Effectiveness of WhatsApp based debunking reminders on follow-up visit attendance for individuals with hypertension: a randomized controlled trial in India.

BACKGROUND: Individuals with high blood pressure in India often miss essential follow-up visits. Missed visits contribute to gaps across the hypertension care continuum and preventable cardiovascular disease. Widespread misconceptions around hypertension care and treatment may contribute to low follow-up attendance rates, but to date, there is limited evidence of the effect of interventions to debunk such misconceptions on health-seeking behavior. We conducted a randomized controlled trial to measure whether combining information debunking commonly-held misconceptions with a standard reminder reduces missed follow-up visits among individuals with high blood pressure and investigated whether any observed effect was moderated through belief change. METHODS: We recruited 388 patients with uncontrolled blood pressure from the outpatient wards of two public sub-district hospitals in Punjab, India. Participants randomly assigned to the intervention arm received two WhatsApp messages, sent 3 and 1 days before their physician-requested follow-up visit. The WhatsApp message began with a standard reminder, reminding participants of their upcoming follow-up visit and its purpose. Following the standard reminder, we included brief debunking statements aimed at acknowledging and correcting common misconceptions and misbeliefs about hypertension care seeking and treatment. Participants in the control group received usual care and did not receive any messages. RESULTS: We did not find evidence that the enhanced WhatsApp reminders improved follow-up visit attendance (Main effect: 2.2 percentage points, p-value = 0.603), which remained low across both treatment (21.8%, 95% CI: 15.7%, 27.9%) and control groups (19.6%, 95% CI: 14.2%, 25.0%). Participants had widespread misconceptions about hypertension care but our debunking messages did not successfully correct these beliefs (p-value = 0.187). CONCLUSIONS: This study re-affirms the challenge of continuity of care for chronic diseases in India and suggests that simple phone-based health communication methods may not suffice for changing prevalent misconceptions and improving health-seeking behavior. TRIAL REGISTRATION: The trial began on July 18th. We registered the trial on July 18th (before recruitment began), including the main outcomes, on the German Clinical Trial Register [Identifier: DRKS00029712] and published a pre-analysis plan in the Open Science Framework [osf.io/67g35].

Leveraging the use of a social media app as a collaborative medical information and knowledge sharing tool-insights from experiential use and survey of a CME WhatsApp community.

BACKGROUND AND AIM: Continuing Medical Education (CME) is crucial for physicians to stay current in the rapidly advancing field of medicine. A WhatsApp (WA) based community of physicians was initiated in 2016 'WhatsApp CME India Group' to facilitate learning, knowledge sharing, and discussion among physicians. Due to participant size constraints of the technology, it evolved into seven distinct WA groups, overseen by a central administrator. A survey undertaken in the group's 7th year aimed to evaluate its effectiveness in achieving its goals, measure participant engagement, and uncover the primary factors driving its usage. METHODS: The survey questionnaire was distributed to 3500 members across the 07 WhatsApp CME groups for voluntary participation. Data collected was analysed using SPSS version 24.0 (SPSS Inc., Chicago, IL, USA) and reported using descriptive statistics. RESULTS: Among the 581 survey respondents, the study found 43% of physicians use the WhatsApp academic groups for CME content, with 32% accessing their group over four times daily. The primary motivation for 77% was to discuss challenging cases and to gain knowledge updates from fellow physician (70%). Medical websites (57%), referral books (49%), and Google (43%) were other significant resources. Every participant (100%) found the WhatsApp CME India group the most beneficial resource for daily medical science updates. A significant portion (57%) of the respondents found the group valuable for real-time information exchange. Over 78% stated it kept them current with knowledge and guidelines. Notably, 94% viewed WhatsApp CME as complementary to physical conferences, not a replacement. The post-conference/webinar summaries were appreciated by 81% participants. Case discussions (31%) and update posts from fellow physicians sharing their insights and learnings (24%) were noted as activities of great academic interest. CONCLUSION: This study underscores the potential of digital platforms like WhatsApp in supplementing CME in India and potentially other comparable settings. The blend of digital and traditional resources suggests a balanced learning approach. While real-time engagement is a strength, challenges like information overload and privacy concerns require careful management. Striking a balance is crucial for ensuring content quality, structured discussions and privacy. As the digital age advances, professionals must critically assess shared information on these platforms to guarantee evidence-based and reliable knowledge dissemination. TRIAL REGISTRATION: ARK 001.

