Abstract
Background
World Federation of Occupational Therapists (WFOT) member organisations comprise 77 national occupational therapy organisations across the world. Each national organisation interacts with its members and the public using diverse methods. Increasingly, national organisations are broadening their communication methods.
Objective
The objective of this study was to examine if and how occupational therapy organisations are using social media for communication, and if so, the types of concerns or barriers they experience and what role they anticipate social media might play in the near future.
Methods
An online survey was developed; 57 of 77 WFOT member organisations responded.
Findings
This study identified that WFOT national organisations are using social media, to varying degrees, with or without an individual formally assigned to manage social media. Respondents reported that they used social media to: communicate with members, promote the organisation and promote the profession. Commonly expressed needs included assistance with guidelines for ethical social media use, developing technical expertise, and recognition of limits of time and competing priorities. Recommendations arising from this research are at the global, national, local and individual levels and incorporate active dissemination and pure diffusion approaches. Taking steps to increase the use of social media could indirectly impact occupational therapy practice through enhancing organisations’ abilities to support practitioners to enhance their practice.
Limitations and recommendations for further research
Although 57% of WFOT member organisations returned usable responses, there may be some additional perspectives that were not captured. It would be helpful to contact non-responding organisations to explore their social media use and plans. Further research could examine how future initiatives put in place by WFOT impact social media use by member organisations.
Keywords
Introduction
Occupational therapy professional organisations exist at the local, national and global level. These professional organisations, which are called Associations in some countries, interact with occupational therapy practitioners and students, consumers, governments and regulatory bodies; and provide structured approaches to facilitate innovation through formal education channels, global visioning and policy development.1,2 Information sharing and knowledge creation is an important role that professional organisations play for their members. Since the advent of the Internet in the early 1990s, the organisation and storage of large amounts of information has been moved to digital repositories. 3 In addition, the emergence of interactive online technologies, also known as Web 2.0 technologies, has led to information sharing and knowledge creation occurring in virtual spaces and in virtual groups.4–7
Social media tools such as Facebook, Twitter and LinkedIn are freely available in many countries to anyone who has an Internet-enabled computing device such as a smartphone, tablet or computer. With hundreds of millions of people across the globe using social media as professional tools, 8 it is important to examine if, and how, the occupational therapy organisations representing the 77 World Federation of Occupational Therapists (WFOT) member organisations are using social media to interact with their members, as well as any barriers they identify in using social media.
Background and rationale for undertaking the study
Information creation and knowledge sharing relies strongly on networking as a core activity and occurs in policy development, advocacy, education, marketing and needs assessment. Digital and social media has reduced the ‘onerous burden in terms of time, cost and energy associated with traditional networking’ (p.589) 9 and can be used to improve the efficiency and effectiveness of networking activities. Therefore, it is important to understand if and how occupational therapy organisations are using digital and social media for networking.
A Delphi study completed by Hamilton 10 recommended that to improve occupational therapy’s capacity to use digital technology for information management and knowledge transfer, professional organisations should integrate digital technology into their core business and provide education to improve the digital literacy skills of their members. Hamilton’s research findings also suggested providing education and support to the professional associations if it became apparent that they lacked the digital literacy skills to educate their members. In addition to skill development, organisations and members should provide education about the ethical implications of use of these media. In a discussion paper published in 2010, Kashani et al. 11 called for WFOT to develop a set of guidelines on the ethical use of social media by occupational therapists.
The adoption of innovations, such as the use of social media, has been shown to be powerfully influenced by the structure and quality of social networks.12–14 Although different professions have different types of social networks, 2 and will differ in their approaches to innovation, it has been shown that individuals are more likely to adopt innovations when they are members of a homophilous group. 2 Each national occupational therapy organisation could be regarded as a homophilous group as their members often share similar socioeconomic, educational and professional backgrounds.2,13 Although a single approach to using social media is not recommended, a set of best practice guidelines, as suggested by Kashani et al., 11 developed by WFOT and acknowledging the autonomy of each member organisation is likely to be helpful.
In order to develop such guidelines, it is important to examine if and how the 77 WFOT member organisations are currently using social media and what role they anticipate social media might play in the near future. Thus, when looking at the adoption of an innovation, such as social media, it is important to examine the practices of each occupational therapy organisation rather than take a global ‘one size fits all’ approach. 14 The purpose of this study was to gather data on WFOT member organisations’ current and anticipated use of social media and explore the factors that would help overcome barriers to using social media.
