Skip to main content

Use of WhatsApp®, for distance teaching during COVID-19 pandemic: Experience and perception from a sub-Saharan African setting

Abstract

Background

In the midst of the COVID-19 pandemic, to palliate to the lockdown and cover academic programs, the faculty of medicine and pharmaceutical sciences (FMPS) of the university of Dschang (UDs) in Cameroon has implemented e-learning using WhatsApp®.

Aim

Describe the opinion of students and lecturers after its implementation of e-learning at the FMPS of UDs.

Methods

We designed a uniform teaching scheme using WhatsApp® during the university lockdown. Students and members of the teaching staff of the FMPS of UDs were enrolled after receiving clear information on the study implementation. At the end of the online-teaching period of two and a half months, we surveyed our students and teaching staff. Sociodemographic characteristics and opinions about e-learning were collected using a standard questionnaire.

Results

We enrolled 229 students and 40 lecturers of the FMPS. Students reported a decremented quality of internet connection (p < 0.001, p-homogeneity < 0.001) despite an increased expenditure related to internet use. Electronic devices were broadly used before the implementation of mobile learning. The use of course materials was significantly more challenging among students because of the size/format of lecture notes and internet connection/cost (all p < 0.05). Perception of discipline compared to classroom-based lessons was not significantly different among students compared to lecturers (all p > 0.05). While lecturers were mainly more comfortable conveying the contents of their lectures, students tended to be less prone to actively participate. The motivation and satisfaction of the latter group toward e-learning were modest compared to classroom-based lectures while their feedback about the organization was positive.

Conclusions

E-learning using WhatsApp® could be an effective alternative to conventional classroom-based lessons in the context of COVID-19 pandemic. The use of a blended-learning program including classroom-based sessions could help improve its limitations.

Peer Review reports

Background

The novel Coronavirus disease (COVID-19) outbreak has led to a lockdown in almost all countries of the world. By March 18, 2020, 107 countries had implemented national school closure as a major preventive strategy [1]. In Cameroon, Central Africa, the government response strategy to the coronavirus pandemic included the closure of all public and private training institutions of the various levels of education, from nursery school to higher education, including vocational training centers and professional schools [2].

In this context, the faculty of medicine and pharmaceutical sciences (FMPS) of the university of Dschang (UDs) had to set up a strategy to deliver academic programs and to ensure the continuity of training. To comply with the need of social distancing during the COVID-19 pandemic, internet-based teaching was the most convenient strategy. Given the fact that the faculty was not prepared to face this challenge and considering the urgent need to find a solution, the choice felt on WhatsApp® that would be used as a teaching channel.

This social media offered the advantage of being widely used by both teachers and students before containment measures. It also offered a minimum of functionalities in terms of transferring text, video, sound and image files to users within classes organized in study groups. Finally, it offered the opportunity to be used both on smartphones and computers without the need of heavy logistics such as servers [3,4,5]. Moreover, it has been shown in another context to be more applicable in settings where there are challenges to obtain permanent or regular optimal internet bandwidth or speed [6].

The rapid implementation of this teaching strategy enabled to carry on with academic programs using e-learning as soon as from March 18, 2020, the day Cameroonian universities closed. The purpose of this study was to describe how e-learning was put in place and the perception as well as difficulties encountered both by students and faculty members of the FMPS during COVID-19 pandemic.

Methods

Study setting

A cross-sectional study was conducted among students and lecturers of the FMPS, from April 26 to May 4, 2020. This faculty is part of the UDs located in the city of Dschang, in the West Region of Cameroon since 2017. The UDs is one of the main universities in Cameroon with more than 600 lecturers and almost 30, 000 students. The population included in this study was recruited among students and lecturers (permanent and non-tenure track faculty members) of the FMPS. The study was approved by the institutional board of the UDs and the FMPS.

Study population

Students and lecturers of the FMPS were approached and consecutively included regardless of study type and level for students and independently of administrative position or teaching subject for the lecturers. By the time of conduct of the study, the FMPS had 40 lecturers and 698 students. Clear information was given to all students and faculty members about the study purpose, adequate filling of questionnaires and participation modalities. All participants who responded to the questionnaire were included. Informed consent was obtained from all study participants and the study protocol was implemented according to the recommandations of the latest revision of the Helsinki declaration.