Utility of instant messaging application, WhatsApp, as a tool to augment post-graduate radiology education.

BACKGROUND: Smart phone technology including different instant messaging applications like, WhatsApp, can be used for the development of radiological skills, reporting, and performance. To determine the utility, attitude, and outcome of WhatsApp for augmenting education in FCPS radiology residency program. To assess the opinion of radiology residents regarding WhatsApp as a tool to enhance postgraduate training. METHODOLOGY: A mixed method (qualitative and quantitative) was conducted at Dow Institute of Radiology, Karachi, Pakistan. All FCPS Radiology residents were given a radiological case by principal investigator followed by residents' response in 24 h. Key findings were shared by the mentor. Before and after the intervention of WhatsApp, all residents were evaluated with written and radiological imaging reporting exam. For quantitative analysis, a closed ended questionnaire was used containing information about total number of messages, images, webpage links shared, level of contribution (active/non-active), and utility (contribution in education related topic only). A feedback form with Likert scale was also got filled by all residents. For qualitative research, semi structured interviews (SSIs) were conducted. RESULTS: Median number of total images shared were 293 (IQR 1002 images), messages shared 110 (IQR), webpages shared were 54 webpages (61 webpages) and total contents shared by participants was 243 (544 contents). Active contributors showed better performance in utility, competency of contents and attitude towards using social media as a medium for learning. Comparison of written and OSCE results showed better performance after the intervention. Feedback form with Likert scale revealed that students responded positively regarding the shared learning content. Thematic analysis showed 52 codes and 16 themes. CONCLUSION: In this research we have observed that WhatsApp is highly efficient and productive academic tool which can amplify postgraduate radiology education. Student's narrative reflects that residents have found the missing link which can take them to radiological professional excellence through targeted high-profile learning outside lecture hall in time and place convenient motivational environment. Once it will be blended with existing teaching strategy, it can prove to be a game changer.

Insights on associations between the frequency of use of diverse social media products and social networks use disorder tendencies from a German speaking sample.

OBJECTIVE: In the present work we investigate how individual differences in at least occasionally using distinct social media platforms is linked to social networks use disorder (SNUD) tendencies. A final sample of n = 2200 participants filled in the AICA-C-9 measure to get insights into individual differences in overuse of social media and participants also indicated which platforms they used at least once a month. RESULTS: The analysis revealed a robust positive association between number of at least occasionally used social media apps and SNUD tendencies (r = .44, p < .001). Further, platforms differed in terms of their "addictive potential", if one takes associations between frequency of distinct platforms use and SNUD tendencies as a proxy for this (and of course the actual descriptive statistics of the SNUD scale for the (non-)frequent user groups of the different platforms). In this regard, at least occasionally using some platforms (here Tumblr, Twitter and TikTok) was associated with highest SNUD tendencies. Moreover, largest differences in terms of effect sizes between the occasional and non-occasional user groups regarding SNUD scores could be observed for Instagram, WhatsApp, and TikTok. The present work bases on data from a larger project investigating associations between SNUD and tobacco use disorder.

People with type 2 diabetes experiences of using WhatsApp-based diabetes self-management education and support: The process evaluation.

RATIONAL: Online Diabetes Self-Management Education and Support (DSMES) offers people with type 2 diabetes mellitus (T2DM) accessible and tailored education, utilising innovative and interactive tools such as social media to enhance engagement and outcomes. Despite the demonstrated effectiveness of social media-based DSMES in improving health outcomes, there remains a significant gap in qualitative insights regarding participants' experiences. AIM: This study aims to explore the experiences of people with T2DM who are using a newly developed WhatsApp-based DSMES. METHODS: A qualitative descriptive approach was adopted. Data consisted of 23 semi-structured phone interviews with people with T2DM who had received the WhatsApp-based DSMES. Interviews were analysed using qualitative content analysis. The present study adheres to the COREQ guidelines. RESULTS: Four themes emerged from the data: (1) acceptability of the programme, (2) flexible accessibility of the programme, (3) promoting healthy lifestyle and (4) future preferences for the programme use. CONCLUSION: This study explored the experiences of people with T2DM participating in a 6-week WhatsApp-based DSMES. The findings indicated that the programme was acceptable, accessible, effectively revealing necessary self-management knowledge and skills, and provided essential support from professional and peer. The study also indicated that WhatsApp-based programmes could be feasibly implemented in various populations, healthcare settings and communities to support people with T2DM globally.

