“WhatsApp is best!” Acceptability and feasibility of WhatsApp-based HIV microlearning for healthcare workers in remote South African clinics: A pragmatic, mixed-methods, cluster-randomised trial

AIM: To determine the usability of WhatsApp-based HIV microlearning for healthcare workers. This paper reports acceptability and feasibility. BACKGROUND: HIV guidelines are regularly updated making ongoing training essential. Distance, infrastructure, human and financial resource constraints are challenges to training in South Africa. Innovative, accessible, scalable and sustainable training is needed. The country has 100 % mobile phone penetration; 93 % WhatsApp use. DESIGN: A pragmatic, mixed-methods, parallel-group cluster-randomised trial, conducted in 50 clinics, with intervention and control groups receiving training at different times. METHODS: 233 nurses and 206 community health workers participated. Short case-based lessons were held in WhatsApp groups. Uptake, feasibility, accessibility, changes in knowledge and patient care were measured with analysis of online questionnaires, WhatsApp interactions, focus groups and folder reviews. Focus group sampling was purposive and convenience. Twelve focus groups and one interview were held, with 21 nurses and 42 community health workers. Qualitative data were analysed using template analysis. RESULTS: Overall sentiment was positive, with 98 % of participants saying they would participate if the training were held weekly throughout the year. Three themes described sentiment: (1) 'WhatsApp group is best' - training was effective and interesting; easy and enjoyable; live group learning, with trainer access was appreciated; and further training was wanted; (2) Challenges - infrastructural/technology-based; language barriers/jargon; and message fatigue; (3) Recognition, appreciation and empowerment. Participants expressed satisfaction, with 98.6 % of nurses and 95.2 % of CHWs finding the training useful. CONCLUSIONS: WhatsApp-based microlearning for healthcare workers is feasible and well-received. Future research should explore application at scale.