Using WhatsApp messenger for health systems research: a scoping review of available literature

Leadership competencies and behaviours in pharmacy: A qualitative content analysis

BACKGROUND

Across complex healthcare systems, effective leadership rises as a cornerstone for improving patient care, promoting innovation, and maintaining a thriving professional landscape. As with most healthcare professions, pharmacists are confronted with medication complexity, changing legislation, and technological integration into healthcare delivery. Lack of leadership in a pharmacy can lead to unorganized medicine dispensing, patient care, and stagnant innovation. Effective leadership requires competencies that blend knowledge, abilities, and behaviours to achieve tasks successfully. Leadership competencies empower pharmacists to lead change in their profession and healthcare system. Despite extensive research and development in various industries, the development of pharmacy leadership competencies and frameworks is limited due to specific challenges. It is essential for the pharmacy profession to continue investing in the development of leadership competencies to drive innovation and improve patient outcomes.

OBJECTIVE

The objective of the document analysis is to identify pharmacy leadership competencies and analyse related behaviour statements from a global perspective.

METHOD

This study employs an integrative review utilizing a document analysis to conduct a qualitative content analysis on various sources to identify leadership competencies and behaviours within the pharmacy sector. A systematic approach was followed by searching five electronic databases (Medline, CINAHL, SCOPUS, ERIC, and Google Scholar) in addition to grey literature, policy documents and seeking experts for related documents to ensure comprehensive coverage of relevant field-based literature.

RESULTS

Forty-eight documents were selected for analysis from the literature, most of which originated from Western countries with few representing the Middle East and African countries. Eighteen pharmacy frameworks incorporating leadership competencies were identified, two of which were healthcare frameworks encompassing pharmacists. A total of 96 competencies and 155 behaviour statements were identified from the documents. When grouped and similar competencies conjoined, 8 themes with 34 competencies emerged.

CONCLUSION

The document analysis portrays a comprehensive picture of the multifaceted landscape of pharmacy leadership competencies. By exploring the eight themes, their associated competencies and behaviour statements this study offers a roadmap for pharmacists to embark on their own leadership journeys. Future research, armed with the clarity and action-oriented language of effective behaviours, can bridge the gap between leadership and tangible impact.

Assessing the fidelity of the "photo-with-movement program" (PMP) for community-dwelling older adults with pain: A randomized controlled trial

PURPOSE

To measure intervention fidelity of the Photo-with-Movement Program (PMP) and to report the findings of the program.

METHODS

This study was a two-arm, pilot randomized controlled trial of the PMP. An intervention fidelity checklist and semi-structured interviews were utilize to evaluate the fidelity of the PMP. Twenty-four older adults and informal caregiver dyads enrolled in the study, with 12 dyads in the experimental group and another 12 in the control group. The PMP integrated visual stimulation, physical exercise, and digital-based activity to deliver a comprehensive, non-pharmacological pain relief syllabus to the participants in the experimental group. The control group received pain management pamphlets. The data collected were analyzed using SPSS to compare the outcomes between the experimental and control groups.

RESULTS

The PMP led to significant findings on reducing pain intensity and high scores on intervention fidelity. Participants showed great acceptance of this delivery format.

CONCLUSIONS

This study revealed the fidelity and effectiveness of a multimodal non-pharmacological intervention, suggesting that it could be used for pain management and caregiving.

Digital solutions for migrant and refugee health: a framework for analysis and action

Digital technologies can help support the health of migrants and refugees and facilitate research on their health issues. However, ethical concerns include security and confidentiality of information; informed consent; how to engage migrants in designing, implementing and researching digital tools; inequitable access to mobile devices and the internet; and access to health services for early intervention and follow-up. Digital technical solutions do not necessarily overcome problems that are political, social, or economic. There are major deficits with regard to (1) reliable data on the health needs of migrants and mobile populations and on how they can use digital tools to support their health; (2) evidence on effectiveness of solutions; and (3) a broad framework to guide future work. This article provides a wide socio-technical perspective, as a framework for analysis and developing coherent agendas across global-to-local spaces, with particular attention to the European region.

Depression and anxiety in patients with type 2 diabetes in Indonesia and Malaysia: do age, diabetes duration, foot ulcers, and prescribed medication play a role?

Patients with type 2 diabetes mellitus (T2DM) are susceptible to mental health issues, impacting medication adherence and diabetes control. This study aimed to evaluate factors associated with depression and anxiety among T2DM patients in Indonesia and Malaysia. A cross-sectional study was conducted in Indonesia and Malaysia from October 2022 to April 2023 among T2DM patients. The study utilised an instrument with patient and disease data and three validated tools to assess depression, anxiety, and medication adherence. Statistical analysis, including binary logistic regression, was performed using SPSS® version 28 software. A study of 606 T2DM patients revealed that 56.5% were at risk of depression, while 41.6% were at risk of anxiety. Older patients with T2DM had lower rates of depression (AOR = 0.41, 0.25-0.68) and anxiety than younger patients. Normal-weight patients were less likely to experience depression and anxiety (AOR = 0.44, 0.27-0.72) than overweight patients. Patients without diabetic foot ulcers had a lower risk of depression (AOR = 0.34, 0.21-0.55) and anxiety than those with foot ulcers. Patients with a shorter duration of diabetes had a higher risk of depression (AOR = 3.27, 1.70-6.30) and anxiety than those with a longer duration. Patients on insulin-based regimens had higher rates of depression and anxiety (AOR = 2.28, 1.20-4.30) than those on metformin-based regimens. Nonadherent patients were more likely to experience depression and anxiety (AOR = 4.30, 2.22-8.32) than patients who adhered to their medication. The prevalence of depression and anxiety is concerning and influenced by factors such as age, diabetes duration, the presence of diabetic foot ulcers, and the prescribed medication regimen. Further efforts are necessary to enhance the mental health of T2DM patients and improve management outcomes.

Effectiveness of a Novel Global Telemedicine Curriculum for Medical Students

BACKGROUND

The University of Pittsburgh School of Medicine collaborated with The Addis Clinic to create a global telemedicine elective for fourth-year medical students during the COVID-19 pandemic. The elective aimed to promote cross-cultural understanding by providing unique, hands-on telemedicine experience.