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.

A text-based conversational agent for asthma support: Mixed-methods feasibility study.

Objective: Millions of people in the UK have asthma, yet 70% do not access basic care, leading to the largest number of asthma-related deaths in Europe. Chatbots may extend the reach of asthma support and provide a bridge to traditional healthcare. This study evaluates 'Brisa', a chatbot designed to improve asthma patients' self-assessment and self-management. Methods: We recruited 150 adults with an asthma diagnosis to test our chatbot. Participants were recruited over three waves through social media and a research recruitment platform. Eligible participants had access to 'Brisa' via a WhatsApp or website version for 28 days and completed entry and exit questionnaires to evaluate user experience and asthma control. Weekly symptom tracking, user interaction metrics, satisfaction measures, and qualitative feedback were utilised to evaluate the chatbot's usability and potential effectiveness, focusing on changes in asthma control and self-reported behavioural improvements. Results: 74% of participants engaged with 'Brisa' at least once. High task completion rates were observed: asthma attack risk assessment (86%), voice recording submission (83%) and asthma control tracking (95.5%). Post use, an 8% improvement in asthma control was reported. User satisfaction surveys indicated positive feedback on helpfulness (80%), privacy (87%), trustworthiness (80%) and functionality (84%) but highlighted a need for improved conversational depth and personalisation. Conclusions: The study indicates that chatbots are effective for asthma support, demonstrated by the high usage of features like risk assessment and control tracking, as well as a statistically significant improvement in asthma control. However, lower satisfaction in conversational flexibility highlights rising expectations for chatbot fluency, influenced by advanced models like ChatGPT. Future health-focused chatbots must balance conversational capability with accuracy and safety to maintain engagement and effectiveness.

WhatsApp as a Tool in Blended Learning in Dental Education.

Background and Objective: Dental education is unique, with clinical/practical learning much different from other professionals. In dentistry, students are exposed much earlier in their curriculum to patients, performing procedures under direct/indirect supervision. Hence, the present review attempted to assess the standing position of dentistry in blended learning worldwide. Materials and Methods: E-learning modality was at its primitive stage as food for thought among educational task force committees, with only a handful of developed and developing countries equipped with it. During this pandemic, "WhatsApp" became a savior, as it was a widely used educational device among dental teachers and students. Furthermore, it was easily applicable in places where there was difficulty in obtaining regular internet bandwidth, especially in remote/rural areas. It is noteworthy that blended learning/e-learning, when complemented with the conventional teaching method, upskill critical thinking and problem-solving capabilities. Blended learning or virtual reality education should be made feasible without disparity, worldwide. Mind training, both students and staff in hybrid e-learning, is the need of the hour not only to keep pace with digitalized dentistry but to prepare the students to face real-world situations. Conclusion: The sustainability of dental education should be rethought by dental schools with "Complimented Digital learning" wherever feasible, not only to cope with current trends but also to face unforeseen future challenges.

Zoom & WhatsApp Digital Information and Communication Technologies (ICTs) Enhance Community Engaged Research with Women Immigrants from Mexico.

This article demonstrates how digital information and communication technologies (ICTs) (Zoom/WhatsApp) unexpectedly and counterintuitively proved to be valuable tools for community-engaged health research when, in the context of the COVID-19 pandemic, they were integrated into a research study testing a peer support group intervention with female immigrants from Mexico. Because of pandemic restrictions, we changed the study protocol to hold meetings remotely via Zoom rather than in person as originally planned. Because we recognized that this would lack some opportunities for participants to interact and develop relationships, we created a WhatsApp chat for each group. Despite challenges for participants to use ICTs and participant-stated preference for in-person meetings, the results demonstrated that participants overwhelmingly endorsed these technologies as promoting access, participation, engagement, and satisfaction. Zoom/WhatsApp created a valuable environment both as a method for conducting research with this population, but also as part of the intervention for immigrant women to support and learn from each other. ICT adaptations have now permanently changed the way we conduct community-engaged health research.

WhatsApp-based intervention in urban Colombia to support the prevention of arboviral diseases: a feasibility study.