Methods
Data collection
A mixed-methods online survey was developed to gather information about WFOT member organisations’ current use of social media and intention to use social media in the future (see Appendix 1). The survey used in this study was adapted from previous surveys15,16 which investigated occupational therapy students’, educators’ and practitioners’ use of social media, and the first author can be contacted for details about the related survey. The questions included in this current study were developed in consultation with the WFOT and peer reviewed by an occupational therapy scholar and an occupational therapist who uses English as a second language. Following ethics approval (HREC approval: A/14/622), an information letter and link to the online survey was circulated to the 77 national member organisations by the WFOT Secretariat. Data collection occurred in early 2015 over a period of four weeks after consent was obtained online from participants prior to completion of the survey.
Data analysis
Question responses that provided quantitative data were organised using Excel® (Microsoft Office Professional Plus 2013 package) so that the findings could be depicted using graphs and tables that describe the location of the centre of a distribution, or the frequency of occurrence of the values (e.g. Age of Respondent) or a variable or characteristic (e.g. Role within Member Organisation). Thematic analysis of qualitative data was completed using Leximancer™ (Version 3.5) text analysis software. Leximancer™ is a well-established tool that has been used to analyse text from message board transcripts, 17 interview transcripts 18 and open-ended questions in surveys. 19 In addition, the use of Leximancer™ ensured that coder subjectivity by the researchers (all skilled competent users of social media) could be avoided as it provides ‘a clear bracketing process in identifying the concepts embedded in the responses’ (p.263). 18
Leximancer™ analyses text-based documents and presents the extracted information as a concept map or visual diagram. Concepts are developed by computer analysis of the frequency of word occurrence and co-occurrence, and represented by the size of the dot on the diagram. The proximity that words appear within text influences the closeness of terms on diagrams. 20 The more times one concept co-occurs directly with another, the stronger the relationship will be; these thematic groups of concepts are represented by coloured circles on the diagram. 21
Prior to and after using Leximancer™ for thematic analysis, the researchers read all individual text responses to verify the analysis and to select statements that captured the themes emerging from the combined words of the respondents. Although Leximancer™ concepts are represented using single words, each concept represents a collection of words that tend to appear together within the text. 22 The concepts are named using the most semantically significant words. Manual alteration of themes generated by Leximancer™ is possible, but was not used.
Response to survey
To encourage openness and to protect the identity of each member organisation responses were de-identified. A total of 57 survey responses were received; 11 respondents did not complete the entire survey. In two instances there were two responses from the same member organisation, their responses were each merged. The number of usable surveys was 44, representing a 57% usable response rate. Where survey questions sought information about the national organisations’ current use of social media (Questions 13–16), 42 responses were provided; therefore, in those particular questions the usable surveys numbered 42. The following section presents findings from the survey after data analysis.
Demographics
Distribution of respondents by age (n = 44).
Roles within member organization
Role of respondents (n = 44).
Respondents were asked to indicate whether their organisation had an identified individual who was responsible for managing social media. Twenty-six organisations reported that they have someone responsible for social media. Of these 26, eight have someone who receives pay for this role, three provide incentives to a volunteer who manages social media and 15 utilise volunteers with no incentives.
Application of social media
The information provided by all 26 respondents whose organisations have an identified social media coordinator role was analysed. The thematic analysis is depicted in Figure 1 and a summary of the key themes is provided below.
Current role of Social Media Coordinator.
For the organisations that currently have a social media coordinator the two most frequent reasons for using social media were for promoting occupational therapy (exemplified by the themes ‘information’ and ‘publishing’) and for communication with members (exemplified by the themes ‘information’, ‘members’ and ‘occupational therapists’).
The theme ‘social media’ included comments such as ‘develop content, share content, review the analytics, follow Association’s [Organisation’s] objectives for social-media’ and ‘posting content on all social media channels on a day-to-day basis’. The comment ‘providing information to other professions and public through media and Internet’ identifies the link between the theme ‘social media’ and ‘information’ and highlights an overarching theme of promoting occupational therapy. The links between the themes ‘information’ and ‘occupational therapists’ were illustrated by the overlapping circles in the Leximancer™ concept map, and by comments such as ‘sharing information among occupational therapists’ and ‘gives feedback to questions asked by occupational therapists’.
