As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
Can WhatsApp be effectively used to increase knowledge about family planning among healthcare providers and students?
Senior Program Officer II
Johns Hopkins Center for Communication Programs
Johns Hopkins Center for Communication Programs (lead)
Recruited participants: Students from Kenya Medical Training College in Kitui and Outspan Medical College and healthcare providers from nursing facilities at the Kitui District Hospital; Nairobi University; University of Eastern Africa, Baraton; Moi University; and Masinde Muliro University of Science and Technology.
August 2016 – May 2017
Health Care Provider
To provide quality healthcare, healthcare providers need access to up-to-date technical information. Challenges to improving knowledge among health workers include lack of technical skills, low motivation to improve knowledge and skills, and poor support networks. Traditional training and resources available to health workers, such as conferences and workshops, can pose logistical challenges for those in remote areas who must arrange both for travel and for work coverage during their absence. Paper resources, such as textbooks and manuals, eventually become outdated, and it can be costly to update, publish, and distribute new versions. In recent years, online and mobile learning platforms have emerged as possible solutions to these training challenges (Sissine et al., 2014).
Given the popularity of WhatsApp, the USAID-funded Knowledge for Health (K4Health) Project tested the WhatsApp Messenger platform as a mode to deliver family planning continued professional development training content to Kenyan health workers and promote knowledge exchange and discussion. A seven-week training program on healthy timing and spacing of pregnancy (HTSP) was designed and delivered to 160 participants who already provide family planning counseling and care or were expected to provide such services after completing their degree program.
K4Health surveyed students at Kenya Medical Training College (KMTC) Kitui about the family planning and reproductive health topics that most interested them. As HTSP ranked highest, K4Health adapted the WhatsApp training content from K4Health’s “Healthy Timing and Spacing of Pregnancy” topic page (Jayarajan, Lee, and Mwaikambo, 2017). K4Health chose to use its topic page as the primary content source because it provides a highly curated selection of diverse resources. Working with a Kenya-based K4Health expert who has experience in instructional design and eLearning and was familiar with the audience, the K4Health team selected four different resource types to use for the training curriculum: blog posts, videos, infographics, and journal articles. Additionally, 10 questions from the Global Health eLearning Center’s HTSP eLearning course final exam were selected and adapted for the pretest and post-test knowledge assessment survey. The survey was created using Google Forms and was posted as a link in the WhatsApp Group Chat platform.
The WhatsApp HTSP Training employed WhatsApp Group Chat. K4Health’s Kenya-based consultant created four WhatsApp groups and invited 40 participants to each group. In total, 160 participants volunteered for this activity: 80 students and 80 healthcare providers. Participants were recruited from KMTC Kitui, Outspan Medical College, and nursing facilities at the Kitui District Hospital; Nairobi University; University of Eastern Africa, Baraton; Moi University; and Masinde Muliro University of Science and Technology.
The WhatsApp HTSP Training was designed as a seven-week workshop. To earn a certificate of completion, participants had to complete a pretest and post-test knowledge assessment survey, as well as a usability survey.
K4Health measured the acceptability and feasibility of using the WhatsApp Group for continued professional development through a usability survey, a qualitative analysis of the Group Chat transcripts, and comparing pretest and post-test knowledge assessments.
Of the 160 enrolled participants, 107 (67 percent) completed the survey. Of the 160 enrolled participants, 83 (52 percent) completed both the pretest and post-test. The chat transcripts were reviewed to determine the following:
Overall, both providers and students found the WhatsApp HTSP Training to be useful, especially in improving their knowledge of the topic. Videos, research articles, and discussion questions were the content types reported as being the most useful in improving knowledge, whereas the infographic and blog post were the least useful.
The majority (74 percent) of provider and student participants reported that they had posted a message to their WhatsApp Group, while 26 percent reported that they did not. The most frequently mentioned reason why they did not post was they did not have additional comments or questions to add to the discussion.
Of the 160 participants, 83 completed both the pretest and post-test knowledge assessment surveys. Out of a possible 10 points, the average pretest knowledge assessment score was 6.72, and the average post-test knowledge assessment score was 7.10, indicating an average knowledge gain of 0.38 points. The average scores at post-test for both providers and students improved only slightly. Given the small sample sizes (especially for the provider group), we did not run any analysis to test for statistical significance.
Technologies like WhatsApp offer potential solutions to training challenges related to access to face-to-face learning events or updated technical content. Setup and installation are simple and free as the WhatsApp app is available on device app stores, such as Google Play Store or Apple Store. Also, many health providers already use the platform professionally and personally on their own mobile devices, so convincing new users to download and install the popular app is easy, and costs related to training participants on how to use the technology are minimal.
Designing a structured training using the Group Chat feature is relatively easy. However, identifying training content, paying attention to content formats, and employing a group administrator trained in fostering learning communities are key considerations to include in the training activity planning phase.
Finally, further study and evidence is needed to understand best practices for facilitating and fostering productive learning environments on the WhatsApp Group Chat messaging feature.
Notably, although the K4Health Project is no longer active, the use of WhatsApp in this manner for continuing education is still being used by KMTC Kitui instructors. This is not the case at the district hospital, where no medical officer or nurse matron considered it was their role to provide this type of continuing education and take on the role of WhatsApp Group administrator.