Using Twitter to Facilitate an Allied Health Professional ...€¦ · Twitter. Twitter, a micro...

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1 | Page Using Twitter to Facilitate an Allied Health Professional Continuing Education Program LNR/18/SCHN/272 LNRSSA/18/SCHN/306

Transcript of Using Twitter to Facilitate an Allied Health Professional ...€¦ · Twitter. Twitter, a micro...

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Using Twitter to Facilitate an Allied Health Professional Continuing Education Program

LNR/18/SCHN/272 LNRSSA/18/SCHN/306

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Summary ........................................................................................................................................................ 3 Introduction .................................................................................................................................................. 4 Methods and Technologies ................................................................................................................... 10

Research Question ............................................................................................................................................. 10 Primary Objectives ............................................................................................................................................. 10 Ethics ......................................................................................................................................................................... 11 Participants ............................................................................................................................................................. 11 Materials/resources ............................................................................................................................................ 12 Procedure ................................................................................................................................................................ 12 Statistical Analysis .............................................................................................................................................. 13 Privacy ...................................................................................................................................................................... 14

Results .......................................................................................................................................................... 15 1. Participants .................................................................................................................................................. 15 2. Use of Twitter .............................................................................................................................................. 17 3. Advantages and disadvantages of Twitter use .......................................................................... 22 4. Strategies for facilitating Twitter ........................................................................................................ 24 a. Strategies of continuing need for education ................................................................................ 24 b. Clear guidelines for Twitter use ......................................................................................................... 25 c. Need for support by employing organisations ............................................................................ 25 5. Twitter Analytics ........................................................................................................................................ 25

Discussion ................................................................................................................................................... 29 Principle Findings ................................................................................................................................................ 29 Advantages and Disadvantages of Twitter Use ................................................................................... 31 Limitations ............................................................................................................................................................... 32 Future research .................................................................................................................................................... 33 Conclusion .............................................................................................................................................................. 33

References .................................................................................................................................................. 35 Appendix One: Twitter Pre-Survey ............................................................................................................. 43 Appendix Two: Twitter Post-Survey........................................................................................................... 47 Appendix Three: AHTVE Sessions from July 2018 to April 2019 ............................................... 51

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Summary

The introduction of social media has lead to the development of modalities such as

Twitter. Twitter, a micro blogging platform, has the potential to enhance health

professionals’ networking and exchange of resources and ideas without the

boundaries of time, space or geography. This research aimed to explore the benefits

of Twitter within the context of allied health professions by examining its use in

relation to Allied Health Telehealth Virtual Education (AHTVE).

The goal of this research was to analyse the integration of Twitter with the existing

education modality AHTVE. Demonstration of the potential use of Twitter in bringing

together allied health professionals across a broad geographical area to discuss and

share resources, best practice and experiences around nominated session topics

was the aim.

The research identified that in terms of professional development benefits, Twitter

was perceived as being helpful for improving knowledge and problem solving. The

majority of allied health professionals, however, remained unsure of the benefits of

the integration of Twitter into AHTVE. The findings of the study suggested that

Twitter has the potential to be a useful tool at future AHTVE sessions, but there are

pitfalls that should be recognised including many technological challenges.

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Introduction

Contemporary communication and the evolution of social media have ensued from

the establishment of the Internet and rapid technological advances (Casella, Mills, &

Usher, 2014; Chretien, Tuck, Simon, Singh, & Kind, 2015; McKee, 2013; Rolls,

Hansen, Jackson, & Elliot, 2016). Social media is a communication mode that

utilises web-based applications that allow people to create and exchange online

content (Kaplan & Haenlein, 2010; Kung & Oh, 2014; Usher, 2011). The introduction

of social media has enabled the access of information by a large number of people.

This has included the facilitation of professional networking and knowledge sharing

by health care professionals (Rolls et al., 2016). Facebook and Twitter are the two

social media platforms experiencing the biggest growth as social media becomes an

increasingly important part of our lives (NSW Government, 2016).

Twitter is a free micro-blogging platform, optimised for mobile application that permits

information to be exchanged in 140 characters or less (Bolderston, Watson,

Woznitza, Westerink, Di Prospero, Currie, Beardmore, & Hewis, 2018; Chretien et

al., 2015). The forced limit on character numbers requires the author to be succinct,

although the use of pictures and links enable greater information to be shared (Mills

& Kohl, 2016). Since the introduction of Twitter in 2006 its usage has increased.

During the month of April 2019, Twitter had approximately 4,700,000 monthly active

Australian users (Cowling, 2019). Further to its use in the general population, Twitter

is also reported to be widely used amongst health professionals (Chan & Leung,

2018). Twitter provides a modality that enables users to connect with their colleagues

and professional networks, providing an opportunity to exchange ideas, share

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learning, and engage in critical debate regardless of distances (Forgie, Duff, & Ross,

2013; Maclean, Jones, Carin-Levy, & Hunter, 2013).

Health professionals utilising Twitter are able to exchange resources, ideas and

communicate with peers, mentors and leaders within their discipline (Forgie et al.,

2013). Twitter is currently being utilised by a range of health professionals to

facilitate virtual communities of practice that enhance professional networking and

knowledge sharing (Barry & Pearson, 2015; Forgie et al., 2013; Rolls et al., 2016).

Professional networking is a process of developing mutually beneficial relationships

with other like-minded professionals (Rolls et al., 2016). Virtual communities of

practice are groups of people who interact regularly and share a common interest for

something they do (Wenger, 2004). The advancement of social media and the

development of modalities such as Twitter may enhance health professionals’

networking and virtual communities of practice by facilitating professional interactions

not restricted by time, space or geography (Ardichvili, Maurer, Li, Wentling, &

Stuedemann, 2006; Barry & Pearson, 2015; Camden, Rivard, & Hurtubise K, 2017;

Ellison, Steinfield, & Lampe, 2007; Lai, Pratt, Anderson, & Stigte, 2006).

