Online Outreach

Visit the PDF for the full document from ECDC from which the following information is taken.

Getting Started:

“Reaching out to communities in digital spaces is also known as online outreach or online fieldwork.

The purpose of online outreach is to provide an array of services in digital meeting places where men who have sex with men (MSM) commonly spend time.

• Health messages are primarily delivered to individuals (via personal profiles on websites or dating applications) and sometimes to groups of people (for instance via chatrooms or bulletin boards websites)
• Online outreach may include education, risk-reduction counselling and provider-based referrals to reliable information sources and other resources including testing and treatment locations.

Outreach work in digital communities can be effective in:

• Reaching MSM typically considered at risk, invisible or hard to reach
• Identifying previously unidentified communities
• Providing contextually-relevant information to ‘gated’ communities based on their sexual practices, identities and HIV status.

For projects with limited resources (budget, time and/or trained staff), advertising may be more cost effective than online outreach provided by paid staff members.

Differences between online outreach and advertising on dating platforms

	Online outreach	Advertising
Provider	Staff member	Automated algorithm
Target	Individual profilee	Group of users
Interaction	Personal, tailored, agile, real-time	Mass-medial, targeted, determined in advance, asynchronous
Scale and reach	Small scale, depending on staff time	Large scale, depending on budget
Required resources	Staff, time, training	Promotion budget, visual and/or animated materials, mobile-optimised online content
Expenses determined by	Time and cost of staff memebers	Total number of clicks or impressions

Active versus passive outreach

Approach	Active	Passive
Description	Increasing awareness and use of services Sharing information with target populations Partner notification	Offering online counselling, tailored and/or in-depth information Stimulating communication about sexual health
Use	Provision-centred	Needs-centred
Activities	Sending health-related messages to individual profiles Posting messages in discussions or chatroom sessions withmultiple users Sending invitations to multiple users on bulletin boards, forums or chatrooms to join one-on-one conversations	Answering direct messages of individual users/profiles Answering questions in discussion threads on bulletin boards/forums Sharing information or dispelling myths in publically visible profile texts
Advantages	Large output in a short amount of time Greater visibility Targeting populations with filters Incidental or irregular activity is possible	Clients’ needs central Greater acceptability among users Less likely to be blocked or reported Multi-tasking is possible In-depth
Disadvantages	First message needs to be concise and effective Less focused on needs of clients Can be considered ‘spam’ by users Terms of services (conditions of use) may not allow active outreach May compete or interfere with automated broadcast messages May cause lasting effects to provider’s reputation	Time and labour intensive Fast and adequate answers required Unpredictable and variable output Regular presence is needed Demands comprehensive knowledge and skills Difficult to reach users with low awareness or engagement Sensitive to abuse of service and privacy concerns

Meeting the needs of your target population

Health promotion should always meet the needs of your target populations. Based on international literature, the following objectives match the needs of MSM related to HIV, sexual health and online prevention. Depending on your country’s context, issues of homophobia, stigma and discrimination may require equal attention in your outreach work. ILGA’s Rainbow Europe resources and the European Commission’s Eurobarometer on Discrimination provide up-to-date information on discrimination and human rights in your region.

• Potential objectives of online HIV prevention and sexual health promotion
• Increase awareness and perceptions of risks relating to HIV and STIs
• Increase basic knowledge and dispel myths about HIV and STIs (transmission, symptoms)
• Increase knowledge of local or online services for HIV and STI testing and prevention
• Increase knowledge of safe and pleasurable sex
• Recruit MSM for online or offline HIV prevention interventions
• Improve knowledge about consistent and correct condom use
• Increase communication about protective behaviours and HIV and STI testing
• Increase awareness and knowledge of new biomedical prevention strategies, including pre- and post exposure prophylaxis (PEP/PrEP)
• Increase awareness and knowledge of HIV viral load and risk reduction strategies
• Promote harm reduction in relation to sex-related alcohol and drug use
• Promote information-seeking behaviour
• Support meaningful and fulfilling sexual and intimate relationships
• Stimulate open communication about sexuality
• Decrease HIV-related stigma and support respectful communication about HIV
• Support partner notification

Guiding principles for online outreach:

Client-centred approach

A client-centred approach means providing an environment of empathy and openness, free of judgement. Negative experiences and long waiting times are the primary reasons why MSM who have experience with online prevention work would not use them again. Confidentiality concerns stop some MSM from accessing online prevention. It is necessary to always uphold a client-centred approach that is sensitive to your clients’ needs, expectations and interests including their right to privacy.

Positive approach to sex and relationships

Gay culture is often considered as highly sexualised, but when European MSM are asked individually what they consider to be the best sex life, most of them formulate this in terms of desire for relationships and intimate connections [12]. A positive approach to sex and relationships is necessary to create engaging and holistic HIV prevention work.

