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Originally published in the Journal of Medical Internet Research http: This is an open-access article distributed under the terms of the Creative Commons Attribution License http: The complete bibliographic information, a link to the original publication on http: This article has been cited by other articles in PMC.

Abstract Background A growing number of health promotion interventions are taking advantage of the popularity and interactivity of new social media platforms to foster and engage communities for health promotion. However, few health promotion interventions using social networking sites SNS have been rigorously evaluated.

Now in its fifth season, QAF is among the few published examples internationally to demonstrate the sexual health promotion potential of SNS. Objective The objective of this evaluation is to assess reach, interactivity, and engagement generated by QAF to inform future health interventions and evaluations using SNS. Methods We undertook a mixed method process evaluation using an uncontrolled longitudinal study design that compared multiple measurements over time to assess changes in reach and engagement.

We adapted evaluation methods from the health promotion, information systems, and creative spheres. We incorporated online usage statistics, interviews informed by user diary-scrapbooks, and user focus groups to assess intervention reach and engagement.

These webisodes attracted over 30, views; ranging from views per individual episode. Interview and focus group participants supported the balance of education and entertainment. They endorsed the narrative "soap opera" format as an effective way to deliver sexual health messages in an engaging, informative, and accessible manner that encouraged online peer discussion of sexual health and promoted community engagement.

Conclusions QAF offers a successful example of exploiting the reach, interactivity, and engagement potential of SNS; findings from this process evaluation provide a model to inform the delivery and evaluation of future health promotion interventions on SNS. The advent of social media and Web 2. Eager to capitalize on this potential, many organizations have developed online health interventions for a variety of health issues and clinical outcomes [ 1 , 4 - 6 ], including for HIV prevention to gay men [ 7 - 9 ] with some reporting positive outcomes [ 10 - 12 ].

Yet to date, there have been very few published examples of evaluation of interventions delivered on SNS [ 13 ]; a recent review of sexual health promotion on SNS found the vast majority of activities are unreported in the scientific literature and showed limited success in practice [ 14 ]. One very recent randomized controlled study in the United States showed some promising results for SNS as a sexual health education tool [ 15 ].

This trial aimed to determine the effect of STI prevention messages delivered to youth via Facebook in reducing sexual risk behaviors compared to a control group that received news stories via Facebook. SNS are of particular interest for health promotion due to their enormous potential audience reach and interactive features.

Previous studies have shown benefits of such interactive health communication capabilities to enhance learning [ 18 ]. The adaptive and interactive features of Web 2.

These learning strategies have shown some potential in helping individuals internalize and process messages and increase knowledge and improve attitudes and skills for HIV prevention and sexual health; however, these data are largely inconclusive [ 21 - 23 ]. Additionally, using social networking features, interventions are able to disseminate health messages quicker through a population when compared to traditional forms of social marketing [ 24 ]. Yet to date, no study has assessed the relative effect of novel functions of SNS for health promotion, and these dimensions present obvious challenges for both monitoring and evaluating impact.

Additional dimensions to evaluate SNS-based health promotion not typically considered in traditional media approaches, such as user interactions, functions to support interaction, content quality, and credibility of content have been suggested as useful tools to help evaluation future interventions in this space [ 20 ]. We have previously published implementation recommendations based on our experience in the first phase of this project targeting young people [ 27 ]; this paper reports the results of the process evaluation of QAF over the initial pilot phase Series 1 and through the subsequent two series.

The aim of this evaluation is to assess reach, interactivity, and engagement generated by QAF to inform future health interventions and evaluations using SNS. The narratives and health messages were developed during formative evaluation workshops with members of the target audience and key stakeholders.

Much like a TV drama, this online drama series was made up of sequential and individually discrete series, each containing a number of webisodes. Series 2 contained 12 webisodes posted from October 5 - December 21, , and Series 3 consisted of 12 webisodes posted from February 16 - April 18, Between episodes, project staff posted questions and content daily on the QAF Facebook page to prompt online discussion about the sexual health issues embedded in the narrative of the QAF webisodes and encourage interaction with and between QAF Facebook fans.

QAF was promoted through a mix of online and offline advertising, including press advertisements Figure 2 and editorial coverage in local gay media, Facebook advertisements, updates to fans through the QAF page, and community engagement at gay public events.

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Originally published in the Journal of Medical Internet Research http: This is an open-access article distributed under the terms of the Creative Commons Attribution License http: The complete bibliographic information, a link to the original publication on http: This article has been cited by other articles in PMC.

