How are instant messaging applications used informally for paediatric health consultations in Pakistan? A qualitative study with caregivers and healthcare providers in Punjab

Introduction: The informal use of instant messaging applications for healthcare consultations is rapidly increasing in low- and middle-income countries. Despite its widespread adoption, there is limited research on how these tools are implemented, experienced by users and integrated into health systems. This study aims to provide insight into the practical functioning, perceived value and key challenges of WhatsApp-based paediatric consultations in Pakistan. Methods: We conducted a qualitative phenomenological study using an interpretive approach across multiple healthcare settings in Punjab. In-depth, semi-structured interviews were held with 19 parents (13 mothers, 6 fathers) and 12 healthcare providers who actively used WhatsApp for paediatric consultations. Data were analysed thematically, guided by the newly developed ACCESS-Loop model. Results: WhatsApp was used as a user-driven, informal digital channel for paediatric consultations. Access was mediated through social capital and provider altruism, compensating for systemic barriers. Clinical practice involved 'digital auscultation' via multimedia, with providers and parents jointly negotiating diagnostic uncertainty and informal triage thresholds. While this approach enhanced access and convenience, it was marked by a trade-off between interpersonal trust and data privacy and substantial provider burden. Conclusion: WhatsApp-based paediatric consultations represent a complex, grassroots adaptation to healthcare system limitations. While enhancing access, this informal system poses significant challenges regarding clinical quality, patient safety, provider well-being, data privacy and equity. The findings underscore the need for contextually appropriate guidelines, training and policy interventions.