The feasibility of an online discussion group as a component of targeted youth work in Finland

Contents lists available at ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth The feasibility of an online discussion group as a component of targeted youth work in Finland Antti Kivijärvi a,⁎ , Sanna Aaltonen b , Vesa Välimäki c a University of Helsinki, Faculty of Social Sciences, 00014 Helsinki, Finland b University of Eastern Finland, Department of Social Sciences, 70211 Kuopio, Finland c Tampere University, Faculty of Social Sciences, 33014 Tampere, Finland ARTICLE INFO Keywords: Targeted youth work Online group Feasibility study Mixed methods ABSTRACT The aim of this paper is to investigate the potential of online group activities alongside one-to-one offline counselling in youth work targeted toward young adults not in employment or education. The study examines the feasibility of moderated anonymous online group (MAOG) discussions from a comprehensive standpoint, with reference to the perspectives of end-users, service providers and further research. The paper is based on a two-arm, quasi-experimental and mixed methods study. To this end, the data consists of group interviews with young adults and youth workers arranged at the beginning of the study, baseline and follow-up interviews, online discussion threads, as well as evaluations of the online group activities. The piloted intervention was most acceptable to young adults who suffered from loneliness and had difficulties in joining face-to-face groups. Most youth work professionals considered the pilot viable. Finally, several modifications are suggested prior to implementing an experimental setting to study the effectiveness of the intervention. 1. Introduction The understanding of online sociability has expanded in academic discourse. Instead of seeing digital space as either a source of pleasure or peril, most scholars now study online platforms as an aspect of everyday life (e.g. Hendry, Robards, & Stanford, 2017). It has long been acknowledged that most young people use the internet as an extension of offline sociability, not as a replacement (e.g. Calhoun, 1998; see also Pendry & Salvatore, 2015), and digital spaces are consequently recognized as an essential part of their lives and wellbeing (e.g. Best, Manktelow, & Taylor, 2014). The potential of technology-based interventions to bring about positive effects for young people is currently being studied across the youth, health and social work sector. While face-to-face encounters are considered of paramount importance in most services, engaging with young people by using online platforms is seen as a way to promote ease of access and a wide reach, either as an independent element, alongside face-to-face services or as a gateway service (e.g. Collin et al., 2011;Rickwood, Webb, Kennedy, & Telford, 2016;Webb, Burns, & Collin, 2008). Digital technology allows young people and professionals to approach each other for various reasons, be they information sharing, the promotion of wellbeing, or offering opportunities for peer support. There is evidence for the positive wellbeing effects of professional online support for young people, particularly in the context of mental health and positive psychology (e.g. Baños et al., 2017;Burns, 2011; Law, Kwok, Chan, Chan, & Yip, 2019;Manicavasagar et al., 2014; Mitchell, Stanimirovic, Klein, & Vella-Brodrick, 2009). However, the evidence for the wellbeing effects of online sociability for young people has been scant or ambivalent. In some studies, there are indications of online communication fostering self-esteem, strengthening social connections and providing opportunities for self-disclosure and identity experimentation (e.g. Best et al., 2014). In the context of youth work – a profession aimed at supporting the participation and non-formal learning of young people – fostering peer sociability has been essential (e.g. Batsleer, 2008;Fitzsimons, Hope, Cooper, & Russel, 2012). These types of broad and community-based goals are difficult to transform into clear-cut outcome measurements, however (e.g. Ord et al., 2018). Consequently, there is little evidence on the effectiveness of youth work methods that would correspond with the rationale of current European public management (see e.g. Davies, 2019). This also applies to work in online contexts, although in Finland, for instance, digital orientations have been an established part of youth work for several years, or even decades (Kiviniemi & Tuominen, 2017). The starting point for this paper stems from the above discussion on the potential benefits of youth work. In empirical terms, we present an https://doi.org/10.1016/j.childyouth.2019.104411 Received 1 March 2019; Received in revised form 3 July 2019; Accepted 3 July 2019 ⁎ Corresponding author. E-mail addresses: [email protected] (A. Kivijärvi), [email protected] (S. Aaltonen), [email protected] (V. Välimäki). Children and Youth Services Review 105 (2019) 104411 Available online 04 July 2019 0190-7409/ © 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/). T online intervention piloted in the context of targeted youth work and among young adults not in employment or education in Finland. 1 The aim of the intervention – moderated anonymous online groups (MAOG) – was to promote the wellbeing of participants by providing a lowthreshold and secure space to discuss matters of importance to them, to be positively recognized, and to alleviate feelings of loneliness. The rationale behind MAOG lies in the fact that the wellbeing of many clients of targeted youth work is hampered by loneliness, a history of being excluded, and anxiety toward offline group activities (for details, see Kivijärvi et al., 2019;Gretschel & Myllyniemi, 2017). Despite this, the service provision of targeted youth work in Finland includes mostly one-to-one offline counselling in the context of education and employment (for details, see Aaltonen & Kivijärvi, 2018). In this two-arm quasi-experimental study we explore the feasibility of MAOG from three angles. First, the primary focus is on the end-users – young adults – and the acceptability of the intervention. Second, we scrutinize the viability of the intervention from the perspective of the service provider. Third, we explore the possibility of studying the effectiveness of piloted activities with experimental methods. To achieve these aims, we adopt a mixed methods approach and base our analysis on both quantitative and qualitative data produced in the context of targeted youth work in three Finnish cities during 2017–2018. 