After thematic analysis was completed the responses were reviewed to select statements that captured the main themes. One respondent stated: The Association’s social media strategy will be one component of a broad umbrella marketing and communications strategy that is currently under active development. The strategy includes a social media use policy and guidelines, as well as a messaging calendar for social media content. I am responsible for posting content to social media platforms as set out in this calendar.
Training for the role of Social Media Coordinator
When asked about how or if those responsible for social media were prepared for or trained to undertake this role, many reported they had no training, were self-taught or had been mentored by someone else in the organisation. Some reported that they had received training through their workplace. Only two respondents reported that they had learned about social media through formal education.
Potential role for Social Media Coordinator
Of those organisations without an identified Social Media Coordinator, four said they were considering appointing a Social Media Coordinator (paid or volunteer), six said they might consider such a role and eight said they were not considering appointing someone to this role.
The responses to the question, ‘What role do you think a Social Media Coordinator could play in your National Organisation?’ were analysed. The thematic analysis is depicted in Figure 2 and a summary of the key themes is provided below.
Potential role of Social Media Coordinator.
The respondents in the group currently without a Social Media Coordinator identified enhancing communication with members, promoting occupational therapy, providing information to members and to the public, and developing skills in the technical aspect of social media use, such as keeping current on various platforms and tracking analytics.
The responses made by this group were similar to those responses by individuals representing organisations who have a Social Media Coordinator in place. The focus was, again, on using social media for communication and promotion. However, the proximity that words appeared within text influences the closeness of terms on the Leximancer™ concept map20 and Figure 3 highlights that concepts such as communication and promotion did not frequently co-occur with each other. A key difference between the groups with a Social Media Coordinator and those without was the focus on developing expertise in the technical aspects of social media use, including using analytics. The theme ‘development’ was a new and different theme emerging from the member organisations who do not currently have a Social Media Coordinator, their responses were reviewed to select statements that capture the main themes; below is one example: A social media coordinator could develop content specifically for each relevant platform, explore new platforms as they emerge, produce analytics reports, and make recommendations on achieving better engagement with different segments of our target markets/publics [sic].
Factors influencing social media tool use.
Comparison between WFOT member organisations
All survey respondents were asked to identify how they believed their organisation compared with other national occupational therapy organisations in terms of social media use. Two respondents indicated that their organisation was ‘ahead of most’; four said they were ‘ahead of many’; 21 indicated that they were ‘about the same as others’; 14 indicated they thought their organisation was ‘behind many’; and one said they were ‘behind most’. Two participants did not respond to this question.
Fifteen respondents commented in the optional open-ended question associated with this survey question. The thematic analysis, depicted in Figure 3, revealed that most respondents used this question to explain the factors influencing their organisation’s current level of use of social media. A summary of the key themes and statements that capture the themes are provided below.
A cluster of three themes, ‘size’, ‘variation’ and ‘associations’ (organisations) incorporated the main factors influencing if and how occupational therapy national organisations were using social media. The following statement captured this cluster of themes: There is so much variation amongst the WFOT national associations… Our experience is that social media requires a full time resource to do properly and given the size of occupational therapy associations around the world this is not easily attainable or facilitated for most.
‘Resources’ (including time, skills and people) was again identified as a theme. The lack of resources was identified as a barrier to using social media to network with members. One respondent noted that regarding the current application of social media: ‘We just begin with it (only Facebook)… this job is voluntary and as all helpers suffer from lack of time, it is so far more like enthusiasm than a goal directed effort’. Facebook was a theme linked to ‘resources’ and was again identified in the responses to this question as the most used tool; captured in this statement ‘We have grown a lot in the past 2 years when we create[d] the Facebook (with 9879 members now)’. Throughout the survey Facebook was shown to be the most frequently used social media tool by occupational therapy organisations; this is discussed in the next section.
Use of social media tools
Current use of social media
In the survey, respondents were asked to identify the social media tools they currently use and for which purposes. The responses to these questions are presented in Figure 4.
Social media tools used by national organisations (by activity).
Facebook and Twitter were the most frequently used social media tools for sharing organisation news, for advertisements and sales, and communicating about online events and education. Facebook and online surveys were the most frequently used tools for interacting with members. One respondent identified the use of Facebook as the main social media strategy: ‘We have a page on Facebook that I have an access as one of the administrators’. Online journal access was the next most frequently used tool for everything except as a tool to interact with members. One respondent indicated that his/her role was to ‘…lead the social media team and run the Facebook, Twitter, Pinterest, Instagram, Vine, LinkedIn, YouTube and Flickr accounts for the association [organisation]’.