A narrative literature review exploring the impact of Twitter use in health professional

education was completed in 2018. The educative potential of Twitter was identified,

although the review provided varied results regarding the uptake of this modality

(Blayden, 2018). The key concepts of the papers examined encompassed the age of

Twitter users, its uses, integration of Twitter in an educational context, benefits and

barriers. The papers reviewed varied in methodological approaches with a number of

international perspectives, including a number of papers originating in Australia

(Ferguson, Inglis, Cripps, MacDonald, & Davidson, 2014; Usher, Woods, Casellac,

Glass, Wilson, Mayner, Jackson, Brown, Duffy, Mather, Cummings, & Irwin, 2014;

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Wilson, Ranse, Cashin, & McNamara, 2014). Research into Twitter has generally

utilised survey-based tools to investigate health professionals’ use of Twitter

exploring both the benefits and risks. Twitter Analytics and thematic analysis of

tweets have also been used to further explore the quality of this use (Kember, Tse, &

McKay, 2008; Mckay, Steiner Sanko, Shekhter, & Birnbach, 2014; McKendrick,

Cumming, & Lee, 2012).

Generally the adoption of Twitter for professional use is more prevalent amongst

younger professionals with less professional experience (Alsobayel, 2016; Chan &

Leung, 2018; Hart, Stetten, Islam, & Pizarro, 2017). Gender did not appear to be a

causal factor in the professional use of Twitter. In a number of studies a greater

number of males utilised Twitter (Kung & Oh, 2014; Patel, Hawkins, Rawson, &

Hoang, 2017) which contrasted with a study of public health professionals where the

majority of users identified as female (Hart et al., 2017). Twitter has been widely used

across the educational continuum of health professional learning including

undergraduate, postgraduate and continuing professional development. The majority

of the studies focused on nursing and medical applications with very few studies

addressing the professional education uses of Twitter in the context of allied health

professionals (Barry & Pearson, 2015; Kukreja, Heck Sheehan, & Riggins, 2011).

Papers exploring the use of Twitter for specific educational purposes tended to focus

on five main categories including: journal clubs (Bolderston et al., 2018; Currie,

Woznitza, Bolderston, Westerink, Watson, Beardmore, Prospero, McCuaig, &

Nightingale, 2017), facilitation of professional networks (Ferguson et al., 2014), push

notifications for learning nuggets (Pisano, Pettit, Bartlett, Bhagat, Han, Liao, &

Landon, 2016; Reames, Sheetz, Englesbe, & Waits, 2016), assessment tools

(Gagnon, 2015; Lipp, Davis, Peter, & Davies, 2014) and online targeted resources

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(Mason & Batt, 2018). The incorporation of Twitter has been a beneficial adjunct to

journal clubs in assisting facilitation of professional networks or virtual communities of

practice (Ferguson et al., 2014; McKendrick et al., 2012). Apart from the beneficial

use of Twitter at medical conferences (Ferguson et al., 2014) there is no evidence of

its use to support stand-alone education sessions with the focus on both facilitating

education and professional networking.

The potential benefits and strengths of Twitter and its integration into continuing

professional development were explored in a number of papers (Forgie et al., 2013;

Rolls et al., 2016; Wilson et al., 2014). Common themes acknowledged the absence

of geographical and temporal boundaries, the facilitation of virtual communities, and

the potential to facilitate learning and promote change through social dialogue.

Constructive aspects of Twitter usage were described as the capacity to use Twitter

to stay connected with other professionals, share knowledge, and engage in

continuing education (Hart et al., 2017; Panahi, Watson, & Partridge, 2016; Rolls et

al., 2016). Health professionals identifying as utilising Twitter for professional

purposes reported “following” a variety of individuals and organisations, including

other health professionals, medical journals, professional advocacy and health care

organisations (Barry & Pearson, 2015; Kukreja et al., 2011). These studies did not

comment on the “active” interactions or evaluate the postings of these health

professionals.

It is not possible to explore the integration of Twitter into health professional

education without candid discussion of potential risks and barriers. A number of

papers discuss the risks and barriers including issues around maintaining

confidentiality, lack of time, workplace acceptance and support, and difficulty

separating personal and professional lives (Bolderston et al., 2018; Chan & Leung,

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2018; Panahi et al., 2016). Educators also identified perceived barriers in utilising

Twitter for education purposes including lack of understanding of how to integrate

Twitter into learning programs and lack of technical skills to use social media

(D'Souza, Henningham, Zou, Huang, O'Sullivan, Last, & Ho, 2017).

The effectiveness of Twitter in facilitating education is being evaluated across

different levels of the educational continuum and various health professions (Curran,

Matthews, Fleet, Simmons, Gustafson, & Wetsch, 2017; Hart et al., 2017; Roberts,

Perera, Lawrentschuk, Romanic, Papa, & Bolton, 2015). Current literature details

how this can be achieved including collaboration at professional conferences,

creation of virtual communities in journal clubs or promoting student engagement,

active learning in courses shown through the production of assessments or delivery

of educational material. Based on this information it appears evident that Twitter has

potential to be integrated into continuing professional development of health

professionals and positively impact on educational practices. The barriers and

limitations identified need to be further explored and addressed when integrating this

medium into educational initiatives (D'Souza et al., 2017).

Despite seemingly positive support for the use of Twitter in the sphere of health

professional education there are no randomised controlled studies and few objective

evaluations assessing the knowledge uptake and retention from education delivered

or facilitated using Twitter. There is also very little comparison between the flow of

education material via Twitter, that is, does reciprocal interaction improve the impact

and effect of learner engagement and knowledge acquisition. An increasing number

of papers reflect the uptake of Twitter by health professionals internationally

(Alsobayel, 2016; Hart et al., 2017; McKendrick et al., 2012). There is, however, a

paucity of knowledge in existence with regard to integration of Twitter specifically

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within the Australian context and allied health use of Twitter within the continuing

education sphere.

Twitter has been integrated in health professional education utilising a variety of

initiatives, with different target groups and aims. This narrative review highlights

opportunities for Twitter to be used within allied health continuing education to foster

a community of learning (Blayden, 2018). Moving forward, attention needs to focus

on more rigorous evaluation and studies including under-represented health

professional groups.