Greater involvement and meaningful engagement of people living with HIV

Meaningful engagement and greater involvement of people living with HIV are important principles for any prevention activity. This included involving HIV-positive MSM in activities that aim to prevent new HIV infections as well as activities involving STI prevention, including Hepatitis C.

Participatory quality development

Participatory quality development strives for continuous improvement of health promotion projects. It is characterised by the optimal participation of stakeholders (target populations, service providers, funding bodies and other important parties). The needs and insights in the local situation of your ‘front line’ outreach workers and target populations are key to the success of the activity. As part of the Quality Action project, a handbook on participatory quality development has been developed in 5 languages.

Protecting privacy and confidentiality

Online outreach work provides a level of anonymity not found in many other types of interventions. However, concerns of confidentiality and privacy are common among MSM. During the design and implementation of online outreach work, two aspects require your attention: security and confidentiality.

Secure software

Always discuss software and security issues with your IT department or IT support prior to starting online fieldwork. Some sexual networking platforms may confront you with malware or malevolent software hidden inside advertising banners. Avoid security issues by:

• Installing recommended updates to your operating system, applications and web browsers
• By installing security software on computers, laptops and mobile devices
• Working on private, password-protected Wi-Fi networks. Third parties can easily scan unprotected or public Wi-Fi traffic and steal sensitive data.

Privacy and confidentiality

Organisations that conduct online outreach should have policies in place that explicitly cover online interactions and registration of information that could be used to identify clients. Ensure that:

• All staff members (outreach, IT, support staff and volunteers) have signed confidentiality agreements
• Access to sensitive data remains limited. Avoid registering names, e-mail addresses, phone numbers, IP addresses, geo-location data, profile names and other information that can be used toidentify individuals.

Collaborating with dating platforms

Endorsement from sexual networking platforms helps to build trust in your online outreach activities. Unfortunately, only a few platforms openly support and facilitate online outreach activities on their platforms. Contact the platform you wish to do outreach on in advance to discuss your objectives and how they can be achieved.

Targeting

Targeting specific populations with your intervention means you can better tailor your activity to their needs and change your message accordingly. Targeting your outreach work can be done in two distinct ways:

• Choosing specific platforms
• Using filters within platforms to reach specific groups of users.

By choosing the right platform and by filtering users, you can improve the effectiveness and reach of your work and prevent negative feedback from users for whom your message is less relevant.

Which apps and websites are most popular among subgroups of MSM differs per country and often per region. In most countries popular platforms exist that are only available in their country or native language.Moreover, there are apps and websites that specialise in specific subcultures or sexual practices.

In order to choose the best platforms in your region, you should first assess two things:

1. Find out which platforms are most popular in your region. Contact the platform and ask how many users they have in your region or conduct a local community assessment to find out which platforms are most popular.
2. Assess the possibilities and limitations of the platform.

Using filters to reach specific groups

Many platforms provide possibilities to selectively show users based on physical, demographic or sexual characteristics. These filters are especially useful for active outreach work, because it allows you to send tailored messages to different subgroups.

Filters also allow you to reach more users in applications that limit the number of users visible in the grid. Use filters to send messages to narrow subsets of users, change the filter to another subset, send messages etc., thereby expanding your reach significantly in a short amount of time.

Creating content

In terms of online outreach, MSM voice concerns over privacy, confidentiality and trustworthiness of online service provision. Because some dating platforms do not officially allow health promotion, it is important not to be careful not to violate their terms and conditions of use.

The most important contents you need to consider in advance are:

• Information on your website
• Profile description
• Message (when conducting active outreach).

Profile description

It is crucial for your profile to be as authentic and professional as possible. Your profile description should include enough information for users to easily identify your organisation. You may choose to develop a mascot or persona to improve your visibility and recognisability, or connect your online presence to a campaign.

Adding a picture to your profile will attract more attention and personalise your service:

• You may choose to use images of your organisation, project staff, events or campaign pictures, or stock images bought via stock image websites
• Consider using stock photograph instead of a profile picture if all outreach workers are female, or if male workers want to remain anonymous
• Make sure your organisation owns the copyrights of each image you use to avoid legal issues

However, too much information about your offers or services could violate the terms and conditions of the platform. Always review the terms and conditions of each platform prior to drafting your profile name and description.

Recommendations for profiles

Do: Create a unique and recognisable username Use the name of the organisation Include basic information and a profile picture Include contact information for the organisation (work-related email address or a phone number) Include social media connections (work-related Facebook, Twitter or Instagram

Don’t: Use personal information Link to personal social media accounts Use personal phone numbers List sexual preferences or sexual statistics about the outreach worker Explicity mention services or offers Link to paid websites or services

Message

Users may consider personal messages actively sent out by healthcare workers to be intrusive. Make sure your message is as inviting and acceptable as possible, be careful with the tone of voice used, and ensure all essential information is given up front. Your objectives should be transparent and it should be easy for the user to find more information or share their questions and comments.

