WhatsApp-propriate? Exploring “WhatsApp” as a Tool for Research Among Ghanaian Immigrants in the United States

Abstract

African immigrants remain underrepresented in research due to challenges in recruitment. Mobile instant messaging applications, such as WhatsApp, present novel, and cost-effective opportunities for conducting health research across geographic and temporal distances, potentially mitigating the challenges of maintaining contact and engagement in research with migrant populations. Moreover, WhatsApp has been found to be commonly used by African immigrant communities. However, little is known about the acceptability and use of WhatsApp as a tool for health research among African immigrants in the US. In this study, we examine the acceptability and feasibility of WhatsApp as a tool for research among Ghanaian immigrants- a subset of the African immigrant population group. We used WhatsApp to recruit 40 participants for a qualitative interview about their use of the mobile messaging application. Three distinct themes related to the acceptability and feasibility of WhatsApp emerged from the interviews: (1) preference for using WhatsApp as a medium of communication; (2) positive perception of WhatsApp; and (3) preference for using WhatsApp for research. The findings indicate that for African immigrants in the US, WhatsApp is a preferred method for recruiting and collecting data. It remains a promising strategy to utilize in future research involving this population.

Introduction

One in ten Black persons in the United States (US) is an immigrant, with African immigrants representing the largest share of Black immigrants in the US [1]. Relatedly, African immigrants are among the fastest-growing Black immigrant group in the US [2]. Their population has experienced remarkable growth, with numbers increasing from around 600,000 in 2000 to 2 million in 2019, reflecting a 233% increase [1]. This growth rate surpasses that of many other immigrant groups [2]. Currently, African immigrants account for 42% of the foreign-born Black population living in the US, up from 23% in 2000 [1]. The failure to acknowledge the diversity within the Black population in the US, encompassing African Americans, Africans, and Caribbean immigrants, results in an oversimplified perspective that significantly impacts the health and healthcare of African immigrants [3]. Despite the shared physical characteristics between African-born black immigrants and U.S.-born black citizens, their health beliefs and outcomes exhibit variation [4]. Notably, infants born to African-born black mothers tend to have higher birth weights in comparison to those born to U.S.-born black mothers [5]. Furthermore, African immigrants demonstrate lower rates of cardiovascular risk factors, including hypertension and diabetes, in comparison to African Americans [6, 7]. The amalgamation of these distinct groups overlooks the unique cultural backgrounds, health needs, and experiences of the African immigrant community.

Research on immigrant health in the US has predominantly concentrated on larger immigrant populations from Europe, South America, and Asia, thereby resulting in a knowledge gap pertaining to the health of immigrants from Africa [8, 9]. It is crucial to recognize that the healthcare needs and experiences of other immigrant populations cannot be assumed to be identical to those of African immigrants. The insufficient availability of published evidence concerning the health and social needs of specific subgroups among African immigrants, such as Ghanaians, leads to shortcomings in designing, framing, and implementing targeted interventions. African immigrants are still under-represented in the health literature for a variety of reasons, including racial or ethnic misclassification and low study participation [10]. Inclusion of African immigrants in research remains critical in reducing knowledge gaps and developing effective health interventions for this population. Addressing these knowledge gaps is essential for developing tailored interventions and reducing health disparities within this population. Therefore, focusing on African immigrants allows for a nuanced understanding of their unique health needs, experiences, and barriers to care, ultimately contributing to more effective health interventions and improved health outcomes for this marginalized group [4, 5]. Existing studies — though few — have highlighted the challenges with recruiting African immigrants for research studies in the US [10, 11]. Several reasons have been proffered on the barriers to successful recruitment and the representation of minority groups in academic research. These reasons are not limited to the history of research misconduct and human subject abuses, which have led to a mistrust of researchers among racial/ethnic minorities and hesitancy to enroll in research studies due to fear of breach of confidentiality [10–12]. Other reasons include the existence of traditional power structures that prioritize the research methods and perspectives of mainstream academic institutions over the lived experiences and indigenous knowledges possessed by minority groups [13]. These structures tend to favor and prioritize research methods and perspectives that align with the established norms and practices of mainstream academic institutions [13]. Consequently, alternative forms of knowledge, particularly those derived from the lived experiences and indigenous wisdom of minority groups, are often marginalized or overlooked. This results in the exclusion of these groups and the characterization of them as difficult to engage or access [13, 14]. Recognizing the limitations of the mainstream paradigm and acknowledging the importance of diverse knowledge systems is crucial for promoting a more inclusive and equitable research practices. Thus, there is the need to create and explore strategies that meet the needs of, and allow for the recruitment of, underrepresented groups such as African immigrant groups.

While studies have reported the challenges of recruitment and the persistent underrepresentation of African immigrants in research [10, 11], effective strategies to successfully recruit such populations in research are not well documented. A previous study among African immigrant women revealed the use of the church, word of mouth, and online surveys via WhatsApp as critical to meeting recruitment targets [15]. WhatsApp is a free cross-platform messaging application that allows users to communicate through various means such as video and voice calls, text messages, and other features using only an internet connection [16]. Researchers have already begun to use WhatsApp in ways that resulted in a high recruitment yield [8]. Although the researchers also recommended it as an innovative and flexible strategy to reach African immigrant women [15], they only used WhatsApp as a recruitment tool and not a broader platform for health research such as data collection or intervention delivery [8].

While WhatsApp is primarily a messaging app, its new features, such as status sharing, the ability to join groups, and posting, have broadened that app to meet the characteristics of a social media platform [17]. WhatsApp is particularly popular among African immigrants of all ages and gender [