Hence, this research aims to address these gaps regarding the benefits of Twitter

within the context of allied health professions by examining its use in relation to Allied

Health Telehealth Virtual Education (AHTVE). AHTVE is an initiative of the New

South Wales (NSW) Children's Healthcare Network Allied Health Educators program

(A2K). AHTVE aims to promote the use of videoconferencing as a means of

supporting and developing allied health professionals' knowledge and confidence in

the treatment of children presenting with more serious or complex clinical conditions.

AHTVE provides NSW Health allied health professionals who work with children, with

fortnightly access to education activities and workshops conducted at various sites

across NSW. The sessions are 60 minutes in duration and presented by allied health

professionals who have identified expertise in various clinical areas. A yearly

calendar of proposed educational topics and presenters is developed and available

on the A2K website as well as promoted in monthly newsletter and email alerts.

When developing educational initiatives it is important to embed active learning in all

sessions as it is well accepted that adults learn more effectively through experiential

techniques including questioning and discussion (Brookfield, 1998; Brundage &

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Mackeracher, 1980). Due to the limitations of the technology used and number of

sites linked into AHTVE there is limited time for discussion and the sessions are often

presented in didactic lecture style format. It is essential to explore further modalities

to facilitate active learning by participants accessing AHTVE.

The research explored how Twitter may be integrated into AHTVE to facilitate

communication, sharing of resources and support, specifically for those in regional

and rural areas. For the duration of the research, the AHTVE sessions were run in

the current fortnightly format for content. Participants however were also invited to

take part in Twitter. Based on the outcomes from the study, recommendations will be

made regarding the effectiveness and potential utilisation of Twitter as an ongoing

component of the existing AHTVE initiative.

Methods and Technologies

Research Question

What is the effectiveness of Twitter in facilitating active participation in Allied Health

Telehealth Virtual Education (AHTVE)?

Primary Objectives Twitter may facilitate active participation in AHTVE. This will be verified through:

Analysis of the integration of Twitter with the existing education modality of

AHTVE.

Demonstration of the potential use of Twitter in bringing together allied health

professionals across a broad geographical area to discuss and share resources,

best practice and experiences around nominated session topics.

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Ethics

The NSW Children’s Healthcare Network Allied Health Educator in conjunction with

the Sydney Children’s Hospitals Network (SCHN) initiated this research. The project

received ethical approval by the SCHN Human Research Ethics Committee’s

Executive Committee with HREC reference LNRSSA/18/SCHN/272. SCHN

Research Governance approved a Site Specific Assessment (SSA) with SSA

reference number LNR/18/SCHN/306. The research component was approved by

James Cook University external HREC approval number H7501.

Participants

The target audience was the allied health professionals employed by NSW Health

facilities that work with children including child life therapists, dietitians, occupational

therapists, physiotherapists, social workers, and speech pathologists.

Participation in this research project was voluntary and if allied health professionals

chose not to participate in the research it did not impact on their ability to engage in

the AHTVE initiative. Content from Twitter that was analysed was in the public

domain and open for public access.

The allied health population participants were drawn from those who participate in

AHTVE. Each AHTVE session has an average of 20 – 35 different sites with a total

of approximately 20 – 80 registered participants. These participants varied from

session to session depending on clinical topic presented, professional background,

work commitments or access to appropriate information technology infrastructure.

Twitter discussions were evaluated from August 2018 to April 2019.

Recruitment for this research was opportunistic utilising the allied health

professionals currently accessing A2K initiatives. The use of Twitter as part of

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AHTVE was advertised and promoted on the A2K website, in the A2K newsletter and

via email with information regarding each of the education sessions. Interest in

taking part in this research snowballed as allied health professionals shared benefits

with their peers.

Materials/resources

Pre- and post-surveys utilised the SurveyMonkey platform to collect data concerning

basic demographics, history of twitter use, perceived advantages and disadvantages

and ways to facilitate its use for professional purposes. They were adapted from

surveys by Alsobayel (2016) and Barry and Pearson (2015) with the addition of some

further open-ended questions to further qualify how Twitter is used for professional

purposes. Open ended questions were those used to identify what professional

groups or individuals allied health professionals connected with and how they would

recommend allied health professional use Twitter for professional purposes (see

Appendix One: Twitter pre-survey).

The post-survey is based on the pre-survey used with the addition of questions

relating to Twitter use and AHTVE (see Appendix Two: Twitter post-survey).

Procedure

A mixed methods study design comprising pre- and post -surveys with analysis of

Twitter activity were used to explore the engagement of allied health professionals in

Twitter discussions regarding AHTVE. A scoping literature review exploring Twitter’s

use in supporting allied health education was used to inform the process of

introducing Twitter into AHTVE.

The research comprised three phases over a 12-month period from July 2018 to July

2019. This process is represented in Figure 1. During the research period the

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AHTVE sessions continued to be conducted regularly. They maintained their

previous format with the addition of Twitter to provide the opportunity for enhanced

professional discussion and sharing of resources. These sessions were advertised

via the A2K newsletter, website and email. Individualised hash tags distinguished

each session.

Figure 1: Diagrammatic Representation of Methodology

Statistical Analysis

In conjunction with basic descriptive data for all outcomes, results were compared

between pre- and post-surveys. Summary statistics are reported as frequency and

percentages. The items in Likert-type questions were coded numerically to support

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analysis. A total score or mean score for the Likert scale items has been presented.

Despite controversy, educators and researchers, when measuring less concrete

concepts, such as perceptions concerning social media utilise this analysis (Diug,

Kendal, & Ilic, 2016; Pisano et al., 2016; Sullivan & Artino, 2013).

Categorical data was analysed by the Fisher’s Exact Test due to small numbers in

subcategories. Thematic analysis was used to identify themes within the open-

ended questions. This analysis was completed using the six-phase guide described

by Braun and Clarke (2006).