Pre-testing and improving your message

To make sure your message is of the best quality, always pre-test your message with your target population.

In order to pre-test your message you should:

• Invite MSM who already use your services to give feedback on your message
• Develop two or three versions of a message and let users chose their favourite
• Improve your message based on their feedback and share your learnings

It is often necessary to change your message regularly to catch the attention of your audience. Before changing your message, always evaluate your previous message and improve your message according to learnings from past interventions.

Resources required for online outreach

Online interventions are at the crossroads of classic prevention work and online education and counselling.

They require time and perseverance:

• Individual conversations between users and professionals often entail complex questions, requiring more than only medical knowledge of HIV and STIs
• Training is necessary to ensure staff members have adequate knowledge and skill to perform highquality outreach work
• Beneficial personality traits include empathy, respect, authenticity, concreteness,directness, commitment, discipline, identification and open-mindedness.

Budgeting and costs

Calculating staff time

No standard calculations for the time it takes to do online outreach can be given. Passive outreach work generally takes more time than active outreach work, but this largely depends on frequency and duration, scale and reach, and the worker’s scope for multi-tasking.

Regarding staff time, make sure that staff members with a medical, IT and communication background are available to provide technical support and feedback. If your financial resources are insufficient, consider working with volunteers to expand your reach.

Membership costs

Memberships and subscriptions are not always necessary for your online outreach. Many platforms offer many options for free. Others limit the number of users they show and the filtering options they provide to non-paying users. Due to the relatively low costs of monthly subscriptions, their benefits may outweigh their costs.

Professional knowledge and skills

Users can disclose many questions and complex issues in a short period of time. Next to a knowledge base in HIV and STI transmission and prevention work care, providers should possess the following professional skills to do online outreach work:

• Written communication
• Knowledge management and self-reflection
• Referral knowledge: when and where to refer users to other support services

Written communication

Text-based communication lacks non-verbal communication such as body language and intonation. This means you should write textual responses consciously and carefully and check if your responses match the user’s needs.

For practical suggestions on managing conversations during online outreach we refer to the chapters on ‘Troubleshooting—Tips and tricks’ in The Cruising Counts Guide and ‘Prolonging and ending conversations’ in the manual ‘We are the Sexperts!’.

Knowledge management and self-reflection

To tackle questions effectively you require in-depth knowledge of topics ranging from basic HIV and STI transmission; available services; specific sexual practices and risks; and broader sexual health-related themes. It is important that outreach workers have the ability to listen, reflect and learn.

Outreach workers themselves can also use online resources to find answers to uncommon questions. This information should always be translated to the individual’s needs and capacities. Additional training may be necessary to ensure that prevention workers have sufficient knowledge and skills to provide the right information and support.

Referral knowledge

The following online resources should be available at hand for online outreach workers:

• HIV and STI information including viral hepatitis
• Testing and treatment locations
• Safe sex and sexual risk reduction information
• Sexual health information and resources
• Mental health and substance abuse resources and counselling services
• Domestic and sexual violence information and resources
• Information and resources specifically for youth
• Information and resources specifically for transgender people.

Cultural communication

Outreach workers need to have sufficient understanding of vernaculars and cultural values to communicate effectively. Online communication between MSM is saturated with euphemisms, abbreviations and acronyms. The perceived anonymity of dating platforms allows MSM to interact in more open and sexually direct ways and express specific interests and fantasies. Prevention workers need to remain cautious when drawing inferences solely based on profile descriptions such as sexual identity and risky behaviour. The importance of sexual fantasy and gratification in online communication between MSM should not be underestimated.

Spending time on digital platforms will help you to learn about the target population and convey messages in your own words.

Summary

Before starting your campaign, you should have done the following:

• Understood the opportunities and limitations of online outreach
• Selected the platform(s) that is/are most appropriate for your work
• Understood the needs of your target audience and adopted a plan for targeting them
• Created a realistic trustworthy profile for your outreach interventions
• Implemented a plan for each intervention and a strategy to avoid risks
• Understood all the associated costs and developed a plan for any necessary funding
• Outlined your key performance indicators and set clear goals and targets

Once you’ve completed these tasks you’re ready to start your first campaign. The success of any campaign will always rely on a certain degree of trial and error so remember to follow your campaign through every stage and be prepared to optimise and make changes as you go.”

There are also ECDC documents on the use of:

Smartphone applications

Google AdWords

These will help provide information about their use in working with MSM. In addition there is an ECD Technical Document: Utilising social media to support HIV/STI prevention: evidence to inform a handbook for public health programme managers that may provide useful evidence for starting to use these platforms to engage with MSM.

Next module: Building Tailored Training for specialised services