Page 288 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 9 Original Research

computed to confirm statistical significance. Type I error rate came timeously. The participants who had posted cases felt
(alpha) for statistical tests was set at 0.05 and 95% CI, and positively about the timely case response. The majority of
were provided when appropriate. participants who posted cases also stated that they were
satisfied with the content of the case response received.
Ethical consideration
Those participants who posted cases were asked what type
Ethics approval was received from: HREC (Human Research of cases they presented (Figure 1). There was a very similar
Ethics Committee) from the University of Witwatersrand; distribution in reporting paediatric (Paeds), adult cases
BMREC (Biomedical Research Ethics Committee) from the (including opportunistic infections [OI]) and cases of
University of the Western Cape. A participant information unsuppressed viral loads (Unsupp. VL) – making up the
form (combined with participant consent), along with the bulk of cases at 65% collectively. Other cases discussed
link to this internet questionnaire was electronically available included dermatological conditions (Derm), adverse events
and posted on the WhatsApp group, as well as emailed to all (Adv Ev), maternal cases and prevention of mother-to-child
participants who had at any stage belonged to the group transmission (PMCT).
within the reporting period. As the questionnaire was
anonymous, no participant name was requested. There was Lastly, in terms of participants’ perceptions of having obtained
no anticipated harm in the study, but there may have been greater clinical confidence in managing complicated HIV/TB
some discomfort to the doctors in completing the online cases (study objective two), the majority (86%) agreed that it
questionnaire. There was also the risk of identifying the did increase their clinical confidence.
locality of where the doctors worked (i.e. EC) but no risk of
identifying individual doctors or patients/cases. Perceived usefulness of the chat group
Results as a learning tool
The questionnaire also assessed the participants’ perceived
Sample description usefulness of the group as a learning tool in managing
Out of the 166 belonging to the WhatsApp chat group, a total complicated cases after taking part in the group (study
of 92 participants submitted Internet questionnaires. One objective three), and whether they would recommend this
form was submitted with no answers and was therefore case discussion platform to other colleagues.
excluded from the analysis.
When participants were asked if they used the clinical
Analysing clinicians’ use of the WhatsApp group guidance posted on the WhatsApp doctors group in their
own patient management, 52% responded that they used
To analyse the usage of the WhatsApp group (objective one the clinical guidance all the time, 44% used the guidance
of the study), the questionnaire included questions that occasionally. Only 4% felt that the guidance given on the group
assessed the participant’s Internet accessibility and their was not relevant to their current patient case management.
engagement in the group. Satisfaction at the relevance of About a third of the participants reported that they actually
responses received (by content and timing) was also referred back to old cases discussed all the time when a
assessed. Lastly, participants were asked what types of cases complicated clinical case presented at their clinic. Out of the
they posted. remainder, 64% used the previous discussions occasionally,
and 8% felt that felt that the guidance given on the group was
Only 1% of participants did not have access to a form of not relevant to their current patient case management.
Internet connectivity. Twenty-nine per cent of the remainder
had only occasional access. Internet connectivity and Again, the majority of the participants strongly agreed that
access was important to permit the receipt and posting of the WhatsApp group was useful in helping them gain new
questions on the app. Seventy-one per cent of participants
had access all the time. The majority (73%) looked on the
app every time a case was posted, with only 2% ignoring 7 1. Paeds (22%)
2. Adult/OI (21%)
the group completely. 6 3. Unsupp. VL (22%)
1
4. Derm (8%)
To further assess engagement in the group, participants were 5. Adv Ev (12%)
also asked how many times they posted cases in the group, 5 6. Maternity/PMCT (12%)
7. Other (3%)
and if they posted any responses to a case that had been
posted by a colleague. Half of the participants reported to
have never posted cases; 47% had posted at least 1–5 times
and 3% had posted 6–10 times. In terms of posting any 4
medical advice or responses to another colleague’s case, 52% 2
posted occasionally, 4% all the time.

3
To determine the satisfaction of case responses received,
participants were asked if the responses to the cases posted FIGURE 1: Types of cases discussed (n = 81).

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