Description of the WhatsApp® e-learning scheme

The implementation of e-learning was done using the same lectures’ schedule prior to the lockdown. No recommendation was given to the lecturers on how to conduct the lessons however, we did not expect any change in contain compared to in person lessons. Virtual classes pertaining to the various study levels were created through WhatsApp® groups. Those platforms were used by all lecturers who were invited to join the class at the day and time of the planned lecture. Lecture notes were first sent in Portable Document Format (PDF), word or powerpoint format and lessons were given via voice-mails. Interactions (questions and answers) during the lesson used the same channel or short message service as an alternative communication medium. The lessons were complemented by an electronic platform where all course materials were provided to students for further reading.

Procedure

Data were collected using an anonymous online survey administered in both official languages (French and English) using Google Forms (Alphabet Inc., California, USA). Data complied with the terms and conditions of Google Forms. In an initial step, we conducted a pilot survey to optimize data collection forms. Responses to the pilot survey were excluded. All issues raised during that preliminary phase of the study were addressed. We then distributed the survey link to students directly via the various class representatives and lecturers via a WhatsApp® (Facebook Inc., California, USA) group. The class representatives disseminated the survey links in the respective official students’ WhatsApp® groups. WhatsApp® was already the primary mean of formal communication among students and lecturers of the FMPS. We collected the total number of students in each group to calculate the participation rate, link dissemination was confirmed by screenshots, and reminder messages were sent every week in the class groups to ensure a reasonable participation rate.

Variables

Using standard questionnaires, data were collected on sociodemographic (age, gender study level) characteristics, challenges and the opinion of the study population about internet-based distance learning. Survey questions were a mix of open, close, and multiple-choice questions.

Statistical analysis

The data collected were processed on Excel 2016 (Microsoft Corp., Washington, USA). We analyzed data using Stata 16 (StataCorp, Texas, USA). Figures were generated with GraphPad Prism 8 (San Diego, California, USA). Quantitative data are presented as median (interquartile range [IQR]) and qualitative data as frequencies and proportions. Group comparisons were performed with Chi-square or Fisher’s exact tests. Variations of the flow of internet access, expenditure and connection time for academic purposes after implementation of internet-based lectures were assessed using Bowker’s test for table symmetry. Statistical significance was adjudicated using Stuart-Maxwell test for marginal homogeneity. The threshold of significance was set at 0.05.

Results

Study population and internet access before online-based lectures

The study population included 229 students and 40 faculty members with median age (IQR): 20 (19–22) and 39 (36–43) years, respectively. This yielded a participation rate of 32.8 % and 100 % respectively among students and faculty members. Female students were more represented than their male counterparts, n = 140 (M/F ratio 0.64) while lecturers were more men than women, n = 29 (M/F ratio 2.6). The large majority of students were registered for biomedical sciences [n(%) = 100 (43.7)] followed by medical studies [(n%) = 84(36.7)]. Students in their first and second years of studies were more represented [n(%) = 77(33.62) and n(%) = 82 (35.8), respectively]. All students had internet access before the implementation of distance learning. The same was true for lecturers who had overall better internet access than students (overall p < 0.001), Table 1. While students reported significantly reduced quality of internet connection during the implementation of online courses than before (p < 0.001, p-homogeneity < 0.001), internet access was similar among faculty members before and during e-teaching (p = 0.549, p-homogeneity = 0.351).

Table.1 Characteristics of the study population

Devices used for internet access, financial and time burden of e-lectures

At the time of the survey and implementation of online lessons using WhatsApp®, one lecturer and seven students did not have a smartphone. However, they had a laptop or a notebook to comply with teaching duties and to follow lectures respectively. Students and faculty members mainly used either a smartphone [n(%) = 222(96.9) and 30(75.0), respectively] or a laptop/notebook [n(%) = 169(73.8) and 33(82.5), respectively], Fig. 1 A and B.

Fig. 1
figure 1

Electronic devices used for lectures by students (panel A) and lecturers (panel B). Black and white bars represent the number of students or lecturers who possess (black bars) or not (white bars) the various devices, respectively. Percentages corresponding to the numbers on the y-axis are represented above the bars of each of the devices

As expected, monthly expenditure related to internet use significantly increased both in the students’ population (p < 0.001, p-homogeneity < 0.001) and among faculty members (p = 0.010, p-homogeneity = 0.001). Baseline monthly expenses related to internet use was less than 1, 000 XAF (USD 1.79) for 70.3 % of students. During the implementation of online-lessons, 75.5 % of them spent up to 2, 999 XAF (USD 5.35) per month to access the internet, Fig. 2 A. On the other hand, the use of social media-based distance learning increased the expenses related to internet access to more than 4, 000 XAF (USD 7.15) in more than a third of lecturers, Fig. 2B.