AIM

To assess the effectiveness of the telemedicine elective, four of five medical students and 11 of 12 Kenyan clinical officers completed one-on-one interviews and surveys.

SETTING

Students and global health faculty connected virtually with patients and clinical officers from several rural clinics in Kenya during the 4-week elective.

PARTICIPANTS

Per elective month, participants of the course included two fourth-year medical students and five Kenyan clinical officers.

PROGRAM DESCRIPTION

A medical school elective designed in collaboration with The Addis Clinic, using WhatsApp and Telemedicus platform, in which each medical student virtually assisted a team of Kenyan clinical officers with a variety of active patient cases.

PROGRAM EVALUATION

Qualitative analysis of interviews with medical students and Kenyan clinical officers yielded themes of increased competency with clinical decision-making and culturally appropriate care delivery.

DISCUSSION

Implementation of a unique global telemedicine elective was feasible and well received by both medical students and clinical officers in Kenya. The elective can be implemented at other institutions with faculty experienced in global health who would like to partner with The Addis Clinic.

Exploring the clinical profiles and management of juvenile dermatomyositis in Africa: a survey of African rheumatology care providers

BACKGROUND

There are limited studies of juvenile dermatomyositis (JDM) in low and middle-income countries (LMIC). Many demonstrate delays to care, high prevalence of severe manifestations, and high mortality. Given the disease-associated damage with JDM, understanding JDM in Africa further is critical. Our objectives are to understand the burden of JDM in Africa and provider access to diagnostic tools and therapy through survey methodology.

METHODS

A survey (available in English and French) was distributed via WhatsApp to 363 total members of the African League of Associations for Rheumatology (AFLAR; n = 233) and Paediatric Society of the African League Against Rheumatism (PAFLAR; n = 130) from November 2022-January 2023. Topics included respondent specialty, number of JDM patients followed, severe manifestations, and available diagnostic tools and medications (with and without considering cost).

RESULTS

Forty-three (12%) of the 363 providers who received the survey started it. Among the 43 who started the survey, 37 (86%) provided consent and manage JDM patients; of these 37 providers, 4 (11%) partially and 16 (43%) fully completed the survey. Most were adult and/or pediatric rheumatologists (n = 19; 95%). Respondents represented all 5 African regions and described 216 children with JDM within the last 10 years. There was high prevalence of calcinosis (as high as 100%) and interstitial lung disease (ILD) (as high as 32%); mortality rates in Kenya (6/42; 14%) and Zambia (2/7; 29%) exceeded the 1-3% mortality reported in studies of high-income countries. Thirteen of 27 diagnostic tools and medications were accessible to ≤ 50% of respondents after considering cost, mostly in Northern or Southern Africa (9/13; 69%). Despite being cost-free, disease assessment tools and physical exam to assess calcinosis were not reported as universally available or accessible.

CONCLUSIONS

This is the first study to explore experiences of providers caring for children with JDM in Africa. Respondents identified 216 children with JDM seen within the last 10 years, exceeding the 196 children with JDM reported within the last 25 years but likely still underestimating prevalence. Our findings align with reports of severe manifestations and poor outcomes in African children with JDM. Access to many diagnostics and medications is limited, and differences in accessibility parallel regional healthcare disparities. The potential differences in JDM severity warrant systematic study and highlight the need to include patients and providers from LMIC in collaborative research efforts.

Connecting verified databases with clinical practice and the patient' s experience through omnichannel communication

INTRODUCTION

Patient-reported outcomes (PRO) collect data directly from patients. These data are utilized in clinical practice, helping decision-making. Studies emphasize the importance of omnichannel communication (WhatsApp, e-mail, SMS) with healthcare professionals and patients. Omnichannel communication enables the integration of different communication channels to improve the end-client experience. In addition to the means of communication, the daily practice of professionals requires different activities that can be performed in distinct systems. The existence of various separate systems for other activities in medical practice may result in complexities and bottlenecks in their use by healthcare professionals and patients.

OBJECTIVE

To present the Digital Health Ecosystem (DHE) that unifies scientific research with medical practice in omnichannel communication and mechanisms to verify the authenticity and integrity of the data collected and stored.

METHODOLOGY

The system requirements and needs were met utilizing the Iconix development methodology. Microsoft Dot Net was used to develop software. Usability, usefulness and user satisfaction with the system were measured using the Post-Study System Usability Questionnaire (PSSUQ).

RESULTS

Omnichannel communication was utilized to contact patients and healthcare professionals autonomously. A single system enabled the carrying out of patientreported outcome data collection, telemedicine, image storage, and notes from patient consultations. The data was collected through structured questionnaires via link and chatbot. The functionalities created in the HDE allowed the integrity and authenticity verification of the data collected and stored.

CONCLUSION

Personalized omnichannel communication via links and chatbots using WhatsApp, E-mail, and SMS accelerates autonomous interaction with patients and healthcare professionals. In addition, the structured and non-structured data were stored in the EHD and able to be verified for integrity and authenticity.

Evaluating the performance of a virtual platform 'T-BOM' for mentorship in tropical diseases research among early career scientists: Insights from a pilot in Nigeria and other resource-limited settings

Background

Research mentorship plays a crucial role in advancing science. However, there are limited virtual platforms for cultivating mentorship among early career infectious diseases researchers in resource challenged settings. This study reports the findings from the utilization of a recently developed virtual mentorship platform, including its achievements, challenges and needs.

Methods

We developed a web-based application called Top-Bottom Open Mentorship (TBOM) freely accessible at www.tbommodel.com. The platform hosts mentors and allows mentees to send connection requests. In this paper, we present the utilization of this platform, including the opportunities and challenges encountered during the first year of implementation. Utilization data was generated monthly, while opportunities and challenges were captured using a users' perception survey. Data were analyzed in R software and summarized thematically as appropriate.

Results

Between October 2022 and November 2023, the platform registered 81 users, comprising 63 mentees [54.3 % males, 75 % graduate students] from five countries [Nigeria, Cameroon, Brazil, Sudan, and Ghana], and 18 mentors [78 % males] from six countries [Nigeria, USA, Cameroon, Kenya, Brazil, and Tanzania]. Platform engagement increased from 19.4 % (7 users out of 36 who registered) to 51 % (41 users out of 81 who registered) over the year. Also, a total of 16 mentorship cycles were completed, with 9 currently running. Mentees reported having access to job opportunities, enhanced skills in writing, time management, and grant sourcing, and improved research prospects. However, challenges identified include time zone differences, limited number of mentors, mentee's readiness, and associated internet connection issues.

