Prospective Acceptability and Usability of a WhatsApp Chatbot for Epidemic Response in Malawi: Convergent Mixed Methods Study

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 May 29, 2020. It remains unclear whether tools like this are acceptable and usable enough to warrant deployment in future epidemic responses.

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

We used a convergent mixed methods design at a national workshop held from September 9 to 10, 2024, in Dowa District, Malawi. Thirty-nine participants (18 health workers and 21 members of the public) were purposively sampled from 10 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 analyzed with thematic analysis, using a hybrid deductive-inductive approach. We compared TAM scores (nonnormally distributed; Wilcoxon rank-sum test) and MARS scores (approximately normally distributed; independent-samples 1-tailed t test) between health workers and the public. Quantitative and qualitative findings were integrated at the interpretation stage.

Thirty-nine participants completed the TAM survey, and 37 completed the MARS survey. The mean overall TAM score was 4.33 (SD 0.82) out of 5, and the mean overall MARS score was 3.84 (SD 0.74) out of 5, both above each tool's acceptability threshold of 3. Health workers scored the chatbot significantly higher than the public in the TAM (median difference 1.50, 95% CI 1.00-2.00; P<.001) and MARS surveys (mean 4.03, SD 0.38 vs mean 3.71, SD 0.53; P=.04); no individual MARS subdomain showed a significant between-group difference. Among the participants, 80% said that they would use the chatbot again. Four themes emerged: accessibility and availability; awareness and acceptance; usage; and areas for improvement. Integration of the 2 strands suggested that the quantitative acceptance gap between groups was driven substantially by unequal prior awareness and exposure.

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 that future investment should prioritize multilingual design and broader public awareness of digital tools.