1.1. Feasibility: acceptability, viability and implementation Evaluating an intervention is often approached from a positivist stance of examining the effectiveness and fulfilling the criteria for a randomized controlled trial (RCT). In this paper we employ the notion of feasibility and acknowledge the need to study interventions from a multitude of perspectives and with different sets of data, while relinquishing the positivist stance of revealing the effectiveness. Studying feasibility is prolific and often necessary when piloting new practices outside laboratory conditions (e.g. Eldridge et al., 2016). Moreover, prior to applying MAOG and in contrast with controlled experimental settings, we did not have a definite theory, operationalized dependent variable and precise hypothesis to be tested (see e.g. Thye, 2007; Webster & Sell, 2007). Our aim was more broadly and tentatively to promote the wellbeing of the participants. In this paper, feasibility is examined from a more comprehensive perspective, which tends to be the case in most studies adopting the concept. We treat feasibility as a threefold notion including the subcategories of acceptability, viability and implementation. Acceptability refers to the end-users, in this case to the young adults participating in online discussion groups, and how useful it is for them to do so. In line with Sekhon, Cartwright, and Francis (2017), we consider that the notion of acceptability should be studied from both objective and subjective perspectives and throughout the trajectory of the intervention (see also Knowles, Stelzer, Jovel, & O'Connor, 2017). This means using behavioral indicators such as withdrawal and adherence rates. Moreover, the different ways of using the intervention can be analyzed with qualitative methods (Patton, 2014, 48). As for the subjective data, self-reported quantitative and qualitative datasets gathered before and after the intervention can be utilized (e.g. Dam, van Bostel, Rozendaal, Verhey, & de Vugt, 2017). In contrast to experimental settings, studying acceptability does not exclude the effect of all unknown factors by random allocation of informants, but rather takes them as an object of investigation. Consequently, it is essential to answer questions of ‘why’, instead of merely enquiring whether the intervention works or not (Patton, 2014). Mixed datasets make it possible to explore any shortcomings that the intervention may have, as well as the type of contexts and the kind of participants that yield the best outcomes. Together with acceptability, it is important to investigate the viability of the intervention. The notion of viability refers to the perspective of the professional practitioners who are responsible for executing the intervention. In order to be put into everyday professional practice, the intervention needs to be perceived as beneficial to the end-users, highlighting the importance of acceptability. Further, the intervention should not be too burdensome for the practitioners, and should be compatible with their professional orientations (Sekhon et al., 2017; Thornley & Marsh, 2010). The aspect of viability has been covered in a number of feasibility studies (e.g. Ellis, Cliff, Howard, & Okely, 2018;Harrison, Al-Khairulla, & Kikoler, 2016). However, it often refers to frequencies in relation to the extent that certain interventions have been executed. This is obviously one indicator of viability but certainly not the only one and the relevant indicators most likely change according to the contexts. As with acceptability, viability can be explored with objective and subjective datasets covering the whole timeframe from planning the intervention to evaluating it (Sekhon et al., 2017). The third and final aspect of feasibility – implementation – is integral to the tradition of feasibility studies, particularly in cases in which the intervention seems to be accepted and viable knowledge needs to be produced on how to conduct a more robust study in terms of causality and effectiveness. In the debates on feasibility studies, fairly established criteria need to be assessed before implementing experimental methods in later phases. These include details of the randomization process, the resources required, and scientific criteria such as the validity and reliability of the research setting and suitability of the outcome measures (e.g. Dam et al., 2017;Ellis et al., 2018;NIHR, 2015;Tickle-Degnen, 2013). 2. Data and methods The present study is part of a consortium project entitled ‘Inclusive Promotion of Health and Wellbeing – PROMEQ (2016–2019)’, funded by the Strategic Research Council (SRC) of the Academy of Finland (303615/303650), aimed at studying and promoting the wellbeing of underprivileged groups in Finland. 2 The overall aim of the consortium was to include end-users in the planning and design of interventions in line with the principles of social marketing (e.g. Thornley & Marsh, 2010; for further details, see Aaltonen & Kivijärvi, 2018). Within the subproject focusing on young adults not in education or employment, we collaborated with targeted youth services such as outreach youth work, one-stop guidance centers, and youth workshops in the cities of Jyväskylä (Central Finland), Kouvola (Southeast Finland) and Vantaa (Southern Finland, metropolitan area). All of these services are targeted toward young adults aged 16–30, who have encountered problems in terms of transitions. 3 2.1. Data The data for the study is threefold and consists of empirical work 1 In Finland, unlike in many other European countries, organizing youth work is the responsibility of municipalities and provided by professional youth workers. Currently, and according to the Youth Act (1285/2016), outreach youth workers are expected to contact and offer their services to all young people not engaged in educational institutes and the labor market. 