HEALTH CARE PROVIDERS PERSPECTIVES ON SOCIAL MEDIA IN PROFESSIONAL PRACTICE by LaNora Bellamy Dixon A thesis submitted in partial fulfillment of the requirements for the degree of Master of Nursing MONTANA STATE UNIVERSITY Bozeman, Montana April 2013 ©COPYRIGHT by LaNora Bellamy Dixon 2013 All Rights Reserved ii APPROVAL of a thesis submitted by LaNora Bellamy Dixon This thesis has been read by each member of the thesis committee and has been found to be satisfactory regarding content, English usage, format, citation, bibliographic style, and consistency and is ready for submission to The Graduate School. Dr. Laura Larsson Approved for the College of Nursing Dr. Helen Melland Approved for The Graduate School Dr. Ronald W. Larsen iii STATEMENT OF PERMISSION TO USE In presenting this thesis in partial fulfillment of the requirements for a master’s degree at Montana State University, I agree that the Library shall make it available to borrowers under rules of the Library. If I have indicated my intention to copyright this thesis by including a copyright notice page, copying is allowable only for scholarly purposes, consistent with “fair use” as prescribed in the U.S. Copyright Law. Requests for permission for extended quotation from or reproduction of this thesis in whole or in parts may be granted only by the copyright holder. LaNora Bellamy Dixon April 2013 iv ACKNOWLEDGEMENTS I would like to extend my sincere thanks and appreciation to my committee chair, Dr. Laura Larsson for her guidance, support, expertise, and encouragement throughout the thesis process. I would also like to express my gratitude to the other members of my committee, Dr. Jeannine Brant, and Dr. Kathleen Schachman for their support and insight. I also wish to extend my appreciation for the support and endorsement of this thesis work by the members of the Billings Clinic Nursing Research Council and administrative liaison, Douglas Carr, M.D. Thank you to my family and friends for all their love, patience, and understanding. I deeply appreciate your support, encouragement, and inspiration. A special thank you to my daughter, Ryanne Dixon, you are my greatest accomplishment. v TABLE OF CONTENTS 1. INTRODUCTION ...........................................................................................................1 Background and Significance ..........................................................................................2 The Changing Health Care Landscape .....................................................................2 The Changing Health Care Consumer ......................................................................5 Purpose .............................................................................................................................8 Conceptual/Theoretical Framework .................................................................................9 Assumptions ...................................................................................................................10 Definitions......................................................................................................................10 Health Care Consumer ............................................................................................10 Health Care Providers .............................................................................................10 e-Health ...................................................................................................................11 Smartphone .............................................................................................................11 Health Information Technology ..............................................................................12 Social Media ...........................................................................................................12 2. REVIEW OF LITERATURE ........................................................................................13 Literature Search Methodology .....................................................................................13 Key Terms and Searches .........................................................................................14 Summary of Articles .....................................................................................................17 Social Media ...........................................................................................................17 Health Care Delivery ..............................................................................................19 Health Care Consumers and Social Media .............................................................20 Health Care Providers and Social Media ................................................................23 Pender Health Promotion Model (HPM) ................................................................24 Gaps and Opportunities ...........................................................................................26 3. METHODS ....................................................................................................................27 Population/Sample .........................................................................................................27 Discussion of Rights of Human Subjects and Consent Process ....................................29 Design ............................................................................................................................30 Data Collection Procedures ............................................................................................31 Instrumentation ..............................................................................................................34 Analysis..........................................................................................................................36 4. RESULTS ......................................................................................................................37 Qualitative Thematic Results .........................................................................................48 vi TABLE OF CONTENTS – CONTINUED 5. DISCUSSION ................................................................................................................50 Evaluation of Results .....................................................................................................50 Age ..........................................................................................................................53 Provider Type ..........................................................................................................53 Practice Area ...........................................................................................................54 Study Limitations ....................................................................................................54 Implications ....................................................................................................................55 Practice ....................................................................................................................55 Research Implications .............................................................................................57 Education ................................................................................................................57 Implications for the Nursing Profession .................................................................59 Health Policy Implications ......................................................................................60 Summary .................................................................................................................63 REFERENCES ..................................................................................................................66 APPENDICES ...................................................................................................................71 APPENDIX A: Letter of Inquiry to Solicit Endorsement of Research (NRC)…..74 APPENDIX B: Letter to IRB(s) ............................................................................76 APPENDIX C: CITI Responsible Conduct of Research .......................................78 APPENDIX D: CITI Student’s Curriculum Completion Report ...........................80 APPENDIX E: Validity Checklist for Survey Instrument .....................................82 APPENDIX F: Permission to Reference SurveyMonkey ......................................84 APPENDIX G: Survey Instrument Hyperlink .......................................................86 APPENDIX H: Consent Form ...............................................................................88 vii LIST OF TABLES Table Page 1. Consumer Age Demographics, Online Use Percentages and Search of Health Care Information ...............................................................7 2. Literature Review Key Term Search CINAHL .................................................16 3. Social Media Types ............................................................................................18 4. Mobile Platform Used for Health 2009 .............................................................21 5. Age Demographics of Target Sample ................................................................38 6. Chi-square Test Stats: Effects of Gender on SMT/Mobile Users ......................43 7. T-test Stats and Group Means: Effects of Age, Tenure, Provider Type, Area of Practice on Study Variables