WhatsApp as a Platform for Continued Professional Development in Kenya

Can WhatsApp be effectively used to increase knowledge about family planning among healthcare providers and students?

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Contact

Lisa Mwaikambo
Senior Program Officer II
Johns Hopkins Center for Communication Programs
Email

Implementation Partners

Johns Hopkins Center for Communication Programs (lead)
IntraHealth (subcontractor)

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.

Funder

USAID

Implementation Dates

August 2016 – May 2017

Geographic Scope

Kenya

Target Users

Health Care Provider

Enabling Environment Building Blocks

Workforce

Family Planning Program Classification

Service Delivery

Introduction

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 Paper resources, such as textbooks and manuals, eventually become outdated, and it can be costly to update, publish, and distribute new versions.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.

Project/Digital Health Solution Overview

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.

Evaluation and Results Data

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: 

  • Participants’ understanding of the training instructions. 
  • Participants’ ability to access the training materials. 
  • Participants’ engagement with the group administrator and other participants. 
  • The technical issues that participants encountered during the training.

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.

Lessons Learned

  • Provide a mix of resource types, including non-multimedia resources, such as PDF files that can be downloaded and printed, so that participants can respond if they are unable to access the multimedia versions.
  • Decrease the number of questions asked of participants.
  • Allow more time for participants to answer questions.
  • If the goal is to promote knowledge-sharing and not simply to increase knowledge around a particular topic, it is important to rethink the structure of the training content. Instead of including only fact-based questions that are right or wrong, it would be useful to present scenarios and ask participants to reflect on those and share how they have responded and/or would respond in the future.

Conclusion

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.

References

  • Jayarajan, N., Lee, A., and Mwaikambo, L. (2017). WhatsApp as a Platform for Continued Professional Development. Baltimore, MD: Johns Hopkins Center for Communication
  • Programs: Sissine, M. et al. (2014). Cost comparison model: blended eLearning versus traditional training of community health workers. Online Journal of Public Health Informatics6(3).