Twitter Analytics was used to explore the uptake and use of Twitter across 10

different AHTVE Twitter sessions. The data reviewed included the number of

followers, impressions, engagement and engagement rates.

Privacy

Privacy considerations are a risk for all social media usage. The privacy

considerations that need to be considered for Twitter include that all posts are within

the public sphere and no personal information, or patient identifiers should ever be

posted. This was reinforced in all promotion regarding Twitter use, with participants

referred to the Social Media Policy within their own Local Health Districts. Education

regarding the use of Twitter provided specific training related to the privacy settings

that can be utilised. There were no foreseeable areas where participant safety may

be compromised.

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Results Results from data collection included a comparison between pre- and post-survey

results in relation to 1. Participants, 2. Twitter use, 3. Thematic analysis of

advantages, disadvantages, and 4. Ways of facilitating Twitter use. In addition,

Twitter Analytics were used to explore Twitter engagement in relation to AHTVE.

1. Participants

The Twitter pre-survey (N= 141) and the post-survey (N=130) were drawn from the

same sample of allied health professionals who work with children in NSW. Variation

between respondents in the two surveys is not accounted for and there was no

control to identify if the same participants completed the pre- and post-surveys. The

respondents in both surveys were located across a wide geographical area as

reflected by the Local Health Districts in which they are employed. This included the

eight Local Health Districts that cover the Sydney metropolitan region, and seven that

encompass rural and regional NSW.

Respondents represented a variety of allied health professional backgrounds that

work with children and their families in NSW. Respondents identifying as other

specified a range of professional backgrounds including medical, nursing, dental and

audiology. The highest qualification held by the majority of respondents was a

Bachelor Degree and the majority of respondents were between 31 – 50 years of age

and over 90% of all respondents identified as female. The demographics of the

respondents are illustrated in Table 1. No further statistical analyses of the groups

was performed due to the low number in some categories.

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Table 1: Demographic data for the pre-and post- surveys.

Characteristic Pre-survey

Number (%)

Post-survey

Number (%)

Mean

Local Health District

Rural and Regional 79 (56%) 79 (61%) 79.0

Metropolitan 60 (43%) 51 (39%) 55.5

Profession

Child life therapist 2 (1%) 1 (1%) 1.5

Dietitian 16 (11%) 17 (13%) 16.5

Occupational therapist 26 (18%) 30 (23%) 28.0

Pharmacist 0 (0%) 1 (1%) 0.5

Physiotherapist 27 (19%) 18 (14%) 22.5

Psychologist 9 (6%) 9 (7%) 9.0

Social worker 7 (5%) 11 (8%) 9.0

Speech pathologist 37 (26%) 32 (25%) 34.5

Other 17 (12%) 11 (8%) 14.0

Highest Qualification

Diploma 3 (2%) 1 (1%) 2.0

Bachelor Degree 97 (69%) 87 (67%) 92.0

Master Degree or higher 41 (29%) 42 (32%) 41.5

Age

21 - 30 19 (13%) 18 (14%) 18.5

31 - 40 38 (27%) 32 (25%) 35.0

41 - 50 48 (34%) 47 (36%) 47.5

51 - 60 25 (18%) 28 (22%) 26.5

61 or above 5 (4%) 3 (2%) 4.0

Prefer not to say 6 (4%) 2 (2%) 4.0

Gender

Female 131 (93%) 119 (92%) 125.0

Male 9 (6%) 10 (8%) 9.0

Other 0 (0%) 0 (0%) 0

Prefer not to say 1 (1%) 1 (1%) 1

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2. Use of Twitter

Overall an average of 20% (n=55) of respondents reported using Twitter. There were

no significant differences in professions between Twitter users and non-users in pre-

and post-surveys (p> 0.05). The number of respondents and corresponding Twitter

use by professional background is reflected in Table 2.

Table 2: Use of Twitter of Different Professions

Pre-Survey n (%) Post-Survey n (%)

Profession Respondents Twitter Users Respondents Twitter Users

Child life therapist

2 (1.4) 0 (0) 1 (0.8) 0 (0)

Dietitian 16 (11.4) 4 (13) 17 (13.3) 2 (8.3)

Occupational therapist

26 (18.4) 2 (6.5) 29 (22.7) 7 (29.2)

Pharmacist 0 (0) 0 (0) 1 (0.8) 1 (4.2)

Physiotherapist 27 (19.2) 7 (22.6) 18 (14) 3 (12.5)

Psychologist 9 (6.4) 3 (9.7) 9 (7) 2 (8.3)

Social worker 7 (5) 2 (6.5) 11 (8.6) 2 (8.3)

Speech pathologist

37 (26.2) 9 (29) 31 (24.22) 6 (25)

Other 17 (12) 4 (13) 11 (8.6) 1 (4.2)

TOTAL 141 31 130 24

Allied health professionals use of Twitter did not increase as a result of facilitating its

use as part of AHTVE. The total number of Twitter users in the pre-survey 22%

(n=31) compared to 18% (n=24) in the post-survey is not a significant difference (p<.

05).

The respondents utilising Twitter, categorised their usage on a continuum from

exclusively personal to exclusively professional use. Twitter use for professional

reasons (excluding those using it as exclusively or predominantly for personal use)

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was reported to be 15 – 16 % of respondents. Comparison of pre- and post-

surveys did not indicate any significant differences although the numbers were very

small. The reasons for Twitter use pre- and post-survey are illustrated in Table 3.

Table 3: Reasons for Twitter use

Reasons for Twitter Use

Pre-Survey n (%) Post-Survey n (%) P

Personal

Exclusively personal

9 (7) 3 (3) 0.33

Predominantly personal

3 (2.3) 5 (4.9) 0.45

Professional

Equal personal and professional

7 (5.4) 3 (3) 0.50

Predominantly professional

7 (5.4) 8 (7.8) 0.57

Exclusively professional

5 (3.9) 5 (4.9) 0.74

Further analysis of those allied health professionals utilising Twitter illustrated the

engagement varied with only 3 – 4% of Twitter users tweeting weekly and 8 – 10%

tweeting monthly. The analysis of AHTVE Twitter use further supported low numbers

of tweet activity as demonstrated by the small number of allied health professionals

who tweeted in relation to AHTVE (see Table 5). These Twitter users generally

viewed and explored the resources rather than tweeting. These results are illustrated

in Figure 1. One respondent summarised their view:

You don’t have to tweet yourself, you can just follow.

