Findings from a multinational research project on WhatsApp use
Social media for global health professionals
Von Christoph Pimmer, Ademola Ajuwon and Jennifer Chipps
In the field of global health, social media and especially WhatsApp are very popular. Many health workers use these tools for a variety of professional and educational purposes. Findings from a research project in Nigeria, South Africa and Zambia show that the systematic use of moderated WhatsApp groups amounts to an increase in clinical knowledge and to higher levels of socio-professional connectedness and resilience. The platform’s informal use is linked to professional connectedness and resilience, which are especially relevant for health workers in marginalised settings. However, the unregulated use of WhatsApp by health professionals who lack social media literacy skills may cause significant damage. Training and policies in the use of these platforms are urgently required.
High popularity of mobile apps among health professionals (Nursing students in Nigeria). Photo: © Social Media 4 Health Project
The professional use of mobile instant messaging is mushrooming
Mobile technology is a growing phenomenon, and, among the many mobile apps available today, Instant Messaging platforms, such as WhatsApp, are particularly popular (Statista, 2017). This is also true for many health professionals and increasingly for the ones who live and work in marginalised areas in Sub-Saharan Africa.
In contrast to typical e-health or m-health projects, instant messaging spreads in a grassroots manner: providers across the health profession spectrum have started using the technology for a variety of work-related purposes, as a recent survey study indicates (Pimmer, Lee & Mwaikambo, 2018).
The scale and breadth of the use of Mobile Instant Messaging (MIM) tools by health workers is impressive. In a recent research project in which we have worked with professional nurses and nursing students from Zambia, South Africa and Nigeria, WhatsApp was one of, if not the most popular application. Workshops and focus groups in the three countries indicate that these nurses use WhatsApp for diverse activities such as: hosting meetings, conferences and even further education and training, coordinating drug logistics, dealing with emergencies, managing all sorts of professional groups from small teams to hospital departments and entire faculties, and sharing knowledge and professional information in special interest groups.
Photo: © Social Media 4 Health Project
Socio-professional and educational benefits of WhatsApp use
These relevance of WhatsApp motivated us to research the professional use of the platform in a more systematic manner. Under the auspices of the Swiss Programme for Research on Global Issues for Development (r4d), which is funded by the Swiss Agency for Development and Cooperation and the Swiss National Science Foundation, we have been working with more than 1300 nurses & nursing students, and implemented more than 15 intervention and non-intervention studies to date. The participants were not provided with phones and were not compensated for associated costs, which confirms the low threshold and the intrinsic motivation of many participants in using WhatsApp for professional purposes.
The findings from these studies highlight the educational and socio-professional benefits of WhatsApp, that is it’s potential to connect, train, and empower nurses. We found that, in comparison with control groups, moderated WhatsApp groups during placements and in the context of school-to-work transitions, positively impacted the participants’ knowledge, decreased feelings of professional isolation, and increased their perceived resilience (Ajuwon et al., 2018) (Pimmer, Brühlmann, Odetola, Dipeolu, Oluwasola, et al., 2018). The key to success was the quality of moderation: moderators shared clinical and practical knowledge in an encouraging and stimulating way, triggered reflective practice and facilitated professional discussions.
Another finding is that the informal WhatsApp use alone, i.e., the participants’ day-to-day use of the platform outside of our interventions, is associated with many relevant socio-professional and educational indicators including reduced professional isolation and enhanced social capital, resilience and even job satisfaction (see for example Pimmer, Brühlmann, Odetola, Dipeolu, Gröhbiel, et al., 2018). Although we cannot empirically confirm causality, the findings underscore the relevance that this digital platform has for nurses to remain connected with relevant social (and knowledgeable) ties when they immerse into new and challenging work contexts.
Supportive digital spaces are especially critical in phases in which young professionals start their new job, because whilst having a huge impact on career success and job retention, these transitions are often characterised by negative feelings of “not knowing” and “not belonging”. These can, in turn, contribute to high levels of frustration and attrition of professionals and, at the same time, decrease job retention (Christmas, 2008) (Clark & Springer, 2012). The results of our studies have particular relevance in light of the limited access to up-to-date knowledge resources and professional isolation that many health professionals experience in particular in rural and marginalised settings (Pakenham-Walsh & Bukachi, 2009) (WHO, 2010).
Rural health workers tend to have little access to knowledge and to other professionals. Photo: © Christoph Pimmer
Harmful consequences of lacking social media professionalism
Despite all benefits, the high use of WhatsApp and other social media platforms for professional purposes bears considerable risks. These are grounded in the general concerns about social media use which is unregulated in many settings. In addition, many health professionals are not trained and prepared to use these tools responsibly.