Fig. 2
figure 2

Monthly expenditure of internet connection in students’ (panel A) and lecturers’ (panel B) population before and after implementation of internet-based lectures using WhatsApp®. Cumulative numbers of participants are expressed in the y-axis for each study group. The proportion of individuals for each expenditure level are expressed as percentages

At baseline, 22.3 % (n = 51) of students used more than 50.0 % of their time on WhatsApp® for academic purposes. This proportion increased to 85.6 % (n = 196; overall p < 0.001, p-homogeneity < 0.001), Fig. 3 A and B during implementation of e-learning. The corresponding proportions in lecturers were lower than in the students’ group before [n(%) = 3 (7.5), p = 0.001, Fig. 3 C] and during e-learning period [n(%) = 28(70.0), p < 0.001, Fig. 3D]. Similar to students, the use of WhatsApp® for academic purpose increased among faculty members with the enforcement of distance learning at the FMPS of UDs (p < 0.001, p-homogeneity < 0.001), Fig. 3 C and D.

Fig. 3
figure 3

Proportion of time spent on WhatsApp® for academic purpose by students (upper panels) and lecturers (lower panels) before (panel A and C, respectively) and after (panel B and D, respectively) starting internet-based lectures

Challenges and opinion of respondents about internet-based lectures

Despite a relatively good internet connection, students and lecturers faced difficulties either to download or upload lecture materials via the social media network. This challenge was more encountered among students and was mainly related to the files’ size and format, internet connection and cost (all p ≤ 0.015).

Opinions of both study groups were similar about discipline during lessons (all p > 0.05), Table 2. While lecturers’ feeling was that they were more comfortable answering questions during distance learning [n(%) = 16(40.0)], students felt less prone to ask questions [n(%) = 137(59.8)]. The motivation related to distance learning was at most similar to classroom-based lectures in the majority of students and lecturers. Moreover, students were globally less motivated by distance learning compared to lecturers [n(%) = 183(79.9) vs. n(%) = 14 (35), p < 0.001]. The observation was similar when satisfaction was explored [n(%) = 191(83.4) vs. n(%) = 25(62.5), p < 0.001]. The majority of students [n(%) = 191(83.4)] and lecturers [n(%) = 25(62.5)] were less satisfied by distance learning compared to traditional classroom-based lectures with a significant proportion among students (p = 0.002). However, most of the students [n(%) = 177(77.3)] and lecturers [n(%) = 37(92.5)], with a higher proportion of lecturers (p = 0.028), had a positive opinion about the practical organization of online lectures. Students [n(%) = 208(90.8)] and faculty members [n(%) = 26(65.0)] suggested in-person lectures to complement e-learning.

Table.2 Challenges and students’ opinion compared to that of lecturers about the performance and the organization of internet-based lectures using WhatsApp® during the COVID-19 pandemic

Discussion

In this report, we share our experience on the implementation of mobile-learning, the perception and difficulties encountered by students and lecturers at the FMPS. Mobile-learning was used as a remediation strategy to cover the academic program during university lockdown due to the COVID-19 pandemic in Cameroon. Our results suggest that teaching equipment was largely available among students and faculty members. The major challenges related to the implementation of distance learning using WhatsApp® in our study population were to access internet and to share teaching materials. Despite a pretty good satisfaction about the organization, this teaching alternative warrants complementary measures to be as attractive as conventional classroom-based learning method for students in our study population.

Smartphone ownership rates were high among students and teachers. Several studies have found a high availability and use of smartphones among medical students in many countries [7]. This was an important prerequisite for the implementation of mobile-learning. Almost three out of four students spent at least four hours a day on WhatsApp® while this proportion corresponded to 43.6 % and 51.9 % of students at Albaha and Dammam universities, Saudi Arabia, respectively [8]. This extended time on WhatsApp® is not necessarily linked to the implementation of mobile-learning since students use this application also for the purpose of social exchanges. As discussed, by Alkhalaf MA et al., this can be a source of addiction, sleep disorders and poor academic performance [8, 9]. Therefore, in the case of concomitant use for social and academic purposes, students should be reminded of the risks associated with prolonged use of this application.