The frequency with which allied health professionals posted on Twitter did not

increase as a result of facilitating its use as part of AHTVE (p<.05). No significant

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difference was noted in the total number of Twitter users generating tweets in the

pre-survey 61% (n=19) compared to 71% (n=12) in the post-survey.

Figure 1: Frequency of Twitter use

Respondents utilising Twitter for professional purposes were able to identify multiple

reasons for using this modality although there were no significant differences

between the pre- and post-surveys. The most popular responses included the

following of professional organisations, keeping up to date with evidence based

practice, and knowledge exchange. Figure 2 displays these results. Respondents

also included a number of other motivations including:

To stay up to date with health news, events and happenings. To

connect with rural health advocates/organisations.

0

2

4

6

8

10

12

14

Never Less than oncea month

At least once amonth

At least once aweek

Num

ber

of

Responses

Frequency of Twitter Posts

Pre Survey Twitter Users Post SurveyTwitter Users

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Figure 2: Reasons for Twitter use

Respondents were asked to rate the effectiveness of using Twitter on their

professional development. Respondents were able to choose from a Likert scale

rating Twitter ‘s usefulness in improving a number of areas including: knowledge,

clinical, critical problem solving, creativity, clinical/professional, or patient care.

These results are illustrated in Figure 3.

0

2

4

6

8

10

12

14

16

Num

ber

of

respondents

Reasons for using Twitter

Pre Survey Twitter Users Post SurveyTwitter Users

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Figure 3: Impact of Twitter on Improvement in areas of Professional Development

The pre-survey identified a range of groups as major contact points including Speech

Pathology Australia, public health, rural networks and areas of clinical interest. The

most prevalent groups Twitter users connected with included general professional

organisations and colleagues (see Table 4).

Table 4: Groups Allied Health Professionals Connect with on Twitter

0

1

2

3

4

Mean L

ikert

Score

(1=

not

at

all,

4 =

exte

mely

help

ful)

Areas impacted by Twitter

Pre-survey Post-survey

Groups Number

Professional organisations and colleagues 11

Allied health, same profession 7

Clinical area 4

Universities or research 4

Public Health or Local Health Districts 2

Conference participation and speakers 2

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3. Advantages and disadvantages of Twitter use

An open-ended question was used to explore the advantages of Twitter for

professional purposes. These responses were thematically grouped with ten

common topics reflecting the advantages of engaging with Twitter around

professional education. These themes related to Twitter facilitating contact with other

professionals (networking, diverse audience, seeking support); facilitating knowledge

(keeping up to date, information sharing) and the type of communication (fast and

efficient, easily accessible). These themes were common across both surveys with

the only notable difference being that more respondents commented on networking

in the pre-survey and on the advantages of ongoing dialogue in the post-survey. The

themes and the times they appear are shown in Figure 4. The most cited reason for

Twitter use on both the pre- and post-survey was for the opportunity to network with

other professionals.

Figure 4: Advantages of using Twitter

0

5

10

15

20

25

30

Nu

mb

er

of

resp

on

den

ts

Advantages of Using Twitter

Pre Survey

Post Survey

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An open-ended question was used to explore the disadvantages of Twitter for

professional purposes. Inductive analysis allowed thematic grouping of responses

into 17 common topics reflecting the identified disadvantages of engaging with

Twitter around professional education and these are reflected in Figure 5. Of the

respondents to the pre- and post-survey, 40% (n=51) or 47% (n=48) respectively

identified no known disadvantages although continued unfamiliarity or reluctance to

engage with the modality was flagged as an ongoing challenge. The most cited

reasons in the pre-survey that were less of a concern in the post-survey included lack

of time and continued anxiety around quality of information. Issues around

confidentiality/privacy as well as that of access and support were concerns

expressed in both surveys.

Figure 5: Disadvantages of using Twitter

0

2

4

6

8

10

12

14

16

Nu

mb

er

of

resp

on

den

ts

Disadvantages of Twitter

Pre Survey Post Survey

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4. Strategies for facilitating Twitter

Insights from respondents providing recommendations for facilitating Twitter were

consistent in both pre- and post-survey. These included a. Strategies of continuing

need for education, b. Clear guidelines for Twitter use, and c. Need for support by

employing organisations. These comments are further explained below.

a. Strategies of continuing need for education

A number of respondents are still seeking further information and support around

utilising Twitter. This includes explanation and reassurance of how this information

would only reach the appropriate audience. A number of respondents are still

reporting that Twitter is an unfamiliar modality and they are seeking more education

and support to maximise any benefits. Part of the education could include further

developing the role of local champions to help clinicians learn and promotion during

professional meetings.

One respondent identified that the education provided to date was useful and

maybe this needs to be further developed.

Keep doing what you’re doing. I’m going to sign up for a professional twitter

account following your email and easy to use guide.

The following comments represent common responses to the question seeking

information on future education strategies to facilitate Twitter use.

Education on how to explore great and appropriate threads as well as

suggestions of professional organisation to follow.

Conduct an AHTVE session on Use of Social Media to Support Health

Professionals.

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Promotion at conferences – that is where one has time to be reflective

and is interested in the value of such tools.

b. Clear guidelines for Twitter use

Allied health professionals are still looking for general guidelines for using Twitter

within the professional workplace. They are looking for specific information regarding

assistance with the setup of filters and feeds as shown by the comment below:

Make the social media policies of the public health system clear to

alleviate fears of the potential negative professional consequences of

identifying as a public servant on social media.

c. Need for support by employing organisations

An obstacle for many health clinicians is the challenge of Twitter access in the

workplace due to information technology restrictions on this platform. Despite all

Local Health Districts having their own Twitter profile many health professionals are

restricted on accessing this modality on work devices such as computers or mobile

phones. These reflections are highlighted below:

If clinicians could access Twitter in the work time on work computers it

would certainly make it more attractive.