2 The project was approved by the ethical research committee of the the University of Eastern Finland. 3 Outreach youth work is provided in most Finnish municipalities, offering primarily one-to-one and often long-term guidance for young adults who have dropped out of educational institutes or who have been of concern among authorities. One-stop guidance centers are currently located in approximately 60 municipalities. Their primary task is to provide information and short-term counselling for young adults who seek help in issues such as education, employment, housing, and wellbeing. Youth workshops are held in most Finnish municipalities and include both rehabilitative activities and more focused professional training. A. Kivijärvi, et al. Children and Youth Services Review 105 (2019) 104411 2 conducted during 2016–2018 (Table 1). The fieldwork began by arranging five group discussions with youth workers (n = 5 + 10 + 4 + 4 + 7 = 30) and two workshops with their young clients (n = 9 + 7 = 16) to qualitatively examine the important aspects and needs in relation to the young adults' wellbeing, the opportunities afforded by digital methods, and the ways in which the young adults and the youth workers would build the online intervention. These discussions constitute the first dataset. The second dataset is based on a two-arm and quasi-experimental setting. Baseline (n = 147) and follow-up (n = 107) surveys were conducted before the intervention and approximately two months after it, with a six-month interval between administering the two surveys. 4 The questionnaires included mainly validated measures on living conditions, quality of life, social relations, trust, capabilities, service use and living habits. For the baseline survey, young adults were recruited through service desks and with the assistance of youth workers. Despite the wide age range catered for by the services, over half of the survey respondents were between 21 and 25, while one fourth were 16–20 and another fourth 26–30. Distribution according to gender was equal, insomuch as 50% were female, 45% male, and the rest chose either the option ‘other’ or ‘would rather not say’. All baseline interviews were conducted in the presence of a researcher with the aim of testing the validity of the questionnaire, improving the reliability of the answers, and discussing issues of importance to the research participants. For the follow-up survey, respondents were sent a link to a digital questionnaire via smart phone or email. After the baseline survey, four similar intervention groups with 8–14 participants were arranged. During the baseline interview, the majority of the participants (n = 91, 61.9%) were interested in joining the online groups. A few of these were very keen on joining, while some volunteered probably out of a sense of obligation. Those who showed the most interest toward MAOG (n = 5) were invited to join outside the procedure of randomization. Despite the relatively high initial interest, there were some difficulties in getting people signed in to the online platform after the randomization. As a result, re-randomization was required for two intervention groups to gain extra participants to join the discussions. After randomization, re-randomization and the selection of certain participants, a total of 41 young adults were included in the four intervention groups, while the rest (n = 106) constituted the control arm. The total allocation of participants during the project cycle is illustrated in Fig. 1. In the end, 26 online group participants (63%) returned the feedback survey immediately after the MAOG. A feedback questionnaire with open-ended questions was also sent to the eight moderators, resulting in six responses. The third dataset consists of the aforementioned feedback received and the actual discussions during the intervention. MAOG took place via a platform called heimo.co. 5 Four nine-week groups with discussants and moderators were organized by the researchers. In addition to inviting the participants to join the groups, the intervention was researcher-driven in terms of content as well, even though the ideas that the youth workers and young adults presented during the previous stages of the research process were taken into account while planning the intervention. While the young adults adopted a nickname, the moderators used their first names and were therefore potentially recognizable to some of the participants. The first two groups were moderated by two professional youth workers each, and the latter two groups had either one or two peer moderators in addition to two professionals. The peer moderators were young adults recruited from the first two groups. Each week, the moderators introduced a discussion theme in a new thread while all the previous threads remained open for discussion (see Table 2). Three researchers working on the project were also present in the groups observing and supporting 6 the discussions. 2.2. Measures and methods The combination of various datasets allowed us to apply both quantitative and qualitative methods in our analysis. Quantitatively, in addition to attrition and adherence rates and the intensity of participation (the number of posts and their combined word count per discussant) in the intervention arm, the key measures in this study are quality of life (QoL) and frequency of loneliness. We apply the WHO definition of QoL as a subjective judgement of one's living conditions and see it as a multidimensional concept, including satisfaction toward physical functioning, mental health, social life and living environments (WHOQOL Group 1994). The WHOQOLBREF instrument was used in the study, comprising all four dimensions of QoL. Each domain contained several five-point items, amounting to 24 altogether, which were transformed into a 0–100 scale, in which high scores indicated a better QoL and low scores a less favorable one. 7 For the purposes of this paper, all four domains were analyzed together, comprising a total level of QoL. When it came to the frequency of loneliness, the participants responded on a five-point scale ranging from never to constantly. The notion of loneliness refers to dissatisfaction with one's social relations and thus differs from being socially isolated or enjoying solitude. Both of these quite well-established indicators, QoL and loneliness, were used as outcome variables. Further, the feedback survey for the young adults included measures on ways of using the MAOG, preferred discussion themes, ideas on how to improve the intervention, satisfaction with the technical functioning of the platform, overall estimation of the intervention, and the measure on the frequency of loneliness. Quantitative analyses were conducted using descriptive indicators such as frequencies and variances. To test the significance of the differences between groups of respondents and between the baseline and follow-up surveys, x 2 and paired samples t-tests were used. Table 1 Datasets for the study. 