Arboviral diseases remain a significant health concern worldwide, with over half the world's population at risk for dengue alone. Without a vaccine or targeted treatment, the most effective strategy of prevention is vector management with community involvement. mHealth interventions, like WhatsApp, offer promising results for engaging communities and promoting healthier behaviors. This study explores the feasibility of integrating WhatsApp in vector control activities to improve arbovirus prevention in Colombia. A mixed-methods approach was employed to assess the WhatsApp-based intervention. WhatsApp messages were sent to 45 community women for 5 weeks to increase their knowledge and practices about dengue, Zika, and chikungunya. Pre-and-post surveys and focus group discussions were conducted in community settings to measure the feasibility and acceptability of this intervention. Chat reviews were done to assess the usability of users. A total of 1566 messages were exchanged in 45 WhatsApp chats. High acceptance and good usability (82% of users used the app for replying) were reported in this study. WhatsApp messages were perceived as short, clear, and enjoyable. Users liked the frequency, and design of messages. Pre- and post-surveys demonstrated improvements in the knowledge and practices of arboviral diseases. The intention to apply this knowledge in practice was reflected in a significant improvement, particularly in cleaning the laundry tank once a week (pre 62.1% to post 89.6%, p < 0.008). This study suggests that using WhatsApp as an additional tool could be a feasible, acceptable, and affordable strategy for improving the adoption of better practices in the prevention of arboviral diseases.

On the Willingness to Pay for social media/messenger services taking into account personality and sent/received messages among WhatsApp users.

WhatsApp has billions of users worldwide. Instead of paying a subscription fee, users provide their data for the use allowance. This data is used by Meta - the company behind WhatsApp - to obtain insights into user characteristics and monetize those insights. However, this data business model is among others criticized for fostering a loss of privacy that arises when platforms analyze user data, and for the use of design elements to attract users to the platform when they are not online or to extend their online time. Therefore, an increasing number of scientists are discussing whether other payment models are needed to overcome those disadvantages, like a monetary payment model. However, users would probably only pay for improved social media products. This paper provides an empirical basis for understanding the user perspective and, in particular, whether and how much users are willing to pay for improved social media products. For this, 2924 WhatsApp users' perspectives on this topic were investigated. They were asked whether and how much they are willing to pay money for a messenger/social media service when its quality would be improved. Variables potentially influencing Willingness to Pay (i.e., personality, sent/received messages) were studied as well. 47% of the participants were unwilling to pay for a healthier messenger service, and about a quarter were willing or stayed neutral. Further analysis revealed that more agreeable people were more willing to pay. Further: Higher Extraversion was associated with more sent/received messages, but the number of sent/received messages was not linked to Willingness to Pay. The present study shows that many users still are not willing to pay for social media (here messengers), which indicates that the advantages of paying for social media with money instead of with one's own data might need to be better communicated.

Uncovering and Expressing our Purpose.

Generative artificial intelligence (AI) is currently a source of angst, because of its ability to give us content that sounds uncannily like a real person, and because of concern that people will not stop at using it as a tool to generate and synthesize ideas, but instead will cede control over our words, and then our thoughts. This editorial details each article in Creative Nursing Vol. 30 Issue 2, highlighting the ways in which social media, different kinds of AI, and other tools for connectivity can be used for good: finding our purpose, uniting people over long distances, expediting knowledge implementation, managing large volumes of literature, advancing health equity, and enriching nursing education.

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.

Exploring How People Interact With Dental Misinformation on Social Media: A Cross-Sectional Study.

BACKGROUND: Social media has been widely utilized to spread health-related information, which has led to the possibility of spreading medical misinformation. The extent of the issue is unknown, even though policymakers, researchers, and medical professionals agree that health misinformation must be controlled and combated. OBJECTIVE: A cross-sectional study was conducted by the faculty of dentistry at Damascus University. METHODS: This quantitative cross-sectional study used a voluntary questionnaire distributed online in social media groups. Participants were of different ages, genders, and educational levels. RESULTS: Of the 301 questionnaires collected, 291 were analyzed. The study sample comprised secondary education certificates, university students, and postgraduate students. 96.6% of the study sample used two or more SM applications. 71.5% of the study sample uses Facebook more than other applications for dental information research, followed by Instagram (14.8%), Telegram (8.2%), and finally WhatsApp (5.5%). There was a significant difference between the age of the respondents and the SM application they used most (p = 0.027). 46.4% of the study sample were neutral in their answer about what they believed in the trust of information on SM sites, followed by 42.3% who did not agree with the trust of information on SM sites and 11.3 who agreed. 89.7% of the study sample visit the dentist when facing a medical problem, while 10.3% follow advice on SM sites. There was a significant difference between the age of respondents and the source they relied on when facing a medical problem (p = 0.019). 50.2% of the study sample sometimes feels that the advice on SM sites is marketing for a company or product or advertising for doctors and not others. CONCLUSION: In particular, understanding the methods and prevalence of health misinformation, as well as the current gaps in knowledge in this area, will help us to guide future research and, more specifically, to develop evidence-based digital policy action plans targeted at addressing this public health issue through various social media platforms.