Hopefully this research may help convince executive that there are clear

professional benefits in using Twitter.

5. Twitter Analytics

A2K in its role as providing education and clinical support to Allied health professionals

working with children across NSW established a Twitter profile in June 2018. The

following information highlights the uptake and use of Twitter across 10 different AHTVE

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sessions utilising Twitter Analytics as illustrated in Table 5. The information presented in

the following section includes the number of followers, impressions and engagement.

Since the creation of the A2K Twitter profile, the number of followers has steadily

increased to 69 in July 2019. These followers are people or organisations that have

chosen to follow A2K tweets and will see these tweets in their Home Timeline

whenever they log in to Twitter. The followers included a mix of individual allied

health professionals as well as organisations.

Impressions were also collected over the period of the study. Impressions are the

number of times users saw a specific tweet on Twitter, they are not necessarily

followers. The impressions varied from 558 in March 2019 to 15 838 in September

2018. The outlying data for March 2019 is likely to be from the period in March when

due to direction from SCHN management Twitter was not to be used in the period

leading up to the NSW State Election.

Engagement statistics are the total number of times a user has interacted with a tweet.

This includes all clicks anywhere on the tweet, retweets, replies, likes and uniform

resource locator (URL) clicks. A retweet is a re-posting of someone else’s tweet, Twitter

likes are illustrated by a small heart and are used to show appreciation for a tweet. URL

clicks reflect the times Twitter users utilise the URLs included in the links to gather

information from the nominated website content. The variability of the engagement may

be due to a number of factors including the clinical areas of interest or resource content

posted at this time. These analytics are useful for gauging these very specific Twitter

metrics but does not supply insight into how allied health professionals use this

information.

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The original plan of thematically analysing the conversations was not completed, as overall

activity did not provide any active dialogue. Rather the activity included retweets, likes or

exploration of links and resources provided. Link or URL clicks and likes were the most

common interactions. This data reflects a slowly expanding audience that predominantly

engaged in Twitter more passively than originally anticipated.

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Table 5: A2K Twitter Analytics

Number of followers

Impressions Engagements Retweets Likes

URL clicks

August

2018

19 9529 64 2 21 21

September 2018

25 15838 46 4 14 12

October 2018

34 1636 48 1 13 7

November 2018

43 5503 47 2 10 8

December 2018

45 3908 49 0 18 10

January 2019

54 3509 76 7 15 0

February 2019

57 871 22 1 4 8

March 2019

*Blackout period

59 558 16 0 2 3

April 2019

69 2837 32 2 6 9

44189 400 19 103 78

The main findings from the results indicate that allied health professionals working with

children in NSW Health facilities have demonstrated a slow uptake of Twitter. Pre- and

post-survey results highlight some reluctance around engaging with Twitter due to

unfamiliarity and concerns regarding confidentiality. There were no significant differences

between pre- and post-survey results. Despite this, the A2K Twitter account opened in

conjunction with AHTVE demonstrated an increasing number of followers. Twitter activity

measured related to likes and exploration of links without active conversations.

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Discussion

Principle Findings

This study explored the benefits of Twitter in AHTVE by allied health professionals

in NSW for the purpose of professional development. Despite the reported uptake

of Twitter by general health professionals to facilitate professional networking,

knowledge sharing and evidence informed practice (Rolls et al., 2016) this was not

supported in this study. In both the pre- and post-survey the majority of allied

health professionals were still wary of using Twitter despite the opportunities

presented within A2K. This is consistent with a study of pharmacists’’ use of

Twitter for professional purposes.

The number of followers of the A2K handle steadily increased over the period of

the study although there was no significant reported increase in the use of Twitter

by respondents. Review of available literature did not identify a baseline for

tweeting activity among allied health professionals, reports however indicate that

22% of medical health professionals tweet regularly (Panahi et al., 2016). Despite

the engagement with the A2K handle, only 3 – 4% of respondents identified

tweeting weekly. The analysis of A2K Twitter activity demonstrated predominantly

likes and retweets as the major tweeting activity rather than any dialogue. There

were no reasons evident for this discrepancy except the population studied and

the integration with AHTVE.

This study reflected the Twitter behaviour of allied health population across

sixteen Local Health Districts of NSW. There were no significant differences found

in the age groups, professional backgrounds or qualification levels of allied health

professionals utilising Twitter. Among this sample the age groups most likely to

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use Twitter were those in the 41 – 50 year age group, this however, did not reach

statistical significance. This is in contrast to a study of pharmacists illustrating that

participants between 20 and 39 years of age were more likely to be users of social

media for professional purposes (Barry & Pearson, 2015).

The integration of Twitter and AHTVE was designed to promote online social

interactions with the aim of enhancing learning and promoting change through

these interactions. No previous analysis of Twitter conversations was identified in

the context of allied health literature. General study results, however, indicate that

the percentage of passive users in social networks is increasing (Abel, Hauff,

Houben, & Tao, 2012). Passive users are not inactive accounts, but rather users

that only consume information on social networks without generating any content.

This passive behaviour may have also been increased by the large number of

allied health professionals identifying that they were first time users, thereby

creating a steep learning curve on their part. It is possible that these newcomers

observed Twitter conversations (liking and retweeting) rather than participating in

active conversations.

Hash tags for individual AHTVE topics were promoted to facilitate discussion.

Unfortunately there were no questions posed by the participants either during or

after the sessions. There was also no feedback or posting through tweets during

AHTVE sessions. This is similar to the findings in previous studies into Twitter use

at professional conferences whereby the majority of postings were prior to or after

the presentations (McKendrick et al., 2012).

