Introduction

The goal of health education is to help students adopt and maintain healthy behaviors (Telljohann, Symons, & Pateman, 2009) . In traditional school settings, health education relies heavily on social support systems and environmental factors to facilitate this objective. A key challenge in creating effective online health education is providing the necessary social support and encouragement for students toward behavioral change objectives. Finding online activities that facilitate and support individual behavior change are essential. Utilizing Web 2.0 social media applications offers promise by increasing encouragement of, and social support for, individual behavior change (Herring, Kouper, Scheidt, & Wright, 2004; Herring, Scheidt, Bonus, & Wright, 2004) . This instructional design uses one type of social media, a social networking site (SNS), to increase social support and accountability for online individual behavior change. SNSs are online locations where students create a profile and join a collaborative electronic community (Lenhart & Madden, 2007) . Inclusion of SNSs in online health education behavior change efforts builds on evidence that social support is critical in helping students change behavior (Elder, Ayala, & Harris, 1999; Elder, Geller, Hovell, & Mayer, 1994) . With a majority of students 12-17 years of age participating in SNSs, the popularity of social media among young people adds significance, relevance, and feasibility to this instructional technique.

Grade Level

This instructional technique is primarily designed for use among secondary students enrolled in an online health education or physical education course but can also be implemented in a university setting.

Objectives

This instructional technique will enable students to:

• Evaluate the use of an SNS application as social support for individual behavior change.
• Analyze how peer support can influence healthy behaviors.
• Demonstrate how to ask for and offer assistance to enhance and support the health of self and others using an SNS application.
• Demonstrate the ability to work cooperatively through social media as an advocate for improving personal and peer health.
• Appraise individual success in reaching a specific behavior change goal.

National Health Education Standards: Performance Indicators

This instructional technique corresponds with the following National Health Education Standards and Performance Indicators:

• NHES # 6 - Students will demonstrate the ability to use goal-setting skills to enhance health. Performance Indicator 6.12.3. - Implement strategies and monitor progress in achieving a personal health goal.
• NHES # 8 - Students will demonstrate the ability to advocate for personal, family, and community health. Performance Indicator 8.12.2. - Demonstrate how to influence and support others to make positive health choices. Performance Indicator 8.12.3. - Work cooperatively as an advocate for improving personal, family, and community health.

Materials And Resources  

• Each student needs computer and Internet access and a personal email account.
• The instructor and each student need an SNS profile.

Activities And Strategies

The activities and strategies for this instructional technique can be used throughout an entire online health education or physical education course depending on specific course and instructor objectives. In a health education course, this strategy may be most appropriate during a personal health unit where individual health behavior change and goal setting are emphasized. A social health unit where communication skills and the importance of supportive relationships are discussed may also benefit from this design. Those instructing students in an online physical education course may find this instructional technique beneficial throughout the entire course. Before implementing activities and strategies for online behavior change projects that include social media, teachers must understand their institutional policies regarding the use of this medium in online courses.

 

• The online curriculum should empower students with basic health behavior change principles including studying the target behavior, setting goals, understanding the role of social support in behavior modification, and providing social support, including the type of socially supportive comments that are most beneficial and useful.
  

1. Students should identify an individual behavior they want to change. Instructors my assist students in identifying goals that can be achieved during the course of the class, that are safe, and that occur frequently enough to benefit from online social support.

 

1. Allow students time to study information about the behavior to gain additional insight, including recommended behavioral frequency and duration. Students also should assess their current behavioral practices, comparing their performance with an accepted standard. Specific guidelines for such behaviors as healthy eating, physical activity, personal protection, stress management, and checkups can be obtained from the Centers for Disease Control and Prevention.

 

• If necessary, include a tutorial demonstrating how students create a free account by going to http://www.facebook.com and filling out the requested information under the “sign up” heading. An email account is required. Following electronic confirmation of an email address, access will be provided to a personal Facebook page. Personal information and photos can be added to the profile page of the site (see top menu bar). With the “wall” page, users communicate with others they have invited or approved as friends. (see Table 1).

 

Table 1. Steps to Create a Facebook Group and Initiate Social Networking

Create an Account

In a web browser, navigate to http://www.facebook.com Create an account if necessary by clicking on the “Sign Up” icon Customize personal Facebook site by adding information and photos to the “profile” page

Invite Friends

Locate the ‘Friends’ tab in the menu bar and select ‘Find Friends’ Identify students that should be participating in this activity and extend an invitation to become friends

Create a Group

From your Facebook home page, click on the group icon located in the application toolbar at the bottom of your screen Click on the ‘Create a New Group’ link located at the top of the page Complete the group information by assigning a group name and description followed by selecting a category Restrict access to the group by selecting “closed” or “secret” under the “access” heading Customize group by selecting the ‘options’ icon. Ensure ‘discussion board’ is selected in order to allow students to post/comment about their progress Students may organize into multiple groups depending on their behavior change goals. Repeat this process for additional groups

Invite Members

From within the newly created group homepage, locate and click on the link, ‘Invite People to Join’ Select from the list of friends those people that should be invited to the group, and highlight their picture Click on the icon, ‘Send Invitation’

Add a Discussion Topic

Once the group is operating and in the group’s home page, click on the link, ‘Start the first topic’ Update progress, or comment about another person’s progress

1. Smaller online classes can remain as one Facebook group, while larger classes or multiple classes can divide into specific groups. Students in online independent study courses can easily be combined into one Facebook group. Students with similar behavior change goals can also align to provide social support for their specific target behaviors.
   