1st dataset 2nd dataset 3rd dataset Time 2016 2017–2018 2017 Format Group interviews and workshops Baseline and follow-up surveys Online discussions and feedback surveys Informants Youth workers (n = 30) and young adults (n = 16) Young adults (n ≤ 147) Young adults (n = 41) and youth workers (n = 6) Analysis Qualitative Quantitative Qualitative & quantitative 4 The attrition rate was quite modest (27.2%), probably due to the inducement provided by vouchers (€10) and several reminders. The rate was highest among men, and those in the control group and in a relationship. 5 Heimo.co (heimo translates as tribe in English) is a free online platform developed by Finnish youth workers to enhance supportive discussions for young adults on any issue that is deemed important. Since heimo.co can be used with a web browser, it is also accessible for those with no smart phones or permanent (footnote continued) subscriptions. 6 The researchers (the first two authors of this article and M.Soc.Sc Martta Myllylä) ‘liked’ some of the posts written by the participants and occasionally commented on them briefly and in a positive tone. 7 For more detailed information on individual domains and a description of the transformation of the scores, see the instructions by WHO (1996). A. Kivijärvi, et al. Children and Youth Services Review 105 (2019) 104411 3 Qualitatively, the analyses of different datasets were informed by the threefold notion of feasibility and by each other. Consequently, the exact foci of the analyses were defined along the trajectory of our empirical work and the intervention. Prior to the MAOG in late 2016 and early 2017, we analyzed how professionals and young adults commented on the idea of online group discussions as a component of targeted youth work. During the intervention, the ways in which discussants participated, as well as the content and the tone of their posts in the online discussions were scrutinized. We focused on the differences between online groups and sought ways to explain the variation in the discussion activity of the young adults. After the intervention, open-ended questions on its applicability and suggestions for how it could be improved were included in the feedback questionnaires distributed to the young adults and the moderators. The feedback from the young adults provided retrospective information on the acceptability of the MAOG, while the feedback from the moderators provided experience-based data on viability. 3. Results 3.1. Acceptability The tentative idea of the MAOG was discussed with the young adults during two workshops. The most frequently mentioned need for help was related to peer sociability, 8 which could be interpreted as one indicator supporting the idea of the intervention, but the need for moderation, safety, a positive atmosphere and anonymity were also emphasized. During the baseline survey, a more detailed plan and an invitation to the online activities were presented to each respondent. As mentioned in section 2.1, relatively keen initial interest (n = 91) decreased during the period between the baseline survey and the start of the intervention (n = 41). According to the baseline survey, when compared to the control group (n = 106), those who eventually joined the groups (n = 41) suffered from relatively low QoL (p = .023), were more likely to be single (p = .044) and more active in social media (p = .021). In addition to the variation between the intervention and control arms, variation was also apparent within those who enrolled in the online groups. An important variable explaining the variation was the intensity of participation, which varied between zero and 20 posts (mean = 7.10, S.E = 5.8) during the discussions. The MAOG was probably most acceptable for 22 active discussants (≥7 posts). In comparison with 19 more passive writers (≤6 posts), active discussants suffered more from loneliness and poor QoL and had fewer contacts with their friends. The above finding is closely related to targeted youth work and its varied clientele. According to the baseline survey, outreach work and rehabilitative workshops reach those with the most shortcomings in their wellbeing, while workshops providing professional training and one-stop guidance centers have clients with more short-term and specific needs for assistance (see Aaltonen et al., 2018). Consequently, those young adults reached through outreach work (mean = 8.0) and rehabilitative workshops (9.2) tended to be more active in the online groups than those encountered in training workshops (5.5) and onestop guidance centers (5.5). Due to the small numbers, the above differences are not statistically significant. Ostensibly, the acceptability of the online discussions was related to the identifiable discussion themes. Even though all the themes were set on the basis of information conducted among potential end-users, some themes were more or less rejected by the discussants. Judging by the degree of the observed discussion activity and the feedback received, the most acceptable discussion themes were related to social relationships and loneliness. This again indicates that the intervention was probably most accepted by those who experienced loneliness relatively often. Previous studies (e.g. Qu & Lee, 2011: 1262; Pendry & Salvatore, 2015) on the wellbeing effects of online discussion platforms share the • 158 interviewed at the baseline • 11 did not meet the inclusion criteria 147 respondents • 91 showed early interest • Multiphase process of invitations and randomizations 41 participants in four