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Advantages and Disadvantages of Twitter Use

Allied health professionals identified a number of reasons for using Twitter for

professional education including the ability to follow professional organisations,

stay up to date with evidence based practice, knowledge exchange and

professional development. The advantages of using Twitter for professional

development were perceived by the participants as helpful in a number of domains

including, networking and information sharing. These findings are consistent with

other studies identifying the benefits of staying connected with other health

professionals, sharing knowledge and engaging in continued education

(Alsobayel, 2016; Hart et al., 2017; Panahi et al., 2016; Rolls et al., 2016). In this

study, the engagement of allied health professionals with searching profiles and

exploring links contained in tweets support that Twitter may be particularly useful

in sharing research updates and clinical resources.

Allied health professionals have concerns about the use of Twitter that need to be

addressed, including patient, personal and other health care professionals’

privacy. Such concerns are increasingly being recognised and discussed (Barry &

Pearson, 2015; Panahi et al., 2016). Guidance for the use of social media is

produced by each of the Local Health Districts although allied health professionals

are unaware of their existence or are still searching for more guidance. Allied

health professionals are still seeking recommendations on strategies for non-users

who are not confident in professional Twitter media use. This is consistent with

suggestions by a number of authors (D'Souza et al., 2017).

The technology acceptance model is a useful tool in examining human

behavioural responses to the adoption of new computer use (McGowan, Wasko,

Vartabedian, Miller, Freiherr, & Abdolrasulnia, 2012). This model, applied to the

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integration of Twitter with AHTVE identifies the importance of usability, trialability,

relative advantage and workplace fit. This model suggests that for allied health

professionals to be able to integrate Twitter and AHTVE they will require a positive

attitude towards Twitter. They need to be able to practice its use, the modality has

to work better than current solutions, and the technology needs to be accessible in

the workplace and compatible with current practice. Allied health professionals

describe their concerns regarding the use of Twitter and the identified technical

challenges with accessing Twitter within work environs. Shortcomings in these

areas were identified within the survey findings and therefore, the poor uptake of

Twitter as an active learning strategy is not surprising.

Limitations

There are a number of limitations to the current study. The first is that the allied

health professionals who participated in this study are those that work with

children and their families within NSW and therefore reflect a small proportion of

allied health professionals overall. This is a significant limitation in both the

characteristics of this population and the generalisability of the results.

The second major limitation was the length of the data collection. Changing health

professional behaviour is a complex undertaking, that can potentially be time

intensive dependent on a number of variables (Dombrowski, 2016; Ramani, 2019).

Changing health professionals’ behaviour when adopting a new behaviour or

clinical guideline can take up to three years (National Institute for Health and

Clinical Excellence, 2007). Therefore, expecting allied health professionals that

have a low uptake of Twitter (less than 31 allied health professionals in the pre-

survey) to embrace this modality in a short period of time may be unrealistic. The

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overall length of this research did not allow for change in behaviour when Twitter

was very new and daunting to many allied health professionals.

The magnitude of technical challenges created another major limitation. This

included the restriction within certain Local Health Districts to access Twitter on

work devices, which further impacted on its uptake.

Future research

Future research should include a broader clinical sample than those that work with

children. In addition to a wider population, research carried out over a longer time

frame may allow analysis of Twitter conversations and networking patterns.

Conclusion The goal of this research was to analyse the integration of Twitter with the existing

education modality AHTVE. Demonstration of the potential use of Twitter in

bringing together allied health professionals across a broad geographical area to

discuss and share resources, best practice and experiences around nominated

session topics was the aim.

The majority of allied health professionals in NSW participating in this study

remain unsure of the benefits of the integration of Twitter into AHTVE. In terms of

professional development benefits, Twitter was perceived as being most helpful

for improving knowledge and problem solving. These findings suggest that Twitter

has potential to engage health care professionals in their professional

development. Twitter has potential to be a useful tool at future AHTVE sessions,

but there are pitfalls that should be recognised including many technological

challenges.

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Despite this, the results obtained provide new data concerning social media usage

for professional development amongst allied health professionals in NSW who

work with children. Twitter is a free and easy to use modality for sharing

information and resources across distances that required minimal administrative

support. Allied health professionals are still seeking recommendations on

principles for using Twitter and strategies for non-users who are not confident in

professional Twitter media use. Further research directions may include

investigating Twitter interaction and the subsequent impact on learning and

behaviour change.

Moving forward there is opportunity to continue to facilitate the use of Twitter and

AHTVE and measure changes over a significantly longer period. Three years may

be appropriate to accurately measure behaviour change and evaluate the

usefulness of Twitter in supporting allied health education.

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Appendix One: Twitter Pre-Survey

Twitter and Allied Health Telehealth Virtual Education Pre-Survey

Introduction: This survey forms part of a research study of Twitter. The aim of the research is to explore how Twitter can be integrated into Allied Health Telehealth Virtual Education (AHTVE) to facilitate communication, sharing of resources and support. Your participation in completing this survey is greatly appreciated. Completion of this survey is voluntary and will not impact on your ability to participate in AHTVE. The completion of this survey implies consent for this information to be used within the research. All responses will be de-identified and used for purposes for this research project only. This is to meet requirements of Master of Health Professional Education. It is anticipated that it will take 5 – 10 minutes to complete. If you have any questions, please do not hesitate to contact the Allied Health Educators at [email protected].

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Participant Details 1. What is local health district do you work within?

Central Coast

Far West

Hunter New England

Illawarra-Shoalhaven

Mid North Coast

Murrumbidgee

Nepean Blue Mountains

Northern NSW

Northern Sydney

South Eastern Sydney

Southern NSW

South Western Sydney

Sydney

Sydney Children’s Hospital Network

Western NSW

Western Sydney

Other (please specify):

2. What is your profession?

Child Life Therapist

Dietitian

Occupational Therapist

Pharmacist

Physiotherapist

Psychologist

Social Worker

Speech Pathologist

Other (please specify):

3. What is your highest level of qualification?

Diploma

Bachelor Degree

Master Degree or higher

4. What is your age?

21 - 30

31 - 40

41 - 50

51 - 60

60 or above

Prefer not to say

5. What is your gender?

Female

Male

Other

Prefer not to say

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Twitter Use 6. How would you describe your use of Twitter?