Abstract Background A growing number of health promotion interventions are taking advantage of the popularity and interactivity of new social media platforms to foster and engage communities for health promotion.

However, few health promotion interventions using social networking sites SNS have been rigorously evaluated. Now in its fifth season, QAF is among the few published examples internationally to demonstrate the sexual health promotion potential of SNS.

Objective The objective of this evaluation is to assess reach, interactivity, and engagement generated by QAF to inform future health interventions and evaluations using SNS. Methods We undertook a mixed method process evaluation using an uncontrolled longitudinal study design that compared multiple measurements over time to assess changes in reach and engagement. We adapted evaluation methods from the health promotion, information systems, and creative spheres. We incorporated online usage statistics, interviews informed by user diary-scrapbooks, and user focus groups to assess intervention reach and engagement.

These webisodes attracted over 30, views; ranging from views per individual episode. Interview and focus group participants supported the balance of education and entertainment. They endorsed the narrative "soap opera" format as an effective way to deliver sexual health messages in an engaging, informative, and accessible manner that encouraged online peer discussion of sexual health and promoted community engagement.

Conclusions QAF offers a successful example of exploiting the reach, interactivity, and engagement potential of SNS; findings from this process evaluation provide a model to inform the delivery and evaluation of future health promotion interventions on SNS. The advent of social media and Web 2. Eager to capitalize on this potential, many organizations have developed online health interventions for a variety of health issues and clinical outcomes [ 1 , 4 - 6 ], including for HIV prevention to gay men [ 7 - 9 ] with some reporting positive outcomes [ 10 - 12 ].

Yet to date, there have been very few published examples of evaluation of interventions delivered on SNS [ 13 ]; a recent review of sexual health promotion on SNS found the vast majority of activities are unreported in the scientific literature and showed limited success in practice [ 14 ]. One very recent randomized controlled study in the United States showed some promising results for SNS as a sexual health education tool [ 15 ]. This trial aimed to determine the effect of STI prevention messages delivered to youth via Facebook in reducing sexual risk behaviors compared to a control group that received news stories via Facebook.

SNS are of particular interest for health promotion due to their enormous potential audience reach and interactive features. Previous studies have shown benefits of such interactive health communication capabilities to enhance learning [ 18 ]. The adaptive and interactive features of Web 2. These learning strategies have shown some potential in helping individuals internalize and process messages and increase knowledge and improve attitudes and skills for HIV prevention and sexual health; however, these data are largely inconclusive [ 21 - 23 ].

Additionally, using social networking features, interventions are able to disseminate health messages quicker through a population when compared to traditional forms of social marketing [ 24 ]. Yet to date, no study has assessed the relative effect of novel functions of SNS for health promotion, and these dimensions present obvious challenges for both monitoring and evaluating impact. Additional dimensions to evaluate SNS-based health promotion not typically considered in traditional media approaches, such as user interactions, functions to support interaction, content quality, and credibility of content have been suggested as useful tools to help evaluation future interventions in this space [ 20 ].

We have previously published implementation recommendations based on our experience in the first phase of this project targeting young people [ 27 ]; this paper reports the results of the process evaluation of QAF over the initial pilot phase Series 1 and through the subsequent two series. The aim of this evaluation is to assess reach, interactivity, and engagement generated by QAF to inform future health interventions and evaluations using SNS.

The narratives and health messages were developed during formative evaluation workshops with members of the target audience and key stakeholders. Much like a TV drama, this online drama series was made up of sequential and individually discrete series, each containing a number of webisodes.

Series 2 contained 12 webisodes posted from October 5 - December 21, , and Series 3 consisted of 12 webisodes posted from February 16 - April 18, Between episodes, project staff posted questions and content daily on the QAF Facebook page to prompt online discussion about the sexual health issues embedded in the narrative of the QAF webisodes and encourage interaction with and between QAF Facebook fans. QAF was promoted through a mix of online and offline advertising, including press advertisements Figure 2 and editorial coverage in local gay media, Facebook advertisements, updates to fans through the QAF page, and community engagement at gay public events.

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  1. May Further information: On a personal level, there are internal conflicts involving religious beliefs, upbringing, and internalized homophobia in addition to feelings of fear and isolation. Originally published in the Journal of Medical Internet Research http:

  2. QAF was promoted through a mix of online and offline advertising, including press advertisements Figure 2 and editorial coverage in local gay media, Facebook advertisements, updates to fans through the QAF page, and community engagement at gay public events.

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