Future use of social media
Through the survey the researchers examined what might motivate national occupational therapy organisations to use social media more frequently. The seven reasons identified as being most likely to influence increased social media use in the future were: if social media helped us do a better job (80%), if members requested it (79%), if there were examples of it being used well (75%), if it was useful (74%), if it looked professional (73%), if it was relevant to the organisation’s role with members (72%) and if organisations had more time (72%). Interestingly, 23% of respondents indicated that having the WFOT require that they use social media would not influence future use.
Use of technology within the local community
In any discussion of the use of social media, it is important to consider local access to Internet connections and to Internet-capable devices. The survey asked if Internet-connected devices had become a usual household item in the community in which the respondent lived. Thirty-six respondents said yes, two said no and two said somewhat. One respondent commented: Occupational therapists (who have had access to University education, and therefore are likely to be above the poverty line) are likely to have this [sic] items in their households. However, a large number of the [country] population has access to basic phones, increasingly to smart phones (although the costs of data plans continue to impose a limit on this area), but not to table[t]s and computers in their households.
Additional comments
At the end of the survey, respondents were invited to share any additional thoughts they had about the use of social media within their organisation. The themes identified in this open-ended question were analysed and were identified as technical (ease of use and usability), communication (usefulness), ethics and appropriate use (guidelines) and time and resources (see Figure 5). Each of these themes will be illustrated by statements made by respondents and explored further below.
Thematic analysis of open response.
Technical (ease of use and usability)
Some respondents indicated that they were trying to identify which platforms members used and preferred. They were exploring which platforms best served their needs as an organisation, including providing analytical tools so the organisation could understand more about the impact their social media efforts were having, for example: Facebook’s changing algorithms for page accounts have dramatically reduced the reach of any posts by pages, so it’s now unlikely that we are effectively capitalising on our members’ strong preference for this platform (budgetary issues also contribute to this). I am watching with interest whether our members’ preferences of platform change in the future, or what future tweaks Facebook makes that might again change our ability to effectively harness the potential of different social media networks.
Communication with members (usefulness)
Some responses to the survey highlighted that one of the reasons national associations find social media useful is for communicating with members. The responses to the survey that reflected this include ‘It is the main tool of communication with our members at large’ and ‘We hope to develop further interaction on Social Media with our members’. One respondent highlighted the importance of social media in providing educational opportunities for members in regional areas: ‘We are trying to do better for our members that are outside the capital area and use webinars when we have meetings, courses, etc., whenever possible’.
Ethics and appropriate use (guidelines)
The importance of guidelines for social media use by organisation members and by other users of these resources was identified. As one respondent said, While we can impose stronger governance over how social media is being used by ourselves, we do have concerns about being vulnerable to occasional irresponsible public comments made. As such, it will be better if associations have resources to support corporate communications.
Time and resources
The issue of resources and time within small, mostly volunteer-driven, organisations was noted: ‘It needs work. And work takes time. In a small organisation you don’t always have that time’. Another respondent noted, ‘We have delegated some responsibilities to branch committees but need a coordinator – at the moment it is really a resource issue based on what we have identified as our priorities’.
Another respondent stated, ‘I think the most important obstacle in using social media is the time it requires, because of not good internet connection and distracting things like extra-professional mails, Facebook news and comments, etc.’.
Respondents were interested in doing more with social media, but this was only one priority amongst many that needed to be addressed by organisations who have limited resources of time and relevant expertise.
Discussion
This survey addressed one of the recommendations made by Hamilton,
10
who called for the WFOT to survey national organisations regarding their use of social media. The survey examined if and how the occupational therapy organisations representing WFOT member countries were using social media, their future plans for social media utilisation and what would motivate them to increase their use of social media. The results of this survey suggest that national occupational therapy organisations who are using social media are achieving several outcomes, with the following three main outcomes identified:
communicate with members; promote the organisation; promote the profession to internal and external audiences.
Organisations using social media were found to most often be relying on unpaid volunteers to establish and maintain their social media efforts, and most social media coordinators were largely self-taught. National organisations’ future plans for use of social media focused on using it to communicate with members and to promote the profession.