Interpretation

The achievements of T-BOM over a period of one-year are challenged by intrinsic factors from both mentees and mentors, as well as erratic internet services in resource-limited settings. While the platform offers significant opportunities for improving research mentorship, these challenges need to be carefully addressed.

Telehealth of Infants at Risk During the COVID-19 Pandemic: Physical Therapists' and Caregiver's Perceptions and Costs

AIM

We aimed to describe telehealth used to detect infants at risk of neurodevelopmental delay and assess the assessors' and caregivers' perceptions and costs.

METHODS

This was an observational study in which five physical therapists applied the General Movement Assessment, the neurological exam based on the Hammersmith Infant Neurological Examination, and the Alberta Infant Motor Scale via telehealth in 65 infants at risk of neurologic delay during the COVID-19 pandemic. The perceptions of assessors and caregivers were assessed using a questionnaire. We tabulated the family's costs (internet access) and the therapist's expenses (internet access and professional fees).

RESULTS

In general, assessors felt comfortable and reported good quality of teleassessment. They highlighted the significant effort they and caregivers required for synchronous methods, challenges in clearly guiding caregivers on infant positioning, difficulties in adjusting the camera's position, and unstable internet connections. Most assessors expressed a willingness to continue using telehealth. Caregivers displayed high satisfaction, and the costs were minimal.

CONCLUSION

Teleassessment during the COVID-19 pandemic was feasible, although implementing this method of health service in general clinical practice still requires further scrutiny.

The impact of a multi-faceted intervention on non-prescription dispensing of antibiotics by urban community pharmacies in Indonesia: a mixed methods evaluation

INTRODUCTION

Non-prescription antibiotic dispensing is prevalent among community pharmacies in several low- and middle-income countries. We evaluated the impact of a multi-faceted intervention to address this challenge in urban community pharmacies in Indonesia.

METHODS

A pre-post quasi-experimental study was carried out in Semarang city from January to August 2022 to evaluate a 7-month long intervention comprising: (1) online educational sessions for pharmacists; (2) awareness campaign targeting customers; (3) peer visits; and (4) pharmacy branding and pharmacist certification. All community pharmacies were invited to take part with consenting pharmacies assigned to the participating group and all remaining pharmacies to the non-participating group. The primary outcome (rate of non-prescription antibiotic dispensing) was measured by standardised patients displaying symptoms of upper respiratory tract infection, urinary tract infection (UTI) and seeking care for diarrhoea in a child. χ2 tests and multivariate random-effects logistic regression models were conducted. Thirty in-depth interviews were conducted with pharmacists, staff and owners as well as other relevant stakeholders to understand any persistent barriers to prescription-based dispensing of antibiotics.

FINDINGS

Eighty pharmacies participated in the study. Postintervention, non-prescription antibiotics were dispensed in 133/240 (55.4%) consultations in the participating group compared with 469/570 (82.3%) in the non-participating group (p value <0.001). The pre-post difference in the non-prescription antibiotic dispensing rate in the participating group was 20.9% (76.3%-55.4%) compared with 2.3% (84.6%-82.3%) in the non-participating group (p value <0.001).Non-prescription antibiotics were less likely to be dispensed in the participating group (OR=0.19 (95% CI 0.09 to 0.43)) and more likely to be dispensed for the UTI scenario (OR=3.29 (95% CI 1.56 to 6.94)). Barriers to prescription-based antibiotic dispensing included fear of losing customers, customer demand, and no supervising pharmacist present.

INTERPRETATION

Multifaceted interventions targeting community pharmacies can substantially reduce non-prescription antibiotic dispensing. Future studies to evaluate the implementation and sustainability of this intervention on a larger scale are needed.

Providing healthcare under the threat of gang-violence: a survey of Haitian healthcare providers

In addition to having some of the worst health outcomes in the region, Haiti faces a political and economic crisis. The most recent humanitarian crisis includes an increase in homicides and kidnappings in the capital Port-au-Prince. This study is a cross-sectional, mixed methods online survey of health workers and medical students in Port-au-Prince from May 20 - September 15, 2023. It provides evidence of the kidnapping risk healthcare workers face and shares the perspective of a medical community operating in a challenging context to provide a continuity of care under the threat of violence. The survey of Haitian health workers and students show a significant risk of kidnapping with 44% of respondents reporting that they had a colleague kidnapped in the previous 2 years. 5 of the 249 respondents had been kidnapped and all were young, female health workers. 74% of health workers and students surveyed reported they plan to continue their profession abroad. Although teletraining was viewed as a positive opportunity to continue training cadres of medical professionals, health workers shared numerous limitations present for the expansion of telemedicine in the Haitian context. In addition to describing the experience of the Haitian healthcare professional during this crisis and documenting barriers to teletraining and telemedicine, this survey documents design considerations for mobile phone surveys with healthcare providers working in areas affected by conflict.

Using a Mobile Messenger Service as a Digital Diary to Capture Patients' Experiences Along Their Interorganizational Treatment Path in Gynecologic Oncology: Lessons Learned

A digital diary in the form of a mobile messenger service offers a novel method for data collection in cancer research. Little is known about the things to consider when using this data collection method in clinical research for patients with cancer. In this Viewpoint paper, we discuss the lessons we learned from using a qualitative digital diary method via a mobile messenger service for data collection in oncology care. The lessons learned focus on three main topics: (1) data quality, (2) practical aspects, and (3) data protection. We hope to provide useful information to other researchers who consider this method for their research with patients. First, in this paper, we argue that the interactive nature of a digital diary via a messenger service is very well suited for the phenomenological approach and produces high-quality data. Second, we discuss practical issues of data collection with a mobile messenger service, including participant and researcher interaction. Third, we highlight corresponding aspects around technicalities, particularly those regarding data security. Our views on data privacy and information security are summarized in a comprehensive checklist to inform fellow researchers on the selection of a suitable messenger service for different scenarios. In our opinion, a digital diary via a mobile messenger service can provide high-quality data almost in real time and from participants' daily lives. However, some considerations must be made to ensure that patient data are sufficiently protected. The lessons we learned can guide future qualitative research using this relatively novel method for data collection in cancer research.

Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions

The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp's role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner's understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.

Evaluation of an ambulatory care pathway for patients with nitrous oxide-induced myeloneuropathy

Introduction

Cases of nitrous oxide (N2O)-induced myeloneuropathy are increasing at UK hospitals. At our centre, a dedicated ambulatory care pathway, endorsed nationally, was established to treat and monitor patients with N2O-myeloneuropathy in 2021 and refined through three audit cycles. We analysed the outcomes of patients on this pathway to better understand factors associated with non-engagement. Alongside, a novel approach using WhatsApp for questionnaire delivery was trialled in an attempt to improve engagement with treatment.

Methods

Patients on the N2O ambulatory care pathway were identified from MDT meeting lists from 9 September 2022 to 25 April 2023. Clinical data were collected via electronic clinical records, including the most recent neurological examination and reason for discharge from the pathway. Patients identified from MDT lists from 27 January 2023 to 14 March 2023 were approached to participate in weekly 12-item surveys, delivered via WhatsApp. This was approved as a service development project with approval for WhatsApp use given by the chief clinical information officer.

Results

35/56 (62.5%) patients were discharged from ambulatory care due to non-attendance and 17/56 (30.4%) completed their treatment course. The median time from initial presentation to discharge was 49 days. 24/40 (60.0%) of patients with a final neurological examination documented had a residual deficit, with objective sensory deficits most common. 12 patients were approached to receive weekly questionnaires via WhatsApp. 5/8 who expressed interest returned a consent form. All participants were withdrawn due to non-response or participant choice. 1/5 returned more than two surveys.

Conclusion

Despite poor participation in surveys delivered via WhatsApp, novel approaches are needed to improve engagement with patients on the N2O ambulatory care pathway.

WhatsApp-based intervention for people with type 2 diabetes: A randomized controlled trial

Diabetes mellitus is a metabolic disease characterized by prolonged elevated blood glucose levels. Diabetes self-management education and support programs are widely used in western countries. The impact of social media education and support interventions such as a WhatsApp-based program and the nurses' role in supporting and implementing this self-management program unclear. Using a WhatsApp-based program, we evaluated the effects of a 6-week program in improving self-efficacy and education among people with type 2 diabetes mellitus in Saudi Arabia. Eligible participants (n = 80) were recruited with the support of nurses into a randomized controlled trial and randomly assigned into self-management intervention and control groups. The intervention group (n = 40) received the self-management program support and the usual care. The control group (n = 40) received only the usual care with nurses' support. Results from generalized estimating equation analysis showed a significant increase in self-efficacy, self-management, and education in the WhatsApp-based intervention support group compared with the control group at 6 and 12 weeks (follow-up). Implementing the program via social media improves self-efficacy. The use of social media platforms should be promoted for global diabetes management.

Effects of a WhatsApp-Assisted Health Educational Intervention for Cardiac Rehabilitation: A Randomized Controlled Clinical Trial Protocol

Although the effectiveness of cardiac rehabilitation (CR) programs in secondary prevention is well-recognized, there is a lack of studies exploring the potential of mobile health to enhance educational interventions within CR. The objective is to assess the impact of a structured WhatsApp-assisted health educational intervention, in conjunction with the usual care, compared to the usual care alone among participants enrolled in a CR program. The trial will recruit 32 participants enrolled in a CR program, who will be randomly assigned to a structured WhatsApp-assisted health educational intervention plus usual care or usual care alone group. The intervention will span 4 weeks, with assessments at baseline, 4 weeks, and 3, 6, and 12 months. The primary outcome measure is the cardiovascular risk factors knowledge score. Secondary outcomes include physical activity levels, anxiety and depression, and quality of life. Expected results include improved knowledge of cardiovascular risk factors, increased physical activity levels, and better mental health outcomes in the intervention group. Additionally, an enhancement in the overall quality of life is anticipated. These findings are expected to underscore the value of integrating mHealth with traditional CR methods, potentially shaping future approaches in chronic disease management and prevention.

Toward identification and intervention to address financial toxicity and unmet health-related social needs among adolescents and emerging adults with cancer and their caregivers: A cross-cultural perspective

PURPOSE

We qualitatively explored the unique needs and preferences for financial toxicity screening and interventions to address financial toxicity among adolescents and emerging adults (younger AYAs: 15-25 years) with cancer and their caregivers.

METHODS

We recruited English- or Spanish-speaking younger AYAs who were treated for cancer within the past 2 years and their caregivers. Semi-structured interviews were conducted to explore preferences for screening and interventional study development to address financial toxicity. The data were coded using conventional content analysis. Codes were reviewed with the study team, and interviews continued until saturation was reached; codes were consolidated into categories and themes during consensus discussions.

RESULTS

We interviewed 17 participants; nine were younger AYAs. Seven of the 17 preferred to speak Spanish. We identified three cross-cutting themes: burden, support, and routine, consistent, and clear. The burden came in the form of unexpected costs such as transportation to appointments, as well as emotional burdens such as AYAs worrying about how much their family sacrificed for their care or caregivers worrying about the AYA's physical and financial future. Support, in the form of familial, community, healthcare institution, and insurance, was critical to mitigating the effects of financial toxicity in this population. Participants emphasized the importance of meeting individual financial needs by routinely and consistently asking about financial factors and providing clear guidance to navigate these needs.

CONCLUSION

Younger AYAs and their caregivers experience significant financial challenges and unmet health-related social needs during cancer treatment and often rely on key supports to alleviate these unmet needs. When developing interventions to mitigate financial toxicity, clinicians and health systems should prioritize clear, consistent, and tailorable approaches to support younger AYA cancer survivors and their families.