This has been confirmed by our research which has identified several challenges, such as the potential to breach patients’ privacy and confidentiality by sharing identifiable patient information in ‘seemingly’ private groups; and the amount of misinformation, rumours, and false information which may be shared on digital networks without evaluating its trustworthiness. These practices can have ramifications not just for individuals but for the entire profession. In addition, the intrusive nature of instant messaging tempts students and professionals to use the phone directly at the bedside in disrespectful manners, reflecting the lack of social media professionalism.
Against this backdrop, it is all the more surprising that in many settings of our research and beyond there is a lack of policies to guide professionals’ social media and WhatsApp use. What is also lacking is training and preparation that help them to use these tools in a meaningful and sensible manner.
To this end, we have started to address this shortcoming. We are currently developing a report that highlights the problem areas of social media use and we are developing guidelines and suggestions for policies for consideration by ministries, health and education institutions. For example, we are in the process of supporting the development of WhatsApp and social media guidelines for 30’000 nurses in Zambia - in collaboration with the General Nursing Council. In addition, we are devising and evaluating an interactive mobile tutorial which can help students and professionals to acquire relevant skills and evaluate their professional use of social media /WhatsApp.
All research and practice deliverables including articles, “WhatsApp” curricula, moderation & facilitation techniques, policies, guidelines and tutorials for the professional use of WhatsApp and social media can be downloaded freely from http://socialmedia4health.net/.
- Ajuwon, A., Pimmer, C., Odetola, T., Groehbiel, U., Oluwasola, O., & Olaleye, O. (2018). Mobile Instant Messaging to support Teaching Practice: Insights from a nurse tutor program in Nigeria. Malawi Medical Journal, 30(2), 118-124. http://www.mmj.mw/wp-content/uploads/2018/08/MIM.pdf
- Christmas, K. (2008). How work environment impacts retention. Nursing Economics, 26(5), 316. https://www.ncbi.nlm.nih.gov/pubmed/18979696
- Clark, C. M., & Springer, P. J. (2012). Nurse residents' first-hand accounts on transition to practice. Nursing outlook, 60(4), e2-e8. https://www.ncbi.nlm.nih.gov/pubmed/22000691
- Pakenham-Walsh, N., & Bukachi, F. (2009). Information needs of health care workers in developing countries: a literature review with a focus on Africa. Hum Resour Health, 7, 30. https://human-resources-health.biomedcentral.com/track/pdf/10.1186/1478-4491-7-30
- Pimmer, C., Brühlmann, F., Odetola, T. D., Dipeolu, O., Gröhbiel, U., & Ajuwon, A. J. (2018). Instant messaging and nursing students' clinical learning experience. Nurse Education Today, 64, 119–124 http://isiarticles.com/bundles/Article/pre/pdf/128171.pdf
- Pimmer, C., Brühlmann, F., Odetola, T. D., Dipeolu, O., Oluwasola, D. O., & Ajuwon, A. J. (2018). Facilitating Professional Mobile Learning Communities with Instant Messaging Computers & Education. https://www.researchgate.net/publication/327712907_Facilitating_professional_mobile_learning_communities_with_instant_messaging
- Pimmer, C., Lee, A., & Mwaikambo, L. Mobile Instant Messaging - New knowledge tools in Global Health Knowledge Management & E-Learning. http://distance-educator.com/mobile-instant-messaging-new-knowledge-tools-in-global-health/
- Statista. (2017). Most famous social network sites worldwide as of August 2017, ranked by number of active users (in millions). Retrieved from https://www.statista.com/statistics/272014/global-social-networks-ranked-by-number-of-users/
- WHO. (2010). Increasing access to health workers in remote and rural areas through improved retention. Global policy recommendations. Retrieved from http://www.who.int/hrh/retention/guidelines/en/index.html
Christoph Pimmer, PhD, is a senior lecturer and researcher at School of Business, University of Applied Sciences and Arts Northwestern Switzerland (FHNW). His work centres on digital global learning and knowledge management with a particular interest in the fields of global and public health. Email
Ademola J. Ajuwon is a professor at the Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria. His areas of research interests are adolescent reproductive health, HIV/AIDS prevention, social media and research ethics.
Prof Jennifer Chipps is a Professor of Nursing at the University of the Western Cape. Her interests are are eHealth, mHealth, mental health, ageing, e-learning and systematic reviews.