WhatsApp and YouTube as platforms for facilitating lifestyle modifications among individuals with hypertension in a low-income, urban community in Karachi, Pakistan: a qualitative study

Introduction Owing to an increase in internet access, mobile health is increasingly used to deliver health interventions in low- and middle-income countries. Applications like WhatsApp have been successfully used to deliver and complement health interventions. Methods This qualitative study explores the feasibility and acceptability of using WhatsApp and YouTube for facilitating lifestyle modification in adults with hypertension, living in a low-income urban community in Karachi, Pakistan. 19 community members diagnosed with hypertension, with access to phone and internet (mean age±SD: 50±8.7 years; 10 male) were engaged for 3 weeks through WhatsApp and YouTube. Culturally relevant videos based on evidence-based guidelines to mitigate risk factors of hypertension, that is, low salt diet, medication adherence and emotional regulation, were created and uploaded on a YouTube channel. Participants were added to two same-sex WhatsApp groups moderated by a clinical psychologist (called behavioural coach), who shared the link to the videos, assigned and tracked practical tasks and facilitated discussions to build peer support. At the end of the 3 weeks, YouTube and WhatsApp engagement metrics were reviewed to understand the way participants engaged on both platforms. In-depth interviews with participants, content of WhatsApp chats and field notes of the behavioural coach were analysed for themes regarding feasibility and acceptability of the delivery mechanism from both the provider and participants’ perspective. Results Asynchronous engagement was appreciated by participants as it provides convenience to engage on their time; it also provided time to the behavioural coach to curate messages according to individual needs of the participants. Acceptability of participants to engage in interventions related to lifestyle modification through such a mechanism increased through education and experience in the groups. Conclusion WhatsApp and YouTube are feasible and acceptable to deliver lifestyle modification interventions for patients with hypertension in a low-income urban community in Karachi.