Mobile instant messaging for rural community health workers: a case from Malawi

Abstract

Background: Mobile instant messaging (MIM) tools, such as WhatsApp, have transformed global communication practice. In the field of global health, MIM is an increasingly used, but little understood, phenomenon. Objectives: It remains unclear how MIM can be used by rural community health workers (CHWs) and their facilitators, and what are the associated benefits and constraints. To address this gap, WhatsApp groups were implemented and researched in a rural setting in Malawi. Methods: The multi-site case study research triangulated interviews and focus groups of CHWs and facilitators with the thematic qualitative analysis of the actual conversations on WhatsApp. A survey with open questions and the quantitative analysis of WhatsApp conversations were used as supplementary triangulation sources. Results: The use of MIM was differentiated according to instrumental (e.g. mobilising health resources) and participatory purposes (e.g. the enactment of emphatic ties). The identified benefits were centred on the enhanced ease and quality of communication of a geographically distributed health workforce, and the heightened connectedness of a professionally isolated health workforce. Alongside minor technical and connectivity issues, the main challenge for the CHWs was to negotiate divergent expectations regarding the social versus the instrumental use of the space. Conclusions: Despite some challenges and constraints, the implementation of WhatsApp was received positively by the CHWs and it was found to be a useful tool to support distributed rural health work.

The Inherent Tensions of “Instant Education”: A Critical Review of Mobile Instant Messaging

“…in a group space), which can be a complex and conflictual process. For example , Pimmer, Mhango, Mzumara, and Mbvundula (2017) found that one of the prevailing challenges in the use of WhatsApp groups was the ongoing negotiation and reconciliation of users' divergent expectations regarding social versus task-oriented use of the space. What complicates this process further is that the poles which create these tensions are neither valuable nor damaging by themselves.…”

Technology and rehabilitation training for community health workers: Strengthening health systems in Malawi

“…The participants were of mixed demographics, age and gender, and training programme attendance was 100%. There were several key -All et al, 2017;Knettel et al, 2017;Pimmer, Mhango, Mzumara, & Mbvundula, 2017;Vijay & Mincy, 2015). These studies all similarly found statistically significant within-group differences be- and consideration of CHW's perspectives (Huang et al, 2018).…”

“…Studies have, however, evaluated training programmes in other areas. Several articles have evaluated various rural CHW training programme effectiveness for areas of healthcare including identification and management of disabilities, maternal health education and CVD management (Abdel‐All et al, ; Knettel et al, ; Pimmer, Mhango, Mzumara, & Mbvundula, ; Vijay & Mincy, ). These studies all similarly found statistically significant within‐group differences between pre‐ and post‐test scores demonstrating training programmes can be effective in improving knowledge of CHWs (Abdel‐All et al, ; Knettel et al, ; Vijay & Mincy, ).…”

WhatsApp Messaging for Sharing Best Practices and Prevention of Professional Isolation: A Case of HIV Nurse Practitioners in Zambia

“…It has changed the communication landscape and made it easier and faster to share information between individuals and among groups (Pimmer & Tulenko, 2016). This is also revealed by Pimmer et al (2017) On the other hand, the use of mobile phone for Mobile Instant Messaging in nursing education and practice comes with its own challenges, some which include, but not limited to high cost, compromise to infection control efforts, interference with medical equipment (Phillippi & Wyatt, 2011), as well as ethical issues involving data security (Pimmer et al, 2017).…”

“…This sharing of social information may serve to minimize feelings of isolation especially to those nurses operating from rural settings (Pimmer et al, 2017).…”