WhatsApp as a medium to collect qualitative data among adolescents: lessons learned and considerations for future use

Introduction

In the field of adolescent sexual and reproductive health (ASRH), candid youth perspectives are necessary to understanding the nuances of contraceptive access and use. In Malawi, where 22% of married and 52% of unmarried sexually active women between the ages of 15–19 report an unmet need for family planning (National Statistical Office/Malawi and ICF, 2017), more precise data on adolescents’ contraceptive barriers, needs and preferences is needed to bridge the gap between adolescents who want to prevent pregnancies but do not use contraception. Technology may provide an avenue for collecting this ASRH data and with added privacy.

WhatsApp is a mobile messaging technology popular across the world, allowing users to send images, text, video and voice messages; and conduct individual or group conversations¹ (Kumar & Sharma, 2017). As WhatsApp has become a popular medium for communication (Rosenfeld et al., 2018), examples have emerged of the platform being used in health care and public health². WhatsApp has been employed to conduct supportive supervision with community health care workers, reduce rural health worker feelings of isolation and recent nursing graduates’ fears about transitioning to professional life, improve communication between consulting and emergency physicians, support delivery of out-of-hours pharmacy services, and bolster medical education programs (Ajuwon et al., 2018; Copestake et al., 2020; Gulacti et al., 2016; Henry et al., 2016; Pimmer et al., 2017; Pimmer et al., 2019; Pimmer, 2015; Raiman et al., 2017; Rathbone et al., 2020; Willemse, 2015; Willemse et al., 2019). WhatsApp has also been utilized to help deliver public health interventions, including a bed net campaign in Mozambique, HIV counseling for men who have sex with men in Peru, and for sending health information to new parents in South Africa³ (Arroz et al., 2019; Bayona et al., 2017). However, there are few recorded examples of WhatsApp being used for research in public health (Chen & Neo, 2019; Fardousi et al., 2019). The use of WhatsApp focus group discussions (FGDs) for a 2019 waste management study in Singapore indicated the potential for using the platform for health research, while underscoring the need to further develop mobile messaging as a qualitative research method (Chen & Neo, 2019). Another study published in 2019 utilized WhatsApp to conduct remote interviews exploring health workers’ perceptions in a conflict zone. The study commented on issues such as internet connectivity and confidentiality concerns as factors that impacted the ability to conduct interviews via WhatsApp (Fardousi et al., 2019).

In June 2018, VillageReach used WhatsApp FGDs to collect qualitative data from Malawian youth on contraceptive needs and preferences, as part of a larger study funded by the Bill & Melinda Gates Foundation entitled Youth-led Contraceptive Knowledge Generation and Design. WhatsApp was selected as a tool for eliciting information from adolescents because the mobile messaging application is popular among sub-populations of Malawian youth⁴ (Matto & Kazungu, 2018), thereby offering researchers a chance to test whether or not the platform could offer an innovative approach to obtaining sensitive information from young people who may be uncomfortable sharing such information in traditional face-to-face FGDs.

Approach

Fifteen WhatsApp FGDs were conducted, either as in-person (12) or remote (3) sessions. In-person WhatsApp FGDs were conducted at a specific time and location, such as youth clubs, sports facilities, schools or health centers, for approximately one hour. Remote FGDs convened several times each week over the period of one month, ranging from discussions totaling three hours to 10 hours each week. Participants were male and female Malawian adolescents, aged 15–19 (n=134). Sessions occurred in three target geographic regions across Malawi (northern, central and southern). The study was approved by the Malawi National Health Sciences Research Committee (Protocol Number: 17/05/1813).

To recruit WhatsApp FGD participants the study team met with youth network community leaders and district youth officers to describe the research and target group. These community contacts then reached out to local youth groups, purposively selecting potential participants who fit the age and geographic sampling criteria. In-person WhatsApp FGD participants (n=96) were loaned a WhatsApp-enabled phone for one hour to allow for their participation in the FGD. In-person participants were mixed gender, stratified by marital status, urban/rural locality, and geographic region (or district); there were eight participants per FDG Remote WhatsApp FGD participants (n=38) did not gather at a central location; rather they used their own WhatsApp-enabled smartphones to respond to the weekly facilitated scenarios as they continued with their daily activities. Remote groups were mixed with regard to participant gender, marital status, and urban/rural locality, and were only stratified by geographic region. Northern, central and southern region remote sessions had 9, 11, and 16 participants, respectively.