Field based research in the era of the pandemic in resource limited settings: challenges and lessons for the future

The coronavirus pandemic that began in December 2019, has had an unprecedented impact on the global economy, health systems and infrastructure, in addition to being responsible for significant mortality and morbidity worldwide. The "new normal" has brought along, unforeseen challenges for the scientific community, owing to obstructions in conducting field-based research in lieu of minimizing exposure through in-person contact. This has had greater ramifications for the LMICs, adding to the already existing concerns. As a response to COVID-19 related movement restrictions, public health researchers across countries had to switch to remote data collections methods. However, impediments like lack of awareness and skepticism among participants, dependence on paper-based prescriptions, dearth of digitized patient records, gaps in connectivity, reliance on smart phones, concerns with participant privacy at home and greater loss to follow-up act as hurdles to carrying out a research study virtually, especially in resource-limited settings. Promoting health literacy through science communication, ensuring digitization of health records in hospitals, and employing measures to encourage research participation among the general public are some steps to tackle barriers to remote research in the long term. COVID-19 may not be a health emergency anymore, but we are not immune to future pandemics. A more holistic approach to research by turning obstacles into opportunities will not just ensure a more comprehensive public health response in the coming time, but also bolster the existing infrastructure for a stronger healthcare system for countries.

Healthcare workers' experiences with COVID-19-related prevention and control measures in Tanzania

The ability of a health system to withstand shocks such as a pandemic depends largely on the availability and preparedness of health-care workers (HCWs), who are at the frontline of disease management and prevention. Despite the heavy burden placed on HCWs during the COVID-19 pandemic, little is known regarding their experiences in low-income countries. We conducted a web-based survey with HCWs in randomly selected districts of Tanzania to explore their experiences with COVID-19-related prevention and control measures. The survey assessed implementation of COVID-19 control guidelines in health facilities, HCW perceptions of safety, well-being and ability to provide COVID-19 care, and challenges faced by frontline workers during the pandemic. We used multivariate regression analysis to examine the association between HCW and health facility characteristics, a score of guideline implementation, and challenges faced by HCWs. 6,884 Tanzanian HCWs participated in the survey between December 2021 to March 2022. The majority of respondents were aware of the COVID-19 guidelines and reported implementing preventive measures, including masking of both HCWs and patients. However, HCWs faced several challenges during the pandemic, including increased stress, concerns about infection, and inadequate personal protective equipment. In particular, female HCWs were more likely to report exhaustion from wearing protective equipment and emotional distress, while physicians were more likely to experience all challenges. While most HCWs reported feeling supported by facility management, they also reported that their concerns about COVID-19 treatment were not fully addressed. Notably, perceptions of protection and well-being varied widely among different HCW cadres, highlighting the need for targeted interventions based on level of exposure. In addition, various factors such as HCW cadre, facility ownership and COVID-19 designation status influenced HCWs' opinions about the health system's response to COVID-19. These findings highlight the importance of consistent implementation of guidelines and social and emotional support for HCWs.

Feasibility of Lantern Using WhatsApp to Improve Antiretroviral Therapy Adherence

This pilot study tested the feasibility of Lantern program, an adherence program to HIV medications using WhatsApp, a secure social media messaging application from Meta, for a smartphone-based platform to enhance medication-taking adherence of antiretroviral therapy among people living with HIV in Indonesia. Thirty participants were recruited for this 8-week study. We recruited persons if they had taken antiretroviral therapy for at least 3 months prior to the study, had a smartphone, Internet access, and could use Lantern with WhatsApp. Here, we report the results from the focus group discussions, with the participants evaluating the qualitative aspects of the experiences. The WhatsApp platform was found to be safe, practical, and relatively inexpensive and provided confidentiality for the participants. Three themes emerged from the focus groups: the study motivated participants to take their antiretroviral therapy medications on time, they still set medication reminder alarms, and being in the study made them feel supported. The Lantern program indicated good feasibility and acceptability for adherence to antiretroviral therapies among people living with HIV. Future research should examine on how community organizations and healthcare providers can take advantage of the WhatsApp program to improve adherence to antiretroviral therapies.

Factors that influence modern contraceptive use among women aged 35 to 49 years and their male partners in Gomoa West District, Ghana: a qualitative study

BACKGROUND

Fertility declines with age, but it remains important to protect women from unplanned pregnancies throughout their reproductive lives. The objective of this study was to describe factors that influence modern contraceptive use among women aged 35 to 49 years and their male partners in Gomoa West District of Ghana.

METHODS

In-depth interviews were conducted remotely for 22 women, 15 male partners of the women interviewed and seven family planning (FP) providers. In all, a total of 44 participants took part in the study. Seven refusals were recorded, four females and three males. Four focus group discussions were organized for 21 participants who took part in the in-depth interviews. Data collected were transcribed and coded after exporting to Nvivo12 qualitative analysis software. Thematic analysis was undertaken using an abductive approach.

RESULTS

Factors that influenced the use of modern contraceptives included: achieved desired family size, providing for the family, counselling by health professionals, influence of the male partner, and health reasons. Barriers cited included: religious or socio-cultural reasons, experience or fear of side effects, rumors or misconceptions, declining fertility, and the belief that contraceptive use is a matter for women. Within the study group, roughly half of women used modern contraceptives, while the majority of male partners were non-users.

CONCLUSION

Contraception among women aged 35 to 49 years and their male partners is influenced by several factors such as achieved desired family size, influence of the male partner, rumors or misconceptions, and declining fertility. Strengthening male involvement in family planning activities and health educational activities could alleviate fear and reduce misconceptions about using modern contraceptives.

Practice points for lymphoedema care in low- and middle- income countries developed by nominal group technique

BACKGROUND

Lymphoedema is a common, distressing, and debilitating condition affecting more than 200 million people globally. There is a small body of evidence to guide lymphoedema care which underpins several lymphoedema clinical practice guidelines developed for high-income countries (HIC). Some of these recommendations are unlikely to be feasible in low-resource settings.

AIM

To develop practice points for healthcare workers that optimise lymphoedema care in low- and middle-income countries (LMIC).

METHODS

A nominal group technique (NGT) was undertaken to gain consensus on which content from HIC guidelines was important and feasible to include in practice points for LMIC, and other important advice or recommendations. Participants included experts, clinicians, and volunteers involved in lymphoedema care in LMIC. The NGT followed five key stages: silent 'ideas' generation, round-robin rationale, clarification, refinement and verification. The first, fourth and fifth stages were completed via email, and the second and third during a video meeting in order to generate a series of consensus based prevention, assessment, diagnosis, and management of lymphoedema in LMIC practice points.