online groups • 34 took part in the discussions • 14 very active discussants 26 feedback surveys returned Fig. 1. Allocation of participants in the intervention arm. Table 2 Discussion themes in the MAOG. Week 1 Welcome and introduction to the platform Week 2 Feeling well and supporting others Week 3 Friendships and loneliness Week 4 Sleep Week 5 Finances and housing Week 6 Making friends and dating Week 7 Leisure activities Week 8 Welfare services Week 9 Closure and feedback 8 Information on the need for support was gathered via anonymous Post-it Notes. Peer sociability was mentioned in 16 out of 71 suggestions. Other frequent support requests that were mentioned included mental health (12), study/work (6), and conversational help (5). A. Kivijärvi, et al. Children and Youth Services Review 105 (2019) 104411 4 view that it is important to identify with others in the group. For many of the active discussants, the common denominator was being excluded from peer circles. Co-discussants often reacted to disclosures on such themes by being empathetic and sharing similar experiences. As for the other themes, a similar type of dialog rarely occurred. Post 1: I have difficulties in making and maintaining social contacts. A couple of years ago I was diagnosed with a fear of social situations […] In elementary school I was bullied […] and it had a strong effect on my self-confidence and sociability. Post 2: I was also suffering from isolation from friends and loneliness about a year ago when I was in vocational school. Post 8: I was bullied in elementary school as well […]. As a child I had no self-confidence and I could not approach my peers without an obvious reason. In addition to activity at an individual level, there was some variation between the four discussion groups (Table 3). The most notable finding in this respect concerned the difference between the second group and the others. The number of active discussants and mean levels of posts and word count per discussant were relatively modest in the second group. This might be explained by the fact that the acceptability of the MAOG is partly dependent on the groups and their dynamics. One factor associated with activity encouraging group dynamics could be the peer moderators (the role of professional moderators is discussed in section 3.2) that were recruited to enhance dialog between discussants instead of only posting an ‘answer’ to each theme. While the benefits of having peer moderators are not clear in the data, they can generate extra activity by sharing their identifiable experiences and by recognizing other discussants and their perspectives. Similarly to the professional moderators, the peer moderators also contributed to building a positive discussion culture: Your story was like my own:D I agree with you on almost everything. The discussion culture formed at the beginning of the online groups probably had an influence on the group dynamics throughout their trajectories. For the most part, discussions in all of the groups were positive and supportive. However, in the second group some provocative comments were posted during the first weeks such as: Not everybody deserves friends. This ambivalent discussion culture at the outset might have caused group members to become more wary. In contrast to the other three groups, the posts in the second group were quite short and impersonal. The feedback survey distributed immediately after the discussions was returned by 26 out of 41 participants. Quite expectedly, the response rate was high for active discussants (20/22) and modest for passive ones (6/19). It is not surprising, therefore, that most of the respondents were satisfied with the online activities. The median overall rating given to the intervention was 4/5. More importantly, eight respondents reported having discussed matters that they had previously kept to themselves. For some of the participants, the online groups functioned as a forum for disclosure and testing one's ideas among a peer group – often in relation to the themes of loneliness or mental health: You rarely talk anywhere about these types of issues. Despite the positive feedback, the survey included indications of disappointment as well. During the research process, some participants expressed hopes of making new friends through the MAOG, but to our knowledge this did not happen. 9 These unmet expectations might have been manifested in the feedback survey as well. Some respondents expressed a wish for more lasting and in-depth discussions and more posts by others: I would have liked more discussion. This indicates that the online group methods have the potential to be enhanced. Lastly, evidence of the efficacy of the MAOG is ambivalent (Figs. 2 & 3). No statistically significant changes in QoL or loneliness could be observed among the research participants or between the two arms of the study. When looking at both QoL and loneliness, it can be observed that levels remained the same for the control group and for active discussants. For passive discussants, a slight drop in QoL and a rise in the level of loneliness was observed. Obviously, the drop in QoL and increase in loneliness among passive discussants was an unexpectedly negative outcome. During the discussions, no signs of harmful effects could be observed. The selection between and also within the two arms might mask the reasons for the drop. Some of the research participants were met the same day they had decided to resort to targeted youth work, which might indicate a worsening condition. Moreover, some evidence emerged from passive discussants via the feedback survey, text messages and emails that they had dropped out of the intervention because of their worsening situation. 10 During the fall, I didn't have enough strength to even take a look at the email notifications sent by the heimo system. I'm sorry for my silence. My condition has been poor lately and someone close to me passed away a couple of weeks ago. I haven't been able to do anything extra. Therefore, I have to drop out of the research. Consequently, there is no evidence that the intervention would have caused the decrease in the wellbeing of passive discussants. Probably the strongest argument for this is that most of the passive discussants did not visit the online groups at all. The system was not designed to gather any data on ‘lurkers’, namely silent observers of the discussions. 