In a resource-limited setting such as that of our study, one needs to consider the increase in the internet connection budget. This could be a limiting factor for the participation of students in online teaching. However, the expenditure must be weighed against the reduction of other costs, those related to transport for example, which could have been reduced due to the lockdown. That notwithstanding, the financial difficulties are not be underestimated in the implementation of online lectures. Indeed, a similar study to ours from Libya, in the midst of the pandemic, conducted in 13 universities medical schools reported financial difficulties in about 40.5 % of students [10]. The various reason of this could be related to the gross domestic product per habitant of the country defining population’s income or to geopolitical conditions such as in Libya [10]. Besides its cost, the quality of internet connection before and during the lockdown is an additional important factor to consider. A slow Internet connection wastes time, increases the cost of connection and can be a source of poor scoring of e-learning for both students and teachers. Indeed, one of our observations is the challenge of downloading and uploading course materials. Although both students and lecturers increased their expenses related to internet use, this did not positively impact the quality of the connection. Considering the difficulties encountered by students and teachers in managing online courses, the major challenges were linked to the quality and cost of the internet connection. Among students, internet speed and related expenses were a challenge for 87.8 % and 82.1 %, respectively. These difficulties were significantly greater for students than lecturers (both p < 0.001). In a Liberian study about introducing e-learning in medical education, the authors found that limited bandwidth was one of the main limitations of distance learning [11]. Similarly, another report from Jordan indicated that internet streaming quality was the main challenge in the implementation of online lectures during the COVID-19 pandemic in 69.1 % of students [12].

Among students, 96 (41.9 %) felt that there was less discipline during online lessons than during face-to-face lectures. The difference in the perception of discipline from the perspective of students and that of teachers 21 (52.5 %) was not significant. While it is true that online teaching gives an impression of freedom (since it can be followed from home), participants should be self-disciplined and teachers should regularly remind students the rules applicable to this specific teaching method. Indiscipline here can take more subtle forms such as not logging in at the right time or logging out during class without a grounded reason [13]. In our study population, students and lecturers were rather satisfied with the modalities and organization of e-learning at the FMPS during the lockdown. However, the majority of surveyed students declared to be less satisfied, less motivated and less prone to actively participate in lectures compared to traditional classroom-based lessons. This could be related to the field and level of study of students included in the present survey. Moreover, the intrinsic nature of e-learning which closely relates to students’ affect cannot be underestimated [14, 15]. In fact, the vast majority of included students were undergraduate students. One could expect less propension to independent work, more need of contact with the tutors and peer interaction in this population [16]. Our data also suggest that 87.0 % of our study population thought that add-on classroom-lectures would improve e-learning using WhatsApp®. Although consistent with previous reports, this needs to be explored in subsequent studies considering as endpoints students’ and lecturers’ satisfaction and the impact on students’ performance [17].

Our survey has limitations that need to be acknowledged. The study was conducted in one-third of the overall students’ population from different fields and years of studies at the FMPS. This could suggest a selection bias related to the relatively low response rate and the heterogeneity of our study population. However, the absolute number of responses should be acknowledged. Furthermore, there is no formal consensual threshold sample size to be acceptable in such studies [18]. Also, postgraduate students are underrepresented in our study population. In this subset of students, one would expect more autonomy to appraise and to follow online lessons. Moreover, one could have considered assessing other determinants of students’ satisfaction, discipline and contribution during lessons which represent a potential source of bias in our data. For this, a larger study will be required in the future to refine the results and provide additional data. The strengths of our study include the high response rate of lecturers (100 %) and the survey of a heterogeneous group of students considering their years and fields of study. Nevertheless, the impact of level and type of study on the need of complementary lectures using conventional learning method needs to be explored in subsequent studies. Besides, the short term implementation of questionnaire after the conduct of online lectures has enabled us to avoid recall bias and has increased the accuracy of the data collected.

Conclusions

In the context of the COVID-19, social media-based e-learning could be an applicable alternative to conventional classroom-based lessons. However, solutions to improve students’ satisfaction and motivation need to be sought. This could potentially be addressed by defining a blended-learning strategy where a specific number of hours of classroom-based courses could complement online lesson,. The effectiveness of this strategy to optimize delivery and assimilation of academic programs and to impact academic performances needs to be investigated.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. VinerRM,RussellSJ,CrokerH, School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review.Lancet Child Adolesc Health.2020;4(5):397–404.

    Article  Google Scholar 

  2. Government response strategy to the coronavirus pandemic (COVID-19) [Internet].2020[cited2020May5].Availablefrom:<background-color:#FF3300;udirection:rtl;>https://www.prc.cm/files/30/a3/b6/c4da402687249418b9fc80ccf64d30be.pdf</background-color:#FF3300;udirection:rtl;><udirection:rtl;>.</udirection:rtl;><udirection:rtl;></udirection:rtl;>AccessedonJuly23,2021.

  3. AlabdulkareemSA.Exploring the Use and the Impacts of Social Media on Teaching and Learning Science in Saudi.Procedia - Soc Behav Sci.182;13:213–224

  4. BediangG,Stoll B,Geissbuhler A.Computer literacy and E-learning perception in Cameroon: the case of Yaounde Faculty of Medicine and Biomedical Sciences.BMC Med Educ.2013;13:57.