RESULTS

Of sixteen participants invited, ten members completed stage 1 of the NGT (ideas generation), of whom six contributed to stages 2 (round-robin) and 3 (clarification). All those who completed stage 1 also completed stages 4 (refinement) and 5 (verification). Practice points unanimously agreed on included Complex Decongestive Therapy (CDT) and good skin care, with management to be determined by lymphoedema stage. For podoconiosis-endemic areas, the use of socks and shoes was identified as very important in the prevention of non-filarial lymphoedema and other lymphoedema-causing conditions. Participants indicated that diagnosing lymphoedema using the lymphoscintigraphy and Indocyanine green (ICG) fluorescent lymphography was not possible due to unavailability and cost in LMIC. Surgical procedures for lymphoedema management were unanimously eliminated due to the unavailability of technology, limited workforce, and expensive cost in LMIC.

CONCLUSION

The consensus-based practice points generated by this project provide healthcare workers with guidance on caring for people with lymphoedema in LMIC. Further development of workforce capacity is needed.

An analysis of migration and implications for health in government policy of South Africa

For over a decade, the global health community has advanced policy engagement with migration and health, as reflected in multiple global-led initiatives. These initiatives have called on governments to provide universal health coverage to all people, regardless of their migratory and/or legal status. South Africa is a middle-income country that experiences high levels of cross-border and internal migration, with the right to health enshrined in its Constitution. A National Health Insurance Bill also commits the South African public health system to universal health coverage, including for migrant and mobile groups. We conducted a study of government policy documents (from the health sector and other sectors) that in our view should be relevant to issues of migration and health, at national and subnational levels in South Africa. We did so to explore how migration is framed by key government decision makers, and to understand whether positions present in the documents support a migrant-aware and migrant-inclusive approach, in line with South Africa's policy commitments. This study was conducted between 2019 and 2021, and included analysis of 227 documents, from 2002-2019. Fewer than half the documents identified (101) engaged directly with migration as an issue, indicating a lack of prioritisation in the policy discourse. Across these documents, we found that the language or discourse across government levels and sectors focused mainly on the potential negative aspects of migration, including in policies that explicitly refer to health. The discourse often emphasised the prevalence of cross-border migration and diseases, the relationship between immigration and security risks, and the burden of migration on health systems and other government resources. These positions attribute blame to migrant groups, potentially fuelling nationalist and anti-migrant sentiment and largely obscuring the issue of internal mobility, all of which could also undermine the constructive engagement necessary to support effective responses to migration and health. We provide suggestions on how to advance engagement with issues of migration and health in order for South Africa and countries of a similar context in regard to migration to meet the goal of inclusion and equity for migrant and mobile groups.

Development of a Technology-Based Intervention to Improve Help-Seeking in Distressed Non-Treatment-Seeking Young Adults With Common Mental Health Concerns

Background There is a dearth of interventions aimed at improving help-seeking for common mental health concerns among distressed young adults, particularly in the urban Indian context. Availability of cost-effective, targeted intervention for improving appropriate help-seeking can pave the way for reducing the treatment gap. This could prove especially beneficial in low-resource settings. This study describes the guiding principles, underlying theory, and development process of a simple technology-based help-seeking intervention for distressed non-treatment-seeking young adults. Methods Several models of professional help-seeking behavior were examined to ascertain a suitable theoretical framework for the development of the intervention to enable help-seeking among distressed non-treatment-seeking young adults. Pilot work was carried out before the development, along with content validation of the intervention by field experts. Results Help-seeking intervention was developed based on the preferences of young adults and literature review. Eight core intervention components and one optional component were developed, which were built on selected theoretical frameworks. These components have been postulated to enhance awareness of common mental health problems, the utility of self-help, and support of significant others, and to increase the skills to understand when it may be appropriate to step up to professional help-seeking. Conclusion Help-seeking interventions delivered beyond the traditional clinic and hospital setups prove useful as low-intensity interventions acting as gateways to seek mainstream mental health services. Further research will evaluate the feasibility, acceptability, and effectiveness of the intervention in reducing perceived barriers and enhancing inclination to seek professional help and help-seeking behavior among distressed non-treatment-seeking young adults.

Construct validity of the physical activity neighborhood environment scale-Oman

Aims

This study aims to examine the construct validity of Physical Activity Neighborhoods Environment Scales, Oman (PANES-O), and compare the subjective perceptions with objective measures in Muscat, the capital area of Oman.

Methods

Walkability index scores using GIS maps were calculated for 35 study areas in Muscat based on which five low and 5 high walkable study areas were randomly selected. A community survey was then conducted in November 2020 in each study area using the 16-item PANES-O instrument to measure the participants' perception of neighborhood density, land use mix, infrastructure, safety, aesthetics, and street connectivity. Due to pandemic restrictions, a social media-based purposive sampling strategy was utilized to reach community-based networks and complete digital data collection.

Results

Significant differences between the low and high walkablehigh-walkable neighborhoods were observed for 2 of 3 macroenvironment subscales, density and land use. Respondents in high walkable neighborhoods perceived their areas as having more twin villas (P = 0.001) and apartment buildings (P &lt; 0.001), greater access to destinations (like more shops, and places to go within walking distance; P &lt; 0.001), easy access to public transport (P &lt; 0.001), and more places to be active (P &lt; 0.001); than their counterparts in low walkable neighborhoods. In terms of microenvironmental attributes, respondents in high walkablehigh-walkable neighborhoods perceived their areas to have better infrastructure, better aesthetic qualities, and better social environment than their counterparts in low walkablelow-walkable neighborhoods. Significant differences in perceptions across 12 of the 16-item PANES tool confirmed that 6 of the 7 subscales were significantly sensitive to built environment attributes between the low and high walkable study areas. Respondents in high walkable neighborhoods perceived their areas as having greater access to destinations (like more shops, places to go within walking distance; P ≤ 0.001), easy access to public transport (P ≤ 0.001), more places to be active (P ≤ 0.001), better infrastructure (like more sidewalks, facilities to bicycle; P ≤ 0.001), and better aesthetic qualities (P ≤ 0.001). PANES-O also was able to rate high walkable neighborhoods to be higher in residential density and land-use mix compared to the low walkable neighborhoods demonstrating its sensitivity to the GIS maps' objective measures.