Six Malawian youth researchers (YRs), aged 22-to 25 and native to the target districts, were recruited to facilitate the WhatsApp FGDs. The YR position was posted on local job boards and newspapers and resulted in over 500 applications, of which 23 applicants were interviewed. The interviews covered past experience and how applicants would handle hypothetical data quality and research ethics scenarios. A scoring rubric was completed by the interview panel and scores were used to select the six YRs for hire. Facilitation training for the YRs lasted four days and included study background, research ethics, FGD logistics, and role as moderator. Just prior to WhatsApp data collection we hosted a four hour refresher training devoted to the WhatsApp technology and how to moderate in that context. Following the training, YR’s worked with VillageReach staff to finalize eight scenarios depicting context-relevant ASRH situations to generate discussion in the FGD sessions.

Participants provided written informed consent and those participating in the in-person FGDs with study phones were given transport reimbursement, while those in the remote FGDs and using personal phones were compensated with 500MB of airtime data. Participants were given an additional 500MB of data as needed during the course of the remote sessions. WhatsApp FGDs consisted of a YR sharing an ASRH scenario, and then managing the virtual discussion with posed questions and probing. Participants were able to message directly with the YR if they did not want to share something with the full group. A VillageReach staff member was present at each in-person session and was included in each remote group to provide support to the YRs if needed.

Debriefing sessions were held either in-person or by phone following each FGD in which VillageReach staff and YRs iteratively discussed their observations and experiences and built consensus on what worked, what did not work and lessons learned for future use of WhatsApp FGDs; these findings were documented as debriefing summaries and approved by all debriefing session participants.

Lessons learned

Applying WhatsApp mobile messaging technology to facilitate FGDs yielded learnings about use of this methodology related to data collection, data quality and data analysis.

Considerations for future use

While there are benefits to the WhatsApp FGD methodology, there are considerations that may complicate data collection in comparison to other qualitative methods. The approach requires certain logistics such as access to power sources to keep phones charged as well as WIFI or stable mobile data network connection to ensure FGDs run smoothly, and ensuring these pre-conditions exist requires planning. Additionally, the methodology may not be conducive to every demographic and as elaborated elsewhere, requires target populations to have some level of smartphone literacy, which should be considered when sampling populations with low rates of smart phone ownership (Chen & Neo, 2019).

Costs associated with WhatsApp FGDs (providing devices, data) may prohibit use of the platform for research in health. However, with a projected increase in smartphone ownership⁵ paired with introduction of low-cost WhatsApp bundles by some sub-Saharan mobile network operators, more people have access to this platform and other social media than ever before⁶. WhatsApp may also be a more cost-effective option in some circumstances, as it allows researchers to collect data on an ongoing basis without traditional costs such as hall rentals, transportation reimbursement to participants, etc.

Regardless of cost, this methodology may be more convenient for researchers and participants in some cases, particularly if aiming to engage the same cohort over time. The method may also be better positioned to reach the adolescent audience due to the technology’s flexibility, convenience and portability, and expanding familiarity of the WhatsApp platform (and of smartphones, generally) in adolescent sub-populations across Africa⁷. Further, our research indicates that the anonymity and privacy offered by WhatsApp FGDs may be an important factor in youth feeling comfortable to share sensitive information, especially in social environments like Malawi where adolescents place a high value on keeping sexual behavior hidden from elders, parents and peers (Limaye et al., 2012; Munthali et al., 2006).

Conclusions/discussion

WhatsApp provides an alternative platform for researchers when eliciting information from adolescents on sensitive topics. The tool has both advantages and disadvantages associated with data collection, data quality and analysis, which should be considered prior to using WhatsApp for FGDs. The potential of this methodology is to allow researchers to collect in-depth and granular qualitative data and is a strength of the approach when working with challenging topics or stigmatized populations, who may be particularly concerned participating in more visible forms of data collection such as in person FGDs or in-depth interviews. Adolescents indicated feeling comfort using WhatsApp to share their perspectives on sensitive topics. Additionally, the opportunity to collect qualitative data over a longer period of time allows researchers to collect a great quantity of data as well as offers the potential for in-depth nuanced data as participants have more time to gain confidence and trust with the researchers and fellow participants.

By utilizing mobile messaging technologies, such as WhatsApp, health researchers may be better able to connect to adolescent experiences in ways reflecting contemporary youth culture and communication preferences. This in turn, could enhance the visibility of youth perspectives in health research and help improve the effectiveness of youth-targeted public health interventions.

As the use of WhatsApp grows to support health sector projects, there is a need to elevate more examples of lessons learned to drive technology to address the challenges faced using the tool. It will also be important to promote successes so researchers can consider whether it is a suitable platform for their work. As technology is applied in new ways in research, it is critical that the research community establishes guidelines for addressing ethical considerations, such as recruitment of diverse perspectives and considerations around data security and privacy.

Data availability

All data underlying the results are available as part of the article and no additional source data are required.