Comparing the effect of LINE-based and WhatsApp-based educational interventions on reproductive health knowledge, attitudes, and behaviors among Triad adolescents: A quasi-experimental study.

Background: Adolescent populations face reproductive health challenges. Persisting gaps in Triad Adolescent Reproductive Health (ARH) comprehension and risky behaviors emphasize the necessity of integrating social media apps into health education to address Triad ARH risks among youths. Teenagers commonly use WhatsApp and LINE for social media communication, and determining the effectiveness of these two apps is scarce. Objective: This quasi-experimental study aimed to investigate and compare the impacts of educational interventions delivered through WhatsApp and LINE platforms on enhancing the knowledge, attitudes, and behaviors of adolescents concerning the Triad ARH. Methods: A total of 154 senior high school students were randomly recruited from two public schools in Bandung Regency, West Java, Indonesia. These students were divided into two groups: Group A, consisting of 78 students who received material messages using LINE, and Group B, consisting of 76 students who received material messages using WhatsApp. Participants completed a pre-test prior to the intervention and a post-test one month after the intervention. Data were collected using validated questionnaires and analyzed using Chi-square and Wilcoxon tests. Results: In the LINE group, there was an average increase in knowledge from 15.68 to 20.21, attitudes from 29.05 to 59.12, and behavior from 55.95 to 64.81 before and after the intervention period (p = 0.001). In the WhatsApp group, there was an increase in knowledge from 15.16 to 19.67, in attitudes from 34.71 to 59.54, and behavior from 54.75 to 65.97 before and after the intervention period (p = 0.001). Further analysis showed no significant difference between the LINE and WhatsApp groups in increasing the average level of knowledge (p = 0.973), attitude (p = 0.682), and behavior (p = 0.067) before and after the intervention. However, it was observed that the increase in knowledge and attitude was slightly higher in the LINE group, while the increase in behavior was slightly higher in the WhatsApp group. Conclusion: This study demonstrates that educational interventions using LINE and WhatsApp both increased the knowledge, attitudes, and behavior of adolescents related to the Triad ARH. This finding is valuable, considering the popularity of LINE and WhatsApp as mobile applications. Leveraging these platforms by nurses and other healthcare professionals can significantly improve adolescents' health, influencing their knowledge, attitudes, and behavior regarding reproductive health.

Assessing effectiveness of WhatsApp messaging program in oral hygiene care for orthodontic patients: A randomised controlled trial.

OBJECTIVE: To evaluate the difference in the oral hygiene status of participants with fixed appliances between a 'weekly WhatsApp application oral hygiene message reminders' trial group and a 'verbal instructions' control group over a follow-up duration of 12 weeks. DESIGN: Prospective, single-blind, randomised controlled trial with an allocation ratio of 1:1 over a 12-week follow-up. SETTING: Government Orthodontic Unit, Raub Dental Clinic, Raub, Pahang, Ministry of Health, Malaysia. PARTICIPANTS: A total of 40 patients aged 13-25 years undergoing orthodontic treatment with fixed appliances. METHODS: The 40 patients were recruited and randomly allocated to a control (n = 20) or trial group (n = 20). Participants in the trial group received weekly oral hygiene reminders via the WhatsApp application for 12 weeks, while the control group did not receive any reminders. The primary outcome was oral hygiene, which was measured by the single-blinded examiner using the Orthodontic Plaque Index (OPI) at three orthodontic check-ups: baseline (T0); 6-week follow-up (T1); and 12-week follow-up (T2). RESULTS: The mean age was 17 years, and 80% were female patients. At the end of the 12-week follow-up, improvements in OPI scores were observed, regardless of the intervention. At T2, the median OPI score for the trial group (n = 20) was 0 (interquartile range [IQR = 0) while that for the control group (n = 20) was 2 (IQR = 0). A Mann-Whitney U test revealed a statistically significant difference (P <0.05), with effect size r = 0.87 between the control and trial groups, whereby the latter witnessed marked improvement in OPI throughout the visits. No harms or adverse effects occurred in this trial. CONCLUSION: The short-term findings demonstrated that participants receiving regular reminders of oral hygiene via WhatsApp messaging had a significant improvement in oral hygiene compared to the control group.