Conclusions and recommendations

These results provide preliminary strong support for the construct validity of PANES-O, suggestingconfirming that it is a promising tool for assessing macroenvironmental perceptions related to physical activity in Oman. Further research using objective measures of microenvironments and device-based physical activity scores is needed to confirm the criterion validity of the 10 micro-environmental attributes of PANES-O using objective measures for the microenvironment. PANES-O could be used to generate and develop the needed evidence on the most appropriate approaches to improving the built environment to promote physical activity and urban planning in Omanthe country.

Barriers and facilitators to implementing Advanced HIV Disease screening at secondary referral hospital -Malawi: Asequential exploratory mixed method-study

Background Malawi continues to register increased HIV/AIDs mortality despite increased expansion of ART services. One of the strategies for reducing AIDS related deaths outlined in the Malawi National HIV Strategic Plan (NSP) is scaling up screening for AHD in all antiretroviral therapy (ART) screening sites. This study investigated factors influencing the implementation of the advanced HIV disease (AHD) screening package at Rumphi District Hospital, Malawi. Methods We conducted a mixed method, sequential exploratory study from March, 2022 to July, 2022. The study was guided by a consolidated framework of implementation research (CFIR). Interviews were administered to key healthcare providers, purposively selected from various hospital departments. Transcripts were organized and coded using NVivo 12 software with thematically predefined CFIR constructs. Newly HIV-positive client records extracted from ART cards (July -Dec, 2021) were analyzed using STATA 14 which generated table of proportions, means and standard deviations. Results Out of 101 data records of the new ART clients reviewed, 60% {(n = 61) had no documented results for CD4 Cell count as a baseline screening test for AHD. Four major themes emerged as barriers: complexity of the intervention, poor work coordination, limited resources to support the expansion of point of care services for AHD, knowledge and information gap among providers. Technical support from MoH implementing partners and the availability of committed focal leaders coordinating HIV programs emerged as major facilitators of AHD screening package. Conclusion The study has identified major contextual barriers to AHD screening affecting work coordination and client linkage to care. Improving coverage of AHD screening services would therefore require overcoming the existing barriers such communication and information gaps.

Virtual Aunting and Public Health Emergencies: A Novel Approach to Sharing Public Health Guidance

Effective communication with the public is essential during health emergencies. As evident during the coronavirus disease 2019 (COVID-19) pandemic, the lack of effective public health communication with equity-deserving groups has contributed to higher morbidity and mortality than the non-racialized community. This concept paper will describe a grassroots community effort to provide culturally safe public health information to the East African community in Toronto at the beginning of the pandemic. Community members collaborated with The LAM Sisterhood to create a virtual aunt, Auntie Betty, and record voice notes with essential public health guidance in Swahili and Kinyarwanda. This manner of communicating with the East African community was well-received and has shown great potential as a tool to support effective communication efforts during public health emergencies that disproportionately impact Black and equity-deserving communities.

Privacy-Aware Architectures for NFC and RFID Sensors in Healthcare Applications

World population and life expectancy have increased steadily in recent years, raising issues regarding access to medical treatments and related expenses. Through last-generation medical sensors, NFC (Near Field Communication) and radio frequency identification (RFID) technologies can enable healthcare internet of things (H-IoT) systems to improve the quality of care while reducing costs. Moreover, the adoption of point-of-care (PoC) testing, performed whenever care is needed to return prompt feedback to the patient, can generate great synergy with NFC/RFID H-IoT systems. However, medical data are extremely sensitive and require careful management and storage to protect patients from malicious actors, so secure system architectures must be conceived for real scenarios. Existing studies do not analyze the security of raw data from the radiofrequency link to cloud-based sharing. Therefore, two novel cloud-based system architectures for data collected from NFC/RFID medical sensors are proposed in this paper. Privacy during data collection is ensured using a set of classical countermeasures selected based on the scientific literature. Then, data can be shared with the medical team using one of two architectures: in the first one, the medical system manages all data accesses, whereas in the second one, the patient defines the access policies. Comprehensive analysis of the H-IoT system can be useful for fostering research on the security of wearable wireless sensors. Moreover, the proposed architectures can be implemented for deploying and testing NFC/RFID-based healthcare applications, such as, for instance, domestic PoCs.

Using mobile phones, WhatsApp and phone interviews to explore how children's hospice nurses manage long-term relationships with parents: a feasibility pilot

BACKGROUND

Mobile phones are familiar to most nurses, but the applications available for voice recording and transfer of audio files in research may not be.

AIM

To provide an overview of a pilot study which trialled the use of mobile phones, WhatsApp and phone interviews as a safe and reliable means of collecting data.

DISCUSSION

A pilot study was designed to test the use of: mobile phones as a safe and reliable way to record audio diaries as research data; WhatsApp to transmit the audio files; and phone interviews to explore them. Undertaking the pilot demonstrated that the tools proposed for collecting data were useable and acceptable to the target population and that the researcher's guidance for doing so was satisfactory.

CONCLUSION

New technologies enable innovation but trialling them for useability is important. Confidentiality and consent need to be carefully managed when using WhatsApp to ensure a study is compliant with data protection regulations.

IMPLICATIONS FOR PRACTICE

Collection of research data digitally and remotely has become increasingly mainstream and relied on during the COVID 19 pandemic. The methods discussed in this article provide solutions for timely data collection that are particularly useful when the researcher is geographically distant from participants. The 'in the moment' reflective nature of the audio diaries could also be applicable to non-research settings - for example, as a method of assisting ongoing professional development and/or collection of reflective accounts.

Rapid implementation of telepharmacy service to improve patient-centric care and multidisciplinary collaboration across hospitals in a COVID era: A cross-sectional qualitative study

Background and Aim

The COVID-19 pandemic forced healthcare systems to apply new technology-based solutions. The main objective of our study was to describe the conceptual model for rapid implementation of telepharmacy service and the main steps that should be considered.

Method

In response to a limited number of on-site clinical pharmacy specialists and a lack of technology infrastructure, a cross-sectional telepharmacy program was established to support major teaching hospitals. A store and forward model of teleconsultation was employed using WhatsApp messenger to cover various aspects of multidisciplinary collaboration in COVID-19 management. All identifiable personal information was removed from all exchanged messages of collaborative consultations. The thematic analysis of consultations was performed to extract the main themes and subthemes that should be considered for designing future telepharmacy systems.