Many of the national organisations not using social media identified the need to develop greater technical expertise with using social media tools and were considering who might assume the role of social media coordinator, or whether assigning such a role was even possible. Respondents noted that they would like to see exemplars of the skilled use of social media by professional organisations and guidelines on using social media in a manner that maintains professionalism. Provision of guidelines and exemplars would likely lead to increased use of social media, as long as access issues for members were not a concern and internal resources were available.
The researchers found that the use of social media to promote the profession of occupational therapy was common across national organisations. This finding aligns with the mission of the WFOT. Watson
23
highlights the importance of the role of WFOT in protecting occupational therapy’s global identity: The World Federation of Occupational Therapists (WFOT) acts as the custodian of the profession’s identity… occupational therapy associations [organisations] affiliated to the WFOT strive to affirm and protect this distinctiveness. They establish the profession’s social organisation, consider historical antecedents and affirm traditional values. (p.153)
Limitations
A number of limitations of this study have been identified. Although the WFOT conducts its business using four official languages, due to resource limitations, the survey was only presented in English. To address this deficit, the survey was piloted with an occupational therapist who has English as a second language. Although slight modifications to the questions were made, it is possible that some participants may not have accurately translated the question into their first language, or their responses back into English. Thus, their responses may not truly reflect their actual experience. Secondly, while every effort was made to encourage participation by all 77 member organisations, 20 did not respond. It is possible that these participants were more likely to come from countries where the use of English is minimal, and thus understanding of the purpose of the survey or ability to confidently complete the survey in English influenced participation rates. In future studies, it would be important to ensure sufficient lead-in time for the translation of any data-collection tools into all four official languages of the organisation, to ensure increased participation. Finally, the design of this study relied on self-report. Answers to questions such as comparing social media use between different member organisations is reliant on a thorough understanding of what is happening outside of one’s own country. While some participants were WFOT delegates or National Presidents, and thus through the biennial meetings more likely to be exposed to the practices of other member organisations, other participants may not have been as active and, therefore, their responses may reflect a narrower understanding. In future studies, it would be useful to gather quantitative data on various member organisations’ use of Facebook and Twitter to allow for more accurate comparisons.
Recommendations
Using social media to connect with members and promote occupational therapy must not place the profession or its member organisations at risk. Potential risks such as overburdening volunteers or unethical practice in the online environment exist. To ensure that innovation occurs safely the WFOT must take steps to ensure that the spread of innovation occurs in a structured way through active ‘dissemination’ while still allowing innovation to occur through ‘pure diffusion’. 24 Active dissemination uses vertical processes that are planned, orderly, often centralized and managed. 25 Pure diffusion is horizontal; unpredicted, unplanned, emergent and self-organising. 26 Recommendations arising from this research are at the global, national, local and individual levels, and incorporate active dissemination and pure diffusion approaches.
Global
It is clear that national organisations would appreciate active dissemination from the WFOT regarding ethical use and standards for using social media for professional purposes. The WFOT has already taken steps to bridge this gap through the establishment of the International Advisory Group (IAG): Social Media, who have developed a Position Statement on Social Media which was approved by the WFOT Executive Council in March 2016 and is available via the WFOT website (http://www.wfot.org/ResourceCentre.aspx).
National
National organisations have two foci: to ensure the safe and effective use of social media; and to ensure that their members understand the ethical use of social media as recommended by Grajales et al., 27 while also providing education and skill development. These two foci can best be facilitated through active dissemination and pure diffusion. 25
National organisations can actively create and disseminate their own Position Statement on Social Media use, using the WFOT position statement as a guide. Through this process, national organisations can actively disseminate information about expectations about the ethical use of social media in the context of their country and culture.
It was interesting to note that only two respondents reported they had learned about social media through formal education; however, the age distribution of the respondents indicates that the majority were likely to have been educated before social media existed. This suggests the need for education about the use of social media as a tool for marketing, promotion and education, as well as knowing how to use analytics effectively. Improving skills in the use of social media to connect with members and promote the profession may be best met using pure diffusion approaches. Pure diffusion is horizontal and self-organising 26 and it could occur by creating peer-to-peer social media development networks. The researchers suggest that peer mentorship between national organisations, in particular between organisations in similar regions, could be more effective than any initiative that comes solely from the global organisation. Similarly, Grajales et al. 27 encourage asking others for help, especially those with similar interests or, alternatively, paying attention to and learning from other’s online practices.
