The m-Health revolution: Exploring perceived benefits of WhatsApp use in clinical practice

https://doi.org/10.1016/j.ijmedinf.2016.10.013Get rights and content

Highlights

  • This study aimed to investigate perceived benefits of WhatsApp use in clinical practice.

  • General medical and emergency teams perceived WhatsApp as beneficial in clinical management.

  • Perceived benefits of WhatsApp use was significantly associated with usage characteristics and type of communication events.

Abstract

Background

The dawn of m-Health facilitates new horizons of professional communication through WhatsApp, allowing health professionals to interact fast and efficiently for effective patient management. This preliminary study aimed to investigate perceived benefits, if any, of WhatsApp use across general medical and emergency teams during clinical practice in Malaysia.

Methods

A cross-sectional study was conducted in a universal sample of 307 health professionals comprising of nurses, medical assistants, medical residents, medical officers and physicians across medical and casualty departments in a Malaysian public hospital. The self-administered questionnaire consisted of items on socio-demographics, WhatsApp usage characteristics and the type of communication events during clinical practice.

Results

The majority of respondents (68.4%) perceived WhatsApp as beneficial during clinical practice. In multivariate analysis, perceived benefits was significantly higher amongst the clinical management group (aOR = 2.6, 95% CI 1.5–4.6, p = 0.001), those using WhatsApp for >12 months (aOR = 1.7, 95% CI 1.0–3.0, p = 0.047), those receiving response ≤15 min to a new communication (aOR = 1.9, 95% CI 1.1–3.2, p = 0.017), and frequent information giving events (aOR = 2.4, 95% CI 1.2–4.8, p = 0.016).

Conclusion

Perceived benefits of WhatsApp use in clinical practice was significantly associated with usage characteristics and type of communication events. This study lays the foundation for quality improvement innovations in patient management delivered through m-Health technology.

Introduction

Incomplete, fragmented and disorganized clinical communications contribute to the bulk of medical errors during patient management [1]. Traditional methods of communications that rely on face-to-face meetings, telephone conversations and alphanumeric paging systems have reported adverse events in patient care [1]. Better reliable, accurate and efficient communication methods are required for acute situations such as to summon a clinician at patient’s bedside or reporting critical test results [2].

Clinical communications have been revolutionized with the proliferation of innovative and versatile sophisticated communication gadgets, like smart-phones, allowing speedy internet connectivity for instant access to vast amounts of medical information, including imaging results, laboratory tests, clinical practice guidelines and drug reference guides [1], [3].

The World Health Organization (WHO) Global Observatory for e-Health (GOe) defined m-Health or mobile health as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices [4]. The dawn of m-Health facilitates new horizon of clinical communication through communication tools like Line, WeChat, Tango, Viber or WhatsApp, allowing healthcare professionals to interact fast and efficiently for effective patient management. WhatsApp (WhatsApp Inc., Mountain View CA), an app compatible in smartphones allow users to text messages and media content via videos, voice messages or photographs to their contacts. It facilitates creation of group chats, allowing multiple users to participate, monitor and reply to conversations. WhatsApp utilizes cellular data plans and wireless Internet networks with an annual subscription fee of $0.99.

There are approximately five billion mobile phone subscriptions globally, with over 85% being covered by commercial wireless signal [5]. In Malaysia the usage of smart phones is estimated to be 63%. WhatsApp, a cross-platform app being compatible in all smart-phone platforms like Android, iPhone and Windows mobile has approximately 500 million users worldwide [6]. Malaysians are the third leading global mobile internet population using WhatsApp as a communication tool [7]. Studies report the ownership of smart-phones amongst healthcare professionals for clinical communication range between 60 and 80% [3], [8].