11 For the active discussants, there were some indications of the possible efficacy of the MAOG in terms of a slight decrease in loneliness immediately after the intervention. As the feedback survey was returned by a great majority of the active discussants, data was generated on the frequency of loneliness in three different waves (Fig. 3). These measures again indicate that the online discussions very likely did not worsen the situation for those who actually participated. However, in the follow-up survey, the frequency of loneliness reverted to the baseline level. Again, due to the small sample size and minor fluctuations, these changes and their differences are not statistically significant. Table 3 The four online groups and their variation according to intensity of participation. Group 1 Group 2 Group 3 Group 4 Participants 14 10 10 11 Ratio (active/passive discussants) 1.8 0.4 1.0 0.8 Posts/participant 7.9 5.1 6.7 5.8 Words/participant 362 99 338 396 Peer moderators 0 0 2 1 Comments/youth workers 47 35 50 34 9 In the feedback survey, none of the respondents reported having written private messages to other group members. Moreover, at the end of the discussions, the opportunity for an offline meeting was offered to all online groups. Only the first group took part in such a meeting, but it did not appear to lead to any exchange of contact information (two researchers were present during the meeting). The second and fourth groups expressed no interest in arranging a meeting. The third group expressed some interest but due to timeframes and the need to travel (the group included participants from two cities), the meeting never took place. 10 Other, more mundane reasons were also given for passivity during the discussions. Some were busy with their new jobs or life in general. Some had simply forgotten the discussions and one participant cited a broken computer. 11 In the feedback survey, only one passive discussant reported having visited the online platform more than once a week. It should also be remembered that fifteen online group participants did not respond to the feedback survey. However, it is likely that those who did not respond included some ‘lurkers’, and were more likely to be those who visited the platform rarely or not at all. A. Kivijärvi, et al. Children and Youth Services Review 105 (2019) 104411 5 3.2. Viability In the group discussions conducted with the youth workers, they acknowledged that loneliness and anxiety about face-to-face sociability were significant issues for many of their clients. The youth workers indicated that some of the young adults had extensive histories of being excluded from peer groups. To this end, a group-based online intervention seemed to have potential. It would be great if we could organize some kind of peer support groups for those who feel lonely and who have been bullied. These are very common occurrences for our young people. Despite the above views, the professionals expressed reservations about including online group activities in the targeted youth work repertoire. Most Finnish youth workers are trained to be experts in group processes, and group methods (e.g. facilitating activities at youth centers) predominate in youth work among teens (e.g. Kiilakoski & Kivijärvi, 2015). However, for young adults, the individualistic orientation tends to be strong and most effort is put into one-to-one counselling (Aaltonen & Kivijärvi, 2018). This is quite understandable given that the success of targeted youth work is measured by the objective outcomes of education and employment. 12 As one youth worker put it: For me, the day-to-day work is number one, meaning individual tutoring. I don't think that I can commit to this [intervention]. In addition, some expressed doubts about the basic premise of the intervention. These doubts were twofold. First, some were skeptical as to whether young adults would join the online groups at all. Many youth workers had discouraging experiences while trying to organize group activities. Second, some professionals had misgivings about the detrimental conversational culture on online platforms and the potential for too explicit disclosures, and were concerned that they might impose unnecessary burdens on both discussants and moderators. Hence, there was concern that instead of promoting the wellbeing of young adults, online group activities would hamper it. I don't see any real need for this. The work we do is so personal and private. If somebody in the online group decides that this is the day that they slit their wrists, who will react to that? And if somebody else replies, ‘Yeah, go head’, who is responsible? Further concerns revolved around the practical arrangements. In line with information gained during youth workshops, one concern related to finding an accessible online platform that would provide a safe space and complete anonymity for participants. Moreover, several youth workers lacked confidence in their own abilities when it came to working in online contexts. To summarize, even though online groups were seen as potentially beneficial for some young adults, youth workers raised several concerns prior to the intervention. Consequently, only a few professionals volunteered after the first round of enquiries. However, as noted in the previous section, most of the concerns were not borne out during the intervention. Obviously, there was some variation during the online discussions with regard to moderators' intensity and style of participation. MAOG was considered most viable among professionals with a relatively strong orientation toward working with groups. In the context of targeted youth work, this type of orientation is most likely to be found in the youth workshops, where activities largely take place within a group, while outreach work and one-stop guidance centers are mostly based on individual counselling. During the discussions, moderators from the youth workshops took a rather strong role in encouraging the young adults to write about their experiences. In practice, encouragement entailed positive acknowledgement, posing probing