2. To start, the teacher uses his/her Facebook profile to set up a “group.” To do so, click on ‘create a group’ under your profile, select a name for your group, select privacy settings, and then invite members. Activate privacy settings to restrict access so only online class members can participate in the group. To do this, the teacher should set up the group so that it is “closed” or “secret” by selecting one of these options under the “access” heading. This means that only the teacher and the group members will be able to see individual posts and comments. To facilitate group discussion, the “discussion board” should be activated. Posts and the associated comments will comprise the content of the discussion board.

1. The ideal group size is 10-15 members. This may result in a large class having several smaller groups. Depending on the number of students enrolled in the online course, the teacher should determine the number of students in each group, but it should be an appropriate size to maximize the benefits of being a group. For example, small groups may not provide adequate social support, while groups that are too large may suffer from students feeling a sense of anonymity, and, therefore, not fully engaging in the process and posting too infrequently.
   
2. Students post their goals and provide progress updates. They complete both tasks outside the classroom using a simple post on the group’s discussion board. Students should post their health behavior change goals to their group discussion board for others to see and comment on, which results in increased accountability.
   
3. Posting progress can be an important way for students to cope with the challenges inherent in behavior change and a mechanism for classmates to offer advice or other helpful information. It is also a way to monitor progress toward completing the goal. Students’ daily posts are part of their status updates, which can be entered on the main Facebook page or on an individual’s profile page.
   
4. Providing feedback and participating on the discussion board are important, not just for the individual student, but also for members of her social network. Students should be encouraged to be active in this process, posting comments to encourage others who are struggling to meet their goals, and reinforcing those who are accomplishing them. Each student should post a minimum of 1-2 comments daily.

Research findings show that tailored communications effectively motivate behavior change (Rimer & Kreuter, 2006) . Effective responses to peer posts should be short, genuine, motivational, and matched to the target behavior (Toscos, Faber, Connelly, & Upoma, 2008) (eg, “Great job at running for 2 miles today, Jorge! Keep up the good work; you’ll soon meet your goal of 3 miles.”).

Following previous implementations of this instructional design, student feedback has been positive. Students enjoyed peer support and found it useful for achieving their individual behavior change efforts. Their satisfaction and participation with this technique was greatest when the social network existed previously. In cases where students were unacquainted with one another prior to implementation, grade incentives were especially useful in increasing participation until motivation for social interaction occurred naturally.

Assessment Techniques

Both formative and summative assessments are key to the successful implementation of this instructional design note. These assessment techniques can safeguard against potential interpersonal conflicts and motivate student participation. The instructor should remind students of the importance of maintaining confidentiality regarding peers’ individual behavior change efforts. Sharing of information, bullying, and hurtful or sarcastic tones should not be tolerated and may result in a failing grade on the assignment.

Formative assessment through reviewing the students’ personal posts and the comments they post in response to a group member’s status can be ongoing. The instructor monitors posts and comments for appropriateness and evidence of supportive communication skills or other criteria she feels should be emphasized throughout this activity.

• Summative assessment of the behavioral objectives can be completed in several ways: Students may write a two-page paper detailing the behavior change goal, the impact of online peer support on their goal, and a description of the degree to which they achieved their goal. Instructors can use or adapt the rubric found in Table 2 to assess student performance. Based on other course assignments, the instructor can determine the total point value for the project.

 Table 2. Rubric to Assess Student Performance in SNS Online Behavior Change Project

Indicator
	5	3	1	Score*
Individual behavior change goal	Specific, measurable, achievable, realistic, and time-specific behavior change goal	Goal is specific, measurable; may not be realistic or achievable	Goal is vague with little specificity
Frequency of posts of his or her personal progress.	Daily posts	3 times a week	Once a week or less
Frequency of response to peer postings	Daily response to at least 2 group members	3 times a week responded to at least 2 group members	Response to peers once a week or less
Quality of individual posts	References the goal; shares progress and challenges toward goal; asks for feedback or advice	References the goal; shares progress and challenges toward goal	Makes brief updates on behavior change goal with no specifics mentioned
Quality of response to peer posting	References specific behavior and the recent individual post; gives behavior specific encouragement; positive; motivational; appropriate grammar and spelling	Gives specific behavior encouragement but does not reference recent post	Comments on post but it does not relate to the behavior change goal; not motivational; inappropriate grammar and spelling
Achievement of personal behavior change goal	Achieved 100% of goal	Achieved 75% of goal	Achieved less than 50% of goal
			Total

*The instructor can determine the value of this assignment based on other course assignments.

The instructor may ask students to submit a copy of their personal SNS wall page showing all the posts they made as evidence of their ability to work cooperatively to advocate for personal and peer health and demonstrate how they asked and offered assistance in support of personal and peer health behavior change.

• Students may respond to the following prompts in a written report submitted to the instructor:
  
• How did online peer support influence your behavior change?
• How did use of an SNS impact the monitoring of your progress in achieving your personal health goal?
• Based upon your experience, can SNSs be used to facilitate social support for individual health behavior change?
• What did you like about this activity?
• What would you change about this activity?