Clinical communications amongst multidisciplinary teams are often obtunded around decision making, autonomy and role enactment as a result from hierarchical structure of the medical system, impeding collegial communication and compromising patient care [9]. A recent report concluded that general and orthopedic surgeons perceive WhatsApp as an intra-departmental tool for quality improvement innovations of patient care, overcoming gaps of professional autonomy, establishing excellent clinical communication and handovers between surgical teams [6], [8]. After an extensive literature search, to date, there has not been a published study which evaluated the use of WhatsApp in medical teams. This preliminary investigation aimed to explore perceived benefits of WhatsApp use amongst general and emergency medical teams.

Section snippets

Study setting and population

This cross-sectional study was conducted among 324 health professionals across general medical and emergency departments at the Tengku Ampuan Rahimah Hospital (HTAR) Klang, which is Malaysia’s second busiest public health facility in terms of patient admissions [10].

All health professionals (nurses, medical assistants, medical residents, medical officers, and physicians) from medical and emergency departments were approached using universal sampling technique during Departmental Continuous

Sample characteristics

Three hundred twenty four healthcare professionals were invited to participate and 307 (94.8%) participated. The sample consisted of 60 (19.5%) males and 247 (80.5%) females. The mean (±SD) age of respondents was 27.9 (±5.8) years.

WhatsApp usage characteristics

Two hundred ten (68.4%) respondents perceived WhatsApp as beneficial in clinical practice. The majority of WhatsApp users were health professionals from the first contact group, 179 (58.3%). The mean (±SD) duration of WhatsApp use, time spent on Whatsapp per day and

Discussion

This study found that almost a third of the participants perceived WhatsApp was beneficial, majority of who were health professionals from the clinical management group. More than half of all respondents used the app during ward rounds, clinics, procedure rooms and during on calls. Information giving was the most common reason although in general; discussions, clinical questions, instruction giving comments and administrative question and responses were also very frequent reasons. All these

Strengths of the current study

Albeit the bulk of potential advantages of WhatsApp use were determined in surgical specialties [6], [8] this study was the first to explore perceived benefits of WhatsApp use among healthcare professionals across both casualty and general medical specialities. Our enthusiasm to explore the usefulness and practicality of WhatsApp as a compatible, easily available and cost-effective communication tool exhibited novel findings on potential benefits of WhatsApp use in clinical practice. The study

Limitations

This cross-sectional single-center study could not establish temporality and limits the generalizability of the study findings. Although perceived benefits are well described, this study could not establish measurable benefits. The absence of a control group lacks further exploration of a comparison communication system. Future research could replicate some of the experimental methods reported by Khanna et al. [6]. The study, conducted in a surgical setting showed better resident knowledge of

Conclusion

Although the benefits of using WhatsApp are abundant but a substantial number of participants reported no perceived benefit. This could be because of they are keen to keep separate between work and private life and they may fear unprofessional communications [25] and are probably worried about the disruption of daily work due to increased accessibility [6]. A previous study reported that nearly 53% of clinical staffs received work-related text-messages while not at work [33]. A universal or

Author contributions

Dr. Kurubaran Ganasegeran, BMedSc (Hons), MBBS, MSc HR (Postgraduate Student): Conception and design, analysis and interpretation of data, manuscript writing and preparation

Dr. Pukunan Renganathan, MD: Technical and material support, literature search

Prof. Abdul Rashid, MBBS, MHSc, PhD: Manuscript writing and preparation, critical revision of the manuscript for important intellectual content

Prof. Sami Abdo Radman Al-Dubai, MBBS, MPH, DrPH: Analysis and interpretation of data, supervision of

Competing interests

The authors declare that they have no competing interests.

Funding

None.

Summary points

What was already known about the topic?

  • Communication mishaps contribute to the bulk of medical errors in clinical practice.

  • The application of m-Health technology through WhatsApp allows efficient interaction for effective patient management.

What this study adds?

  • This study aimed to investigate perceived benefits of WhatsApp use across general medical and emergency teams during clinical practice.

  • Majority of respondents (68.4%) perceived WhatsApp as beneficial during clinical

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    This research project was presented and awarded the Best Poster Presentation Award at the Selangor State Research Day Conference, Ministry of Health Malaysia.

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