Family-Based WhatsApp Intervention to Promote Healthy Eating Behaviors Among Amazonian School Children: Protocol for a Randomized Controlled Trial.

BACKGROUND: Stunting and micronutrient deficiencies have persistently affected children in the Brazilian Amazon for decades. However, in recent years, a notable increase in childhood overweight prevalence has been observed, particularly in the context of heightened food insecurity exacerbated by the COVID-19 pandemic. Despite the limited number of effective solutions proposed to tackle this problem, digital interventions have shown great promise worldwide in preventing obesity and promoting healthy diets. OBJECTIVE: This study aims to describe the protocol of a family-based WhatsApp intervention, specifically designed to investigate the efficacy of multimedia messaging in preventing excessive weight gain and improving healthy eating practices among school-aged children in the Amazon region. METHODS: This study protocol outlines a theory-driven randomized controlled trial based on the cognitive theory of multimedia learning and the social cognitive theory. A total of 240 parents or caregivers of children enrolled in the Maternal and Child Health and Nutrition Cohort Study in Acre (MINA-Brazil) will be recruited by phone and social media. The intervention group will receive persuasive multimedia messages through WhatsApp over 19 weeks, while the waitlist control group will remain in the usual care. The primary outcome is a change in children's BMI in z score. Secondary outcomes are changes in dietary intake and biochemical indicators of the children. Outcome measures will be assessed at baseline and 5 months after randomization in comparison to usual care. The analysis will use an intent-to-treat approach and will be conducted using the statistical package Stata (version 18.0), with a significance level set at P<.05. Paired and unpaired 2-tailed t tests will be applied to compare mean changes in the outcomes. RESULTS: Data collection started in June 2023, and final measurements are scheduled to be completed in December 2023. The results of the main analysis are expected to be available in 2024. CONCLUSIONS: This innovative multimedia message intervention holds significant potential for fostering behavioral changes among Amazonian children. TRIAL REGISTRATION: Brazilian Clinical Trials Registry RBR-5zdnw6t; https://ensaiosclinicos.gov.br/rg/RBR-5zdnw6t. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54446.

Utilisation of WhatsApp for Emergency Medical Services in Garissa, Kenya.

Garissa county, Kenya is a geographically large county with a mobile pastoralist population that has developed a method for emergency medical services (EMS) coordination using the WhatsApp communication platform. This work was based on a site visit, to better understand and describe the current operations, strengths, and weaknesses of the EMS communication system in Garissa. The use of WhatsApp in Garissa county seems to work well in the local context and has the potential to serve as a cost-effective solution for other EMS systems in Kenya, Africa, and other LMICs.

Knowledge, Attitudes, and Subjective Norms Associated with COVID-19 Vaccination among Pregnant Women in Kenya: An Online Cross-Sectional Pilot Study Using WhatsApp.

COVID-19 vaccination during pregnancy has been recommended, but the perceptions related to uptake remain unexplored. This pilot study aimed to explore how perceptions influence COVID-19 vaccine uptake among a sample of 115 pregnant women in Kenya, recruited via WhatsApp. Data were collected using an adapted online questionnaire between May and October 2022. Logistic analyses assessed the relationship between COVID-19 vaccination uptake and the Theory of Reasoned Action (TRA) constructs: attitudes and subjective norms. COVID-19 vaccination coverage was 73%, with vaccine hesitancy estimated at 41.4% among the unvaccinated group. Most participants had completed college education and had good knowledge of COVID-19 vaccines. There was no significant effect of enrollment in WhatsApp pregnancy groups on attitudes toward COVID-19 vaccination. Pregnant women were concerned about vaccine effectiveness (31.1%), and almost one-half (47.3%) were discouraged from receiving COVID-19 vaccines. Positive attitudes towards vaccination were associated with COVID-19 vaccination (aOR 2.81; 95% CI 1.12-7.04; p = 0.027), but no significant relationship was found between COVID-19 vaccination and strong subjective norms (influences to get COVID-19 vaccines). Our findings suggest that strategies to improve vaccination should consider targeting attitudes and proximal social networks (friends/family) to facilitate vaccination decision-making. WhatsApp can be used for research distribution and enhance the dissemination of accurate information.