questions, and urging participants to keep writing. Moderators with a group orientation also related their own experiences and thoughts. Thank you for your comments so far! Really thought-provoking, brave and open comments about the linked story. Every comment is important. Is there anyone else who would like to share their thoughts on this? This reminds me of my own youth when hanging out with friends was the number one thing and studying… well, motivation was lacking… Different orientations toward being a professional moderator were reflected in the quantitative outcomes as well. The two groups moderated by youth workshop professionals included 47 and 50 posts by moderators, while the number of moderator posts in the other two groups led by more individual-orientated outreach and guidance center workers amounted to 34 and 35. Relatedly, moderator activity was positively associated with the activity of the young adult discussants (see Table 3). As a result, it is possible that the perceived viability of professionals is transformed into acceptability and eventually wellbeing effects for end-users. After the intervention, six feedback surveys were returned by four different moderators. The tone of the feedback was positive in two respects. First, the professionals commented about putting their abilities in working in online contexts into practice, and that moderating was not too burdensome. The most time-consuming planning and organizing work was done by the researchers, and hence the working time invested by the youth workers in moderating was approximately one hour per week. With careful preparation, intervention is therefore quite affordable even for organizations with modest budgets. Those respondents who moderated lively discussions were surprised about the straightforward nature of the discussions: I was positively surprised about how much and how openly the young people wrote about different topics. On the other hand, one moderator of a more passive group was disappointed with the amount of discussion: I wasn't expecting it to be so quiet. Something that seemed to be common to all of the moderators was hesitation over how active a role one should take in leading discussions and supporting discussants: This was new for me. I was pretty cautious at first when posting comments. This observation, 50 55 60 65 70 Baseline Follow-u Control group Passive discussants Active discussants Fig. 2. Change in the QoL (0−100) for different groups of respondents in two waves. 2.7 2.9 3.1 3.3 3.5 Baseline Feedback Follow-up Control group Passive discussants Active discussants Fig. 3. Changes in the frequency of loneliness (1–5) for different groups of respondents in two or three waves. 12 There are currently at least three projects underway in Finland investigating the effectiveness of targeted youth work by the levels of enrolment in educational institutes and employment status. The Finnish Youth Research Society, Juvenia (a youth research department in the South-Eastern Finland University of Applied Sciences) and the National Audit Office of Finland coordinate these projects. A. Kivijärvi, et al. Children and Youth Services Review 105 (2019) 104411 6 again, emphasizes the distance between targeted youth work and online group methods. 3.3. Implementation This study was a non-recurring pilot. For this reason, the future directions and criteria for conducting controlled experimental research need to be discussed. Successful implementation of an experimental setting seems to be quite challenging in the context of targeted youth work and group activities for a number of reasons. First, there will probably be a great deal of self-selection between control and intervention groups. Second, the delay between the baseline survey and invitations to online groups might be too long and complicated for many potential participants, reducing the adherence rates in the intervention arm. Third, quite a high attrition rate is expected, particularly among the control group. A certain amount of attrition has to be accepted when outcome measures such as QoL and loneliness have to be self-reported. On a positive note, all of the key outcome measures proved to be reliable and valid for the vast majority of the participants (see e.g. Kivijärvi et al., 2019). To resolve the problems outlined above, a different type of research setting needs to be established (Fig. 4). The results based on acceptability and viability indicated that the intervention should be promoted among clients of outreach work and rehabilitative workshops in particular. The first step would be to establish online group activities as a component of these services in a city large enough to guarantee a sufficient number of potential participants. The intervention would be offered to all clients of these services, while moderators would be recruited among workshop professionals. Subsequently, in order to control self-selection between the two study arms, the control population should be recruited among clients of the same services who reside in a different but similar city, and who would therefore have no possibility of enrolling in the intervention group. Established online groups as a component of targeted youth work would also help to resolve the problem of delay. In line with the feedback provided by some of the online discussants, the digital groups need not be restricted to certain timeframes and could be open to new members. Consequently, all those interested could sign into online groups immediately after enrolment in youth services and filling out the baseline questionnaire. In the follow-up surveys, the length and intensity of online participation would be reported. To avoid attrition in all study arms, some resources should be allocated for vouchers to incentivize the return of questionnaires. 