I do not use Twitter

Exclusively personal

Predominantly personal

Equal personal and professional

Predominantly professional

Exclusively professional

7. How often do you post on Twitter?

Never, I don’t post on Twitter

Less than once a month

At least once a month

At least once a week

At least once a day

Several times a day

8. What are your reasons for using Twitter for professional purposes? (select ALL that apply)

I do not use Twitter

To connect with health colleagues from the same profession

To connect with other allied health professionals

To stay up to date with evidence based practice

To follow professional organisations

To follow healthcare conferences

Health promotion

Knowledge exchange

Employment/research opportunities

Professional development

All of the above

Other (please specify):

9. Rate the impact of using Twitter on your professional development and practice. Not at all

helpful Somewhat helpful

Very helpful Extremely helpful

Improving knowledge about the profession

Improving clinical reasoning skills

Improving critical thinking skills

Improving problems solving skills

Improving creativity Improving clinical/professional decision making

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Improving patient outcomes

10. If you use your Twitter account for professional purposes, list who you regularly connect with, for example professional organisation, colleagues. 11. Please identify any advantages of using Twitter for professional purposes. 12. Please identify any perceived disadvantages of using Twitter for professional purposes. 13. Do you have any suggestions for ways of encouraging allied health professionals to use Twitter for professional purposes?

Thank you for your time spent completing this survey

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Appendix Two: Twitter Post-Survey

Twitter and Allied Health Telehealth Virtual Education Post -Survey

Introduction: This survey forms part of a research study of Twitter. The aim of the research is to explore how Twitter can be integrated into Allied Health Telehealth Virtual Education (AHTVE) to facilitate communication, sharing of resources and support. Completion of this survey is voluntary and will not impact on your ability to participate in AHTVE. The completion of this survey implies consent for this information to be used within the research. All responses will be de-identified and used for purposes for this research project only. This is to meet requirements of Master of Health Professional Education. It is anticipated that it will take 5 – 10 minutes to complete. If you have any questions, please do not hesitate to contact the Allied Health Educators at [email protected].

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Participant Details 1. What is local health district do you work within?

Central Coast

Far West

Hunter New England

Illawarra-Shoalhaven

Mid North Coast

Murrumbidgee

Nepean Blue Mountains

Northern NSW

Northern Sydney

South Eastern Sydney

Southern NSW

South Western Sydney

Sydney

Sydney Children’s Hospital Network

Western NSW

Western Sydney

Other (please specify):

2. What is your profession?

Child Life Therapist

Dietitian

Occupational Therapist

Pharmacist

Physiotherapist

Psychologist

Social Worker

Speech Pathologist

Other (please specify):

3. What is your highest level of qualification?

Diploma

Bachelor Degree

Master Degree or higher

4. What is your age?

21 - 30

31 - 40

41 - 50

51 - 60

60 or above

Prefer not to say

5. What is your gender?

Female

Male

Other

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Prefer not to say

Twitter Use 6.How would you describe your use of Twitter?

I do not use Twitter

Exclusively personal

Predominantly personal

Equal personal and professional

Predominantly professional

Exclusively professional

7. What are your reasons for using Twitter for professional purposes? (select ALL that apply)

I do not use Twitter for professional purposes

To connect with health colleagues from the same profession

To connect with other allied health professionals

To stay up to date with evidence based practice

To follow professional organisations

To follow healthcare conferences

Health promotion

Knowledge exchange

Employment/research opportunities

Professional development

All of the above

Other (please specify):

8. How often do you post on Twitter?

Never, I don’t post on Twitter

Less than once a month

At least once a month

At least once a week

At least once a day

Several times a day

9. How often do you view or post Twitter conversations related to AHTVE?

Never, I haven’t followed any AHTVE conversations on Twitter

Less than once a month

At least once a month

At least once a week

At least once a day

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10. Rate the impact of integrating Twitter and AHTVE on your professional development and practice.

Not at all

helpful Somewhat helpful

Very helpful Extremely helpful

Improving knowledge about the profession

Improving clinical reasoning skills

Improving critical thinking skills

Improving problems solving skills

Improving creativity Improving clinical/professional decision making

Improving patient outcomes

11. Please identify any advantages of integrating Twitter and AHTVE. 12. Please identify any perceived disadvantages of integrating Twitter and AHTVE. 13. Do you have any suggestions for ways of encouraging allied health professionals to use Twitter for professional purposes?

Thank you for your time spent completing this survey.

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Appendix Three: AHTVE Sessions from July 2018 to April 2019

Likes Retweets Detailed

expands

Replies Profile clicks Link clicks Media

engagemen

ts

Hashtag

clicks

Telepractice: Delivering quality allied

health services to children in rural and

remote Australia

(33 site registrations)

12 1 13 2 1 5 3 3

Eating Disorders, Everyone has a Role -

Q&A Session

(15 site registrations)

4 2 0 0 0 11 0 0

Rehabilitation in paediatric palliative care

(17 site registrations)

5 2 2 1 1 1 1 0

Genetic Metabolic Diets

(16 site registrations)

5 0 0 0 0 2 1 0

Paediatric Oral Nutrition Initiative (PONi)

(19 site registrations)

4 0 0 0 0 0 0 1

Executive Functions Disorders

(33 registrations)

2 0 3 0 2 5 4 3

Neonatal Abstinence Syndrome

(29 registrations)

3 0 1 0 3 4 0 3

Supporting Children with Complex

Feeding Difficulties (SuCCEED) Study

(30 registrations)

5 3 4 0 5 3 0 3

NDIS Early Childhood Early Education

(ECEI) NSW Update

(47 registrations)

0 1 1 0 0 0 3 2

New Beginnings: Transition to the NDIS

for children and young people with a

newly acquired disability

(16 registrations)

0 0 0 0 0 3 0 4

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TOTALS 69 9 24 3 12 34 0 19