Results

Through telepharmacy service, 600 intensive care unit teleconsultations for COVID-19 cases were conducted in the residence center and nonresidence centers. In total, 1200 messages were exchanged between specialists in 3 months. The average time taken to respond to a message was 1.30 h. Thematic analysis revealed four main concepts and 15 subconcepts that should be considered in telepharmacy consultations for COVID-19 management. Based on the extracted themes, a conceptual model for developing a telepharmacy program was devised.

Conclusion

The results showed that by utilizing telehealth, clinical pharmacists could cover critically ill patients who need pharmacotherapy counseling through interdisciplinary collaboration. Moreover, the main features of our service that are represented through this survey can be employed by other researchers for developing telepharmacy services.

Implementation of a colorectal cancer screening intervention in Malaysia (CRC-SIM) in the context of a pandemic: study protocol

INTRODUCTION

Colorectal cancer (CRC) is the second most common cancer in Malaysia and cases are often detected late. Improving screening uptake is key in down-staging cancer and improving patient outcomes. The aim of this study is to develop, implement and evaluate an intervention to improve CRC screening uptake in Malaysia in the context of the COVID-19 pandemic. The evaluation will include ascertaining the budgetary impact of implementing and delivering the intervention.

METHODS AND ANALYSIS

The implementation research logic model guided the development of the study and implementation outcome measures were informed by the 'Reach, Effectiveness, Adoption, Implementation and Maintenance' (RE-AIM) framework. This CRC screening intervention for Malaysia uses home-testing and digital, small media, communication to improve CRC screening uptake. A sample of 780 people aged 50-75 years living in Segamat district, Malaysia, will be selected randomly from the South East Asia Community Observatory (SEACO) database. Participants will receive a screening pack as well as a WhatsApp video of a local doctor to undertake a stool test safely and to send a photo of the test result to a confidential mobile number. SEACO staff will inform participants of their result. Quantitative data about follow-up clinic attendance, subsequent hospital tests and outcomes will be collected. Logistic regression will be used to investigate variables that influence screening completion and we will conduct a budget impact-analysis of the intervention and its implementation. Qualitative data about intervention implementation from the perspective of participants and stakeholders will be analysed thematically.

ETHICS AND DISSEMINATION

Ethics approval has been granted by Monash University Human Research Ethics Committee (MUHREC ID: 29107) and the Medical Review and Ethics Committee (Reference: 21-02045-O7G(2)). Results will be disseminated through publications, conferences and community engagement activities.

TRIAL REGISTRATION NUMBER

National Medical Research Register Malaysia: 21-02045-O7G(2).

The Importance of Behavioral and Native Factors on COVID-19 Infection and Severity: Insights from a Preliminary Cross-Sectional Study

The COVID-19 pandemic has had a major impact on a global scale. Understanding the innate and lifestyle-related factors influencing the rate and severity of COVID-19 is important for making evidence-based recommendations. This cross-sectional study aims at establishing a potential relationship between human characteristics and vulnerability/resistance to SARS-CoV-2. We hypothesize that the impact of the virus is not the same due to cultural and ethnic differences. A cross-sectional study was performed using an online questionnaire. The methodology included the development of a multi-language survey, expert evaluation, and data analysis. Data were collected using a 13-item pre-tested questionnaire based on a literature review between 9 December 2020 and 21 July 2021. Data were statistically analyzed using logistic regression. For a total of 1125 respondents, 332 (29.5%) were COVID-19 positive; among them, 130 (11.5%) required home-based treatment, and 14 (1.2%) intensive care. The significant and most influential factors on infection included age, physical activity, and health status (p < 0.05), i.e., better physical activity and better health status significantly reduced the possibility of infection, while older age significantly increased it. The severity of infection was negatively associated with the acceptance (adherence and respect) of preventive measures and positively associated with tobacco (p < 0.05), i.e., smoking regularly significantly increases the severity of COVID-19 infection. This suggests the importance of behavioral factors compared to innate ones. Apparently, individual behavior is mainly responsible for the spread of the virus. Therefore, adopting a healthy lifestyle and scrupulously observing preventive measures, including vaccination, would greatly limit the probability of infection and prevent the development of severe COVID-19.

Research on the move: exploring WhatsApp as a tool for understanding the intersections between migration, mobility, health and gender in South Africa

BACKGROUND

Reflecting global norms, South Africa is associated with high levels of cross-border and internal population mobility, yet migration-aware health system responses are lacking. Existing literature highlights three methodological challenges limiting the development of evidence-informed responses to migration and health: (1) lack of engagement with the process of migration; (2) exclusion of internal migrants; and (3) lack of methodologies that are able to capture 'real-time' data about health needs and healthcare seeking experiences over both time and place. In this paper, we reflect on a four-month pilot project which explored the use of WhatsApp Messenger - a popular mobile phone application used widely in sub-Saharan Africa - and assessed its feasibility as a research tool with migrant and mobile populations in order to inform a larger study that would address these challenges.

METHOD

A four-month pilot was undertaken with eleven participants between October 2019 and January 2020. Using Survey Node, an online platform that allows for the automatic administration of surveys through WhatsApp, monthly surveys were administered. The GPS coordinates of participants were also obtained. Recruited through civil society partners in Gauteng, participants were over the age of 18, comfortable engaging in English, and owned WhatsApp compatible cell phones. Enrolment involved an administered survey and training participants in the study protocol. Participants received reimbursement for their travel costs and monthly cell phone data.

RESULTS

Out of a possible eighty eight survey and location responses, sixty one were received. In general, participants responded consistently to the monthly surveys and shared their location when prompted. Survey Node proved an efficient and effective way to administer surveys through WhatsApp. Location sharing via WhatsApp proved cumbersome and led to the development of a secure platform through which participants could share their location. Ethical concerns about data sharing over WhatsApp were addressed.

CONCLUSIONS

The success of the pilot indicates that WhatsApp can be used as a tool for data collection with migrant and mobile populations, and has informed the finalisation of the main study. Key lessons learnt included the importance of research design and processes for participant enrolment, and ensuring that the ethical concerns associated with WhatsApp are addressed.