Chlamydia/cancer/measles/other medical named condition” Young people do not demonstrate an interest in giving feedback to the NHS via online methods such as patient opinion The project did not result in a significant increase in the number of posts left by young people in Knowlsey on the patient opinion website Workshops conducted with young people who regularly give up their time to participate in giving feedback on the NHS indicated that they did not value or support the idea of online feedback via Patient Opinion. Implications for Public Health In terms of online health promotion a distinction needs to be drawn between Using online tools to provide information to young people who are already seeking health information, about information based on their own needs And, Using online tools as a method for informing or promoting awareness of key issues to young people who are NOT already seeking health information. An example of the first group may be a young person who has recently received a diagnosis and is using the internet to seek further information regarding that diagnosis. At some point in their lives all young people would fall into the second group, key issues in this case would be those identified by health services (such as smoking, sexual health etc) as priorities to provide health information to young people. In this case the individual will not be actively seeking information regarding these issues, but a health promotion service will be seeking to deliver information to this group. This lack of motivation is the key difference between groups. For the second group the range of tools tested in this project needs significant and substantial improvement to be of any use, poor and un-engaging web design (for instance lack of graphical content) is a such substantial barrier to young people accessing health existing tools that it prevent young people from accessing any content. To successfully deliver health information to this group, web design needs to be so engaging that it provides the motivation for accessing the site in and of itself. For instance the use of online games or similar may provide the motivation wanting to access the site, and receiving the health information will be of secondary or importance to the young person. Talk to Frank could be sited as an example of this This is less of an issue for the first group however it is still clear that text Information needs to be provided in small sized chunks no longer than a paragraph, and information needs to be grouped in a person or more accurately symptom centred categories rather than a diagnosis centred categories What is clear is that there is a desire to access both information about health issues and health services online. In addition to this Health promotion services may also want to consider peer marketing as a highly effective method of promotion and marketing.

11. Outcomes The current online tools do provide some use to young people who have actively chosen to look for health based information online. By contrast to the workshops questionnaire respondents scored all of the tools as 3.9 out of 5 or above (with five being “Good” and one being “Bad”) Questionnaire respondents were not asked to look at the website prior to completing the questionnaire and will have chosen to do so as a result of the Get Lays marketing, presumably indicating they may well have been looking for specific health information. This is one possible explanation for the differing results from workshop and questionnaire respondents. Young people will research health information online with a person centred approach rather than the condition centred approach used on some of the sites During workshops when asked to think of a topic on which look for health information, young people’s starting point is more likely to be “I have a rash/pains/concerns about my head/arm/genitals etc” rather than “I would like information about Chlamydia/cancer/measles/other medical named condition” Young people do not demonstrate an interest in giving feedback to the NHS via online methods such as patient opinion The project did not result in a significant increase in the number of posts left by young people in Knowlsey on the patient opinion website Workshops conducted with young people who regularly give up their time to participate in giving feedback on the NHS indicated that they did not value or support the idea of online feedback via Patient Opinion. Implications for Public Health In terms of online health promotion a distinction needs to be drawn between Using online tools to provide information to young people who are already seeking health information, about information based on their own needs And, Using online tools as a method for informing or promoting awareness of key issues to young people who are NOT already seeking health information. An example of the first group may be a young person who has recently received a diagnosis and is using the internet to seek further information regarding that diagnosis. At some point in their lives all young people would fall into the second group, key issues in this case would be those identified by health services (such as smoking, sexual health etc) as priorities to provide health information to young people. In this case the individual will not be actively seeking information regarding these issues, but a health promotion service will be seeking to deliver information to this group. This lack of motivation is the key difference between groups. For the second group the range of tools tested in this project needs significant and substantial improvement to be of any use, poor and un-engaging web design (for instance lack of graphical content) is a such substantial barrier to young people accessing health existing tools that it prevent young people from accessing any content. To successfully deliver health information to this group, web design needs to be so engaging that it provides the motivation for accessing the site in and of itself. For instance the use of online games or similar may provide the motivation wanting to access the site, and receiving the health information will be of secondary or importance to the young person. Talk to Frank could be sited as an example of this This is less of an issue for the first group however it is still clear that text Information needs to be provided in small sized chunks no longer than a paragraph, and information needs to be grouped in a person or more accurately symptom centred categories rather than a diagnosis centred categories What is clear is that there is a desire to access both information about health issues and health services online. In addition to this Health promotion services may also want to consider peer marketing as a highly effective method of promotion and marketing.

12. Outcomes Young people do not demonstrate an interest in giving feedback to the NHS via online methods such as patient opinion The project did not result in a significant increase in the number of posts left by young people in Knowlsey on the patient opinion website Workshops conducted with young people who regularly give up their time to participate in giving feedback on the NHS indicated that they did not value or support the idea of online feedback via Patient Opinion.

13. Outcomes Implications for Public Health In terms of online health promotion a distinction needs to be drawn between Using online tools to provide information to young people who are already seeking health information, about information based on their own needs And, Using online tools as a method for informing or promoting awareness of key issues to young people who are NOT already seeking health information.

14. Outcomes Implications for Public Health For the second group the range of tools tested in this project needs significant and substantial improvement to be of any use, poor and un-engaging web design (for instance lack of graphical content) is a such substantial barrier to young people accessing health existing tools that it prevent young people from accessing any content. Web design needs to be so engaging that it provides the motivation for accessing the site in and of itself. For the both groups text Information needs to be provided in small sized chunks no longer than a paragraph, and information needs to be grouped in a person or more accurately symptom centred categories rather than a diagnosis centred categories

15. Outcomes Implications for Patient and Public Involvement The approaches to engage young people via the Patient Opinion website were not effective within this project. Workshop participants, including those who were most actively engaged in health services indicated they were not likely to use Patient Opinion to leave feedback. During the entire duration of the project, despite the levels of awareness created there were no additional posts made on the Patient Opinion site that could be directly attributed to the marketing. This would seem to suggest that the site itself is not a suitable vehicle for engaging young people.

16. Next Steps