Acceptability of Mobile Health Interventions to Increase Diabetic Risk Factor Awareness Among the Commuter Population in Johannesburg: Descriptive Cross-Sectional Study

Evaluating the Implementation of the GREAT4Diabetes WhatsApp Chatbot to Educate People With Type 2 Diabetes During the COVID-19 Pandemic: Convergent Mixed Methods Study

BACKGROUND

In South Africa, diabetes is a leading cause of morbidity and mortality, which was exacerbated during the COVID-19 pandemic. Most education and counseling activities were stopped during the lockdown, and the GREAT4Diabetes WhatsApp Chatbot was innovated to fill this gap.

OBJECTIVE

This study aimed to evaluate the implementation of the chatbot in Cape Town, South Africa, between May and October 2021.

METHODS

Convergent mixed methods were used to evaluate the implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, cost, coverage, effects, and sustainability. Quantitative data were derived from the chatbot and analyzed using the SPSS. Qualitative data were collected from key informants and analyzed using the framework method assisted by Atlas-ti. The chatbot provided users with 16 voice messages and graphics in English, Afrikaans, or Xhosa. Messages focused on COVID-19 infection and self-management of type 2 diabetes.

RESULTS

The chatbot was adopted by the Metro Health Services to assist people with diabetes who had restricted health care during the lockdown and were at a higher risk of hospitalization and death from COVID-19 infection. The chatbot was disseminated via health care workers in primary care facilities and local nonprofit organizations and via local media and television. Two technical glitches interrupted the dissemination but did not substantially affect user behavior. Minor changes were made to the chatbot to improve its utility. Many patients had access to smartphones and were able to use the chatbot via WhatsApp. Overall, 8158 people connected with the chatbot and 4577 (56.1%) proceeded to listen to the messages, with 12.56% (575/4577) of them listening to all 16 messages, mostly within 32 days. The incremental setup costs were ZAR 255,000 (US $16,876) and operational costs over 6 months were ZAR 462,473 (US $30,607). More than 90% of the users who listened to each message found them useful. Of the 533 who completed the whole program, 351 (71.1%) said they changed their self-management a lot and 87.6% (369/421) were more confident. Most users changed their lifestyles in terms of diet (315/414, 76.1%) and physical activity (222/414, 53.6%). Health care workers also saw benefits to patients and recommended that the service continues. Sustainability of the chatbot will depend on the future policy of the provincial Department of Health toward mobile health and the willingness to contract with Aviro Health. There is the potential to go to scale and include other languages and chronic conditions.

CONCLUSIONS

The chatbot shows great potential to complement traditional health care approaches for people with diabetes and assist with more comprehensive patient education. Further research is needed to fully explore the patient's experience of the chatbot and evaluate its effectiveness in our context.

Wildfire-Like Effect of a WhatsApp Campaign to Mobilize a Group of Predominantly Health Professionals With a University Degree on a Health Issue: Infodemiology Study

BACKGROUND

Online interactions within a closed WhatsApp group can influence the attitudes and behaviors of the users in relation to health issues.

OBJECTIVE

This study aimed to analyze the activity of the members of a WhatsApp group initiated to raise awareness of the possible health effects of 5G mobile networks and mobilize members to sign the related petition.

METHODS

We retrospectively analyzed data from the WhatsApp group of 205 members that was active during 4 consecutive days in August 2019. The messages exchanged were collected, anonymized, and analyzed according to their timing and content.

RESULTS

The WhatsApp group members were invited to the group from the administrator's contacts; 91% (187/205) had a university degree, 68% (140/205) were medical professionals, and 24% (50/205) held academic positions. Approximately a quarter of the members (47/205, 23%) declared in their messages they signed the corresponding petition. The intense message exchange had wildfire-like features, and the majority of messages (126/133, 95%) were exchanged during the first 26 hours. Despite the viral activity and high rate of members openly declaring that they signed the petition, only 8 (8/133, 6%) messages from the group members, excluding the administrator, referred to the health issue, which was the topic of the group. No member expressed an opposite opinion to those presented by the administrator, and there was no debate in the form of exchanging opposite opinions.

CONCLUSIONS

The wildfire-like activity of the WhatsApp group and open declaration of signing the petition as a result of the mobilization campaign were not accompanied by any form of a debate related to the corresponding health issue, although the group members were predominantly health professionals, with a quarter of holding academic positions.