4. Discussion In this study we have investigated the feasibility of digital group methods as a piloted component of targeted youth work. In the previous literature, feasibility studies have assessed “whether a future study, project or development can be done” (Eldridge et al., 2016, 15–16), or have tried out “pieces of the RCT” (Tickle-Degnen, 2013, 172). In our case, the feasibility of the piloted intervention was examined in a context in which there was much uncertainty and little previous evidence. The aim was to uncover some of the inherent benefits and problems related to the intervention and to lay the foundation for further enquiries. To accomplish these tasks, we scrutinized the acceptability, viability and future implementation of the pilot. Studying the causal mechanisms and effectiveness is time-consuming and costly, particularly in occupational and real-life surroundings. Therefore, before investing in experimental research, one should have evidence that the pilot is relevant for end-users (Huppert, 2014), practical for practitioners (Thornley & Marsh, 2010), and analyzable with experimental methods. 4.1. Key results The acceptability of the piloted intervention varied between different end-users. Acceptability was highest among those who suffered from poor QoL and loneliness and who had difficulties in engaging with face-to-face groups. In the context of Finnish targeted youth work, these types of young adults are most likely encountered in rehabilitative workshops and outreach youth work. The intervention should thus have a more specific target group. The results concerning viability were ambivalent. Establishing digital group methods for a service provision which is dominated by oneto-one offline practices turned out to be challenging, even though youth workers recognized a need for the type of activities that MAOG provided. Those professionals who were responsible for moderating the online groups were relatively satisfied, did not see the task as particularly burdensome, and reported that they had enhanced their Establishing the online group method in city 1 and targeting it toward clients of outreach work and rehabilitative workshops + Agreeing to conduct comparative data in similar city 2 Baseline interviews with all clients of outreach work and rehabilitative workshops in cities 1 and 2 Intervention group: Those participants who enrolled in online groups in city 1 Primary control group: Similar participants in city 2 Follow-up e-questionnaires in two waves: six months and two years after the baseline interview Secondary control group: All other participants in cities 1 and 2 Fig. 4. An experimental setting to study the effectiveness of MAOG as a component of targeted youth work. A. Kivijärvi, et al. Children and Youth Services Review 105 (2019) 104411 7 capabilities of working in online contexts. It seems evident that many youth work organizations would benefit from training staff in the skills needed in online contexts. Implementing an experimental study in the future, and reducing participant selection, unnecessary delays and attrition, requires making some modifications to the research setting. The main lesson learned in this study is that the randomization process should be revised. Instead of randomizing voluntary participants within cities, the setting should be based on reasoning between cities and their young adult inhabitants in similar situations. 4.2. Strengths and limitations The main strength of the study has been the ability to resort to manifold datasets produced among a hard-to-reach group, coupled with mixed methods analysis including engagement with both end-users and practitioners. Moreover, using different datasets facilitated scrutinizing the intervention from different perspectives and interpreting the results in a rigorous way. In the context of intervention studies, this has enabled us to answer ‘why’ questions (Patton, 2014), such as why did the intervention work for some end-users and not for others, why were there differences between the intervention groups, and why did some youth workers regard the intervention as more viable than others. Despite the strengths, some limitations can also be identified. Little can be said about the efficacy of the intervention due to the selection and rather small number of participants. Moreover, the results concerning the possible efficacy in terms of wellbeing are quite modest. There is uncertainty about the best outcome measures when exploring the impact of group-based methods in the context of youth work (e.g. Ord et al., 2018). In addition to wellbeing and loneliness, the outcome might be, for instance, non-formal learning or increased knowledge of the self. A further limitation is that the study comprised only two arms. All of the participants in the intervention arm were offered the same inflexible and possibly outdated web platform. There is some evidence in the literature that more sophisticated platforms based on virtual reality could be more attractive for end-users (Knowles et al., 2017). 5. Conclusions It is well known that peer relations are highly important for young people and young adults. A normative expectation is that a great deal of time is invested in friends while detaching from childhood families, and when not yet attached to long-term romantic relationships and the labor market (e.g. Furlong, 2012). Despite this, there are few if any public services for young adults focusing on peer and group relations. These issues are addressed in the domains of civil society and private life. When it comes to teens, peer relations are the focal point of youth work in Finland and in most other European countries as well. On an international scale, youth work is a rather strong profession in Finland, funded by the state and the Church while being implemented by municipalities, NGOs and parishes. However, for young adults, youth work service provision largely comprises one-to-one counselling aimed at guiding them through the transitions toward the labor market. Taking into account the fact that a considerable number of young adult clients suffer from loneliness and have protracted difficulties in joining face-toface groups, it seems evident that interventions based on online and group-oriented methods have potential. In terms of the trial presented in this paper, we cannot claim to have found an all-encompassing solution to the problem, but nonetheless an idea worth developing. Conflict of interests There are no conflicts of interest for the authors. Funding source Strategic Research Council (SRC) of the Academy of Finland (303615/303650). References Aaltonen, S., & Kivijärvi, A. (2018). 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