This is an independent case study showing some young peoples’ experience and views of digital health offers and use of technology. It is not exhaustive but starts to explore potential assumptions.
Such insight, we hope will provoke an appetite within commissioning and services for engaging young people in designing solutions when a need is identified. This could be finding a way of meeting demand or where there is not a service to meet needs.
Learning from other parts of Sussex
The collaborative survey by East Sussex County Council, the East Sussex Youth Cabinet and Healthwatch East Sussex, in April and May, resulted in nearly 1,000 young people (aged 11 to 18) sharing their experiences under lockdown.
Approximately one in ten young people had used a video link or mobile app to access health or care services. Of these, half said it met their needs, but would rather see someone face-to-face in the future, with a quarter indicating they would be happy to use it as their main means of accessing services. In answering the same questions, adult responses to using digital consultations in the future was more favourable.
Our focused listening has unpacked some of this.
Experiences of using digital platforms
We spoke to several young people to find out their experiences of using digital platforms. They all shared a common view that online video platforms - for lessons, out-of-school activities (such as Guides, Scouts, etc) or health consultations - were not something they felt comfortable being seen on and using. The reasons for this included:
'It's too easy to be put on the spot, which you don’t get in classrooms etc because teachers can see your body language and reactions.'
'It doesn’t feel natural. There’s no warning when you’ll be asked a question and I feel quite exposed. Under a microscope.'
'I don’t like the awkward silences when they are recording information. If I had a choice, I’d prefer to see the doctor face-to-face.'
'I don’t like doing Guides on Zoom. I can see the Guide Leader has favourites from how she reacts during the call. This was not an issue when we did Guides in the evening.'
'I had the chance of doing Explorers and Young Leaders training on Zoom, however I found these sessions very stressful and have opted out. I don’t like talking on them. It feels pressured and people can’t tell how you’re feeling as easily, so keep waiting for an answer. I feel really awkward and stressed on them.'
George (15) refused the video/telephone counselling with the YES service and has opted to wait until they can do face-to-face appointments again.
'I’ve never met the counsellor before, so would feel very uncomfortable talking over video because it may drop-out or I may not be able to hear her or see her properly. Also, I would be the focus all the time and I wouldn’t be able to ‘read’ her properly either on video or over the phone.
George is the same with college on Teams and he keeps his camera and mic off unless he really has to put them on.
Ben (15) was reluctant and didn’t want to have the GP consultation (early on during Lockdown). He was anxious about it and wanted to see the GP face-to-face. However, once he’d experienced the video consultation, which was with a GP he’d not met before he said it was better and that he’d probably be happy with this type of consultation in the future. The anticipation was much worse than the reality.
Comments on a current digital offer
We asked young people (aged 11-16) if they had heard of ChatHealth, and how they would feel about using this for support.
ChatHealth offers secure and confidential text messaging for young people, aged 11-19, which provides easy and anonymous access to a healthcare professional for advice and support, for stress and anxiety, bullying, self-harm, alcohol and drugs, sex, contraception and relationships, sensitive issues and any other health matters that are causing concern.
Sydney told us that she had tried ChatHealth in Year 7 (aged 11-12).
‘It’s only open 9am to 4pm (it is now open until 4.30pm) and phones aren’t allowed to be used in school. I would sneak off to the toilet to text the service during school time, so I could get an answer. If I waited until after school I would get anxious waiting for a reply, which wouldn’t come through until the next day.’
Young peoples’ comments about the service (when they had not used it):
'No one texts'. - George (15), who has unlimited texts and probably sends a maximum of two a month, if that. All his communication is done via Instagram.
'Most of the time I like talking to someone I know (my friends, mum, teachers), rather than a stranger, but for some things a stranger may be better as they won’t judge you as much.' - Millie, 12
'I don’t use Messages (texting) because it's boring. WhatsApp is easier – you can send photos, GIFs, change background colours and send voice messages.' - Chloe (12)
Parents’ comments about the service:
'We educate our children not to text/use phones etc to talk to strangers, so this is installed in our young people, which may be why this may not work for them?'
'How does the service provider know who is in the room with a young person using this service?'
Young Peoples' views on digital engagement
We spoke to young people and attended the Mid Sussex Voluntary Action, Young People and Families Forum to gain some insight into young people’s views on digital engagement.
We heard that young people want to be able to contact services themselves (specifically mental health/emotional wellbeing.) They want the knowledge and skills to do so, rather than wait for an adult to notice and make a referral.
We also heard that digital engagement is a useful tool if you already have a relationship with the young person. But that it can be difficult if you haven’t. It can be harder to build the relationship in that space. It’s also tiring, and young people are losing interest in it – particularly when everything is happening over a digital platform like Zoom e.g. socialising, school/college work, clubs etc.
We spoke to the group about inequalities young people may face around digital engagement:
We heard that not all young people have access to IT, many homes only have phones, and access to WIFI can be an issue.
Some homes have strict rules on screen time and digital access. It can also be hard for young people to find a safe space to engage, including a space to talk privately. This could have an impact, especially if the young person wants to be discreet.
Young people can find it hard to find the right time to engage, due to screen commitments for school-work, and the need to make sure they are having time away from the screen.
We also heard that programs such as Zoom work well for teenagers, but don’t necessarily work as well for those who need more support e.g. younger children or children and young people with learning difficulties. This can be an extra burden for the parents and carers supporting them.
So what do young people want for digital engagement?
'I want services advertised as professional people who can help you, rather than “kind, bubbly child helpers”. It’s patronising. More likely to use it if it looks like professionals and that they’ll actually be able to help you. Puns as mental health support names aren’t fun to most people. Don’t make it too childish, it undermines the message and makes me feel they’re less able to help. Need reassurance that they can actually help otherwise why get in touch with them?' - Charlie (17)
'It would be good to have some kind of anonymous forum where people can chat to each other (peers) as well as there being counsellors/therapists/professionals there' - Esme (17)
'I like the idea of some kind of messaging as videos (e.g. Zoom or Teams) can be very intimidating, particularly if you’re feeling anxious' - Pip (16)
A quote from Elsbeth, aged 17
'I don’t use services and feel reluctant to. I’m very private and feel uncomfortable reaching out but if I did, I’d want it to be anonymous and somewhere that I could message (via website or text) who would send me info or answer my questions. It would depend on the urgency, but I’d like a response that day. And if it was urgent, I’d like a much faster response; may be an hour – but that would depend on the problem. I’d like the opportunity to have a real time conversation through text or messaging. It would be good if someone could check back on me, that I’m ok. It would be good if this could then develop into different interactions if I needed it. I’d already know I could trust them, and I might be less reluctant to share my concerns.
I want the information of who to contact for what to be clear. What’s the point of talking to someone and them then directing you to another service where you have to start the conversation all over again? I want to be able to find the right service and start the conversation with them. Because I hate reaching out, that contact needs to feel worthwhile. That it’ll change something, otherwise what’s the point?
Opening times are really important. I wouldn’t use it at night, but a lot of my friends would. They’re up all night and things often feel worse then.'
Credits:
Created with images by freestocks - "untitled image" • NESA by Makers - "untitled image" • Chris Montgomery - "Zoom call with coffee" • Tim Mossholder - "Texting" • Chad Madden - "untitled image" • Jan Baborák - "The young woman has a home office." • Tyler Lastovich - "Greetings!"