JMIR Publications

ABSTRACT

Background:

Background:

Digital health tools were widely adopted during the COVID-19 pandemic and helped to strengthen surveillance, risk communication, and health education. The government of Malawi launched the Malawi COVID-19 WhatsApp Chatbot on 29 May 2020. It remains unclear whether tools like it are acceptable and usable enough to warrant deployment in future epidemic responses.

Objective:

We assessed the prospective acceptability and usability of the Malawi COVID-19 WhatsApp Chatbot for future epidemic or pandemic preparedness and response.

Methods:

We used a convergent mixed-methods design at a national workshop held from 9th to 10th September 2024 in Dowa District, Malawi. thirty-nine participants (18 health workers, 21 public) were purposively sampled from ten districts. Quantitative and qualitative data were collected using the Technology Acceptance Model (TAM) and Mobile Application Rating Scale (MARS) tools. Qualitative data from facilitated group discussions were analysed using thematic analysis using a hybrid deductive-inductive approach. We compared TAM scores (non-normally distributed; Wilcoxon rank-sum test) and MARS scores (approximately normally distributed; independent-samples t-test) between health workers and the public. Quantitative and qualitative findings were integrated at the interpretation stage.

Results:

39 participants completed TAM, and 37 completed MARS. Mean overall TAM score was 4.33 (SD 0.82) of 5, and mean overall MARS score was 3.84 (SD 0.74) of 5 both above each tool's acceptability threshold of 3. Health workers scored the chatbot significantly higher than the public on TAM (median difference 1.50, 95% CI 1.00–2.00, P=.0001) and MARS (mean 4.03 vs 3.71, P=.04); no individual MARS subdomain showed a significant between-group difference. 80% of participants said they would use the chatbot again. Four themes emerged: Accessibility and Availability; Awareness and Acceptance; Utilisation; and Areas for Improvement. Integration of the two strands suggested the quantitative acceptance gap between groups was driven substantially by unequal prior awareness and exposure

Conclusions:

Among this purposively selected group, the chatbot was viewed as prospectively acceptable and usable for future epidemic response. These findings indicate prospective support among engaged stakeholders and suggest future investment should prioritise multilingual design and broader public awareness of digital tools.