    Article  Google Scholar 

  5. LatifMZ,HussainI,SaeedR,QureshiMA,MaqsoodU.Use of Smart Phones and Social Media in Medical Education: Trends, Advantages, Challenges and Barriers.Acta Inform Med.2019;27:133–138.

    Article  Google Scholar 

  6. CarmonaS,AlayedN,Al-IbrahimA,D’SouzaR.Realizing the potential of real-time clinical collaboration in maternal-fetal and obstetric medicine through WhatsApp.Obstet Med.2018;11:83–89.

    Article  Google Scholar 

  7. LatifMZ,HussainI,SaeedR,QureshiMA,MaqsoodU.Use of Smart Phones and Social Media in Medical Education: Trends, Advantages, Challenges and Barriers.Acta Inform Med.2019;27:133–138.

    Article  Google Scholar 

  8. AlkhalafAM,TekianA,ParkYS.The impact of WhatsApp use on academic achievement among Saudi medical students.Med Teach.2018;40(sup1):S10–14.

    Article  Google Scholar 

  9. NasirudeenAMA,Lee Chin AdelineL,Wat Neo JosephineK,Lay SengL,WenjieL.Impact of social media usage on daytime sleepiness: A study in a sample of tertiary students in Singapore.Digit Health.2017;3:2055207617699766.

    Google Scholar 

  10. AlsoufiA,AlsuyihiliA,MsherghiA .Impact of the COVID-19 pandemic on medical education: Medical students’ knowledge, attitudes, and practices regarding electronic learning.PLoS One.2020;15(11):e0242905.

    Article  Google Scholar 

  11. WalshS,DeVilliersMR,GolakaiVK.Introducing an E-learning Solution for Medical Education in Liberia.Ann Glob Health. 2018. 30;84:190–197.

  12. Al-BalasM,Al-BalasHI,JaberHM. Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: current situation, challenges, and perspectives.BMC Med Educ.2020;20(1):341.

    Article  Google Scholar 

  13. ChestonCC,FlickingerTE,ChisolmMS.Social media use in medical education: a systematic review.Acad Med.2013;88(6):893–901.

    Article  Google Scholar 

  14. RaupachT,MuenscherC,AndersS.Web-based collaborative training of clinical reasoning: a randomized trial.Med Teach.2009;31(9):e431-e437.

    Google Scholar 

  15. SutherlandS,JalaliA.Social media as an open-learning resource in medical education: current perspectives.Adv Med Educ Pract.2017;8:369–375.

    Article  Google Scholar 

  16. HaleLS,MirakianEA,DayDB.Online vs classroom instruction: student satisfaction and learning outcomes in an undergraduate Allied Health pharmacology course.J Allied Health.2009;38:e36-e42.

    Google Scholar 

  17. MokaripourP,ShokrpourN,BazrafkanL.Comparison of readiness for e-learning from the perspective of students and professors of Medical Sciences.J Educ Health Promot.2020;9:111.

    Article  Google Scholar 

  18. HegeriusA,Caduff-JanosaP,SavageR,ElleniusJ.E-Learning in Pharmacovigilance: An Evaluation of Microlearning-Based Modules Developed by Uppsala Monitoring Centre.Drug Saf.2020;1–10.

Download references

Acknowledgements

The authors are grateful to students and faculty members who contributed to the study. They are also grateful to the class representatives who assisted in the dissemination of the link to the survey questionnaire.

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

Concept and study design: DE, EVB, SRSN, SPC; Data collection: DE, EVB, SRSN, CNO, FKL, DNN, JFT, JMK, GSSN; Data analysis: EVB; Writing of the manuscript: DE, EVB, SRSN, CNO, FKL, DNN, JTF, JMK, GSSN; Manuscript revision for intellectual content: BK, PW, SPC. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Simeon Pierre Choukem.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the institutional board of the University of Dschang and the Faculty of Medicine and Pharmaceutical Science. All study participants provided informed consent. Study protocol was implemented according to the recommandations of the Helsinki declaration as revised in 2013 (https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/, accessed on July 28, 2021).

Consent for publication

Not applicable.

Competing interests

There is no conflict of interest to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Additional file 1

Supplementary material 1

Additional file 2

Supplementary material 2

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Enyama, D., Balti, E.V., Simeni Njonnou, S.R. et al. Use of WhatsApp®, for distance teaching during COVID-19 pandemic: Experience and perception from a sub-Saharan African setting. BMC Med Educ 21, 517 (2021). https://doi.org/10.1186/s12909-021-02953-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12909-021-02953-9

Keywords