Abstract
The increasing use of messaging applications such as WhatsApp for both social and personal purposes has determined an increase in the widespread use of these technologies, even in healthcare. A growing number of healthcare professionals have adopted WhatsApp in their daily work in order to share information with peers and patients. Past research has highlighted the advantages and disadvantages of WhatsApp usage in healthcare settings; in particular two positions appear to coexist in the scientific debate: those that expose and underline all of the positive aspects of the phenomenon, and those which also highlight the negative aspects, linked in particular to the clinical risks for patients, data security and privacy protection. The main objective of this study was to assess if and how individual and organizational determinants can trigger or inhibit the use of WhatsApp in a hospital setting, and which variables managers can exploit to guide professionals’ behaviors. Data were collected through a survey administered to physicians and nurses in an Italian University Hospital in Rome; a total of 191 high-quality responses were received. The results show that WhatsApp is widely used in the Hospital, and that its use is mainly due to the perception of numerous advantages and benefits reported in clinical practice. Moreover, an interplay exists between organizational and individual factors in determining the use of WhatsApp between healthcare professionals and with patients. In particular, individual factors play a key role as determinants of the use of WhatsApp; healthcare professionals use this technology mainly based on its perceived usefulness. Instead, organizational factors play a secondary role; they do not have a direct influence on the use of WhatsApp, but always act through individual factors. This study is the first to analyses the influence of individual and organizational determinants of WhatsApp usage in the hospital setting, and provides hospital managers with important information in order to manage this phenomenon and implement adequate strategies to exploit its potential increase.
Introduction
The increasing use of messaging applications such as WhatsApp for both social and personal purposes has determined an increase in the widespread use of these technologies in healthcare [1–6]. A growing number of healthcare professionals have adopted WhatsApp in their daily work in order to share information with peers and patients [7–11]. Past research has highlighted the advantages and disadvantages of WhatsApp usage in healthcare. In this regard, two positions appear to coexist in the scientific debate: those that expose and underline all of the positive aspects of the phenomenon [6–16], and those which highlight the negative aspects, linked in particular to the clinical risks for patients, data security and privacy protection [8,16–21].
Some of the main advantages of using WhatsApp in healthcare are as follows: improvement of communication [22]; no requirement for a computer [23,24]; time saving [6,15]; possibility of an immediate response [20,25]; improvement of surgery performance and reduction of consultation time [25,26]; smoothing of hierarchy [8]; and the encouragement of junior doctors to seek help and improve the team perception of effectiveness [19]. On the other hand, existing risks or disadvantages have also been reported: increase in workload, disparity in the sense of urgency, worsening of professional relationships and risk of unprofessional behavior [18]; need to stay online 24 hours a day; impossibility to print a record of the chat; clinical information not being included in medical records; difficulty identifying patients in chats [16,19]; possible issues of privacy and data protection [20]; and the risk of reducing the autonomy of junior doctors [8]. Despite the many benefits, WhatsApp is used by professionals without political strategies, so it is necessary to develop guidelines for its usage by interdisciplinary groups and for communication between patients and professionals [27]. Hospitals are increasingly looking to evaluate the impact of WhatsApp usage on care delivery [11]; however, there is still very limited evidence regarding if and how individual and organizational determinants can trigger or inhibit such phenomenon.
The main objective of the study is to assess if and how individual and organizational determinants can trigger or inhibit the use of WhatsApp in a hospital setting, and which variables managers can exploit to guide professionals’ behaviors. In particular, the following research questions have been investigated:
- In what way is WhatsApp used in hospital settings by physicians and nurses with patients and between colleagues?
- Which are the main perceived benefits and threats concerning the use of WhatsApp in a hospital setting by physicians and nurses?
- Which are the determinants (individual and/or organizational) of the use of WhatsApp in a hospital setting?
- Is there an interplay between individual and organizational determinants?
Theoretical background
In order to evaluate the interplay between individual and organizational variables, it was necessary to create a theoretical model that could explain this phenomenon (Fig 1). In particular, we drew inspiration from two well-established and respected theories:
- Technology Acceptance Model (TAM): that has been widely used in the last decades in healthcare in order to understand what leads people to accept or reject information technology [28, 29];
- Institutional Theory, which explains how “institutional”–in our case, “organizational”–forces shape organizations and professionals’ behaviors [30–32].