None of the survey respondents mentioned that they had made connections with other national organisations regarding social media use. If this communication isn’t happening, the WFOT, through its IAG on social media, could facilitate these connections without being overly prescriptive. Given the constraints of time and energy reported, networking would need to be facilitated in such a way as to be respectful of these limitations. National organisations would need to commit to engaging in these networking conversations, and a platform that was accessible to all would need to be used. National organisations might also develop or endorse ethical standards for professional social media use, which would also take into account the cultural and political realities of their country. Finally, national organisations could influence social media use through exploring if and how social media literacy is addressed in national educational standards for occupational therapy education.
Local
At the local level both active dissemination and pure diffusion approaches can be used to advance the effective and ethical use of social media. Individual educational programs could be used to explore how students can be introduced to a variety of social media tools and have the opportunity to examine how to use these tools for professional purposes. Educational programs could also ensure that students have reviewed the WFOT and national standards for ethical professional use of social media.
Local professional organisations could sponsor workshops for practitioners; knowledgeable students might become mentors to their fieldwork supervisors. Students could also be supported to develop educational materials and processes to increase digital/social media literacy with vulnerable populations. 28
Individual
Individual occupational therapists could commit to becoming more familiar with social media use for professional purposes and, perhaps, peer mentoring others once they have gained some expertise and confidence in using these important tools. Self-education is one of the best ways to gain expertise and confidence in using social media; for instance, through participating in Facebook groups, Twitter chats, following occupational therapy bloggers, taking online courses or learning from colleagues or students.
Conclusion
This research identified if and how occupational therapy organisations are using social media and identified the role organisations anticipate social media will play in the near future. Overall, the survey responses suggest that occupational therapy organisations use social media to achieve several outcomes: to communicate with their members; to promote their organisation; and to promote the profession to internal and external audiences.
It is clear from these results that the majority of the WFOT member organisations are willing and enthusiastic to embrace the use of social media to assist in the day-to-day operations of their respective organisations. It became evident, however, that many of the organisations are asking for guidance by the WFOT regarding ethical standards for using social media for professional purposes and education about how to access and use analytics built into social media programs. The recommendations highlight that strategies for increasing skills and confidence in using social media will need to be implemented at national, local and individual levels using active dissemination and pure diffusion approaches.
Through the appointment of an IAG: Social Media, the WFOT has demonstrated awareness of the need to guide national organisations in the ethical and effective use of social media. This was evident through the request by WFOT that the IAG: Social Media develop a Position Statement on Social Media and then follow up by undertaking this survey to explore the current use of social media by national organisations.
It is proposed that the next step for the IAG: Social Media will be to help facilitate the effective use of social media tools by national organisations using peer-to-peer approaches such as a mentoring program. Ongoing monitoring of education, training and support needs will also be important. In the future, the IAG: Social Media may suggest to the WFOT that development of minimum standards for digital literacy in occupational therapy education needs to be explored so the profession can further develop its potential to use social media and other online technologies to make connections and promote the profession.
Footnotes
Acknowledgements
We would like to thank Dr Matthew Molineux for his assistance and guidance in the development of the ethics application and Tanja Krizaj for reviewing the questionnaire for comprehensibility for respondents whose first language is not English.
Author's note
Here are the Twitter handles for the other authors who tweet: Susan Burwash @SuBu_OT; Merrolee Penman @Merrolee; Karen Jacobs @karenjacobsOT; Angela Hook @AngelaDH; Sarah Bodell @OTSalfordUni; Ritchard Ledgerd @thewfot
Contributorship
AH and MP researched literature, conceived the study. AH, MP and WFOT were involved in protocol development, gaining ethical approval and member organisation recruitment. AH and SB completed data analysis. AH and SB wrote the first draft of the manuscript. KJ reviewed and edited the manuscript before sending the manuscript to all authors for additional editing. AH and SB completed all final edits and AH submitted the manuscript for review and completed the ethics reporting process. KJ, AH and MP completed all revisions.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical approval
The ethics committee of University of the Sunshine Coast, Queensland, Australia approved this study (REC: A/14/622).
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Guarantor
AH.
Peer review
This paper was reviewed by Francisco Jose Grajales, University of British Columbia and one other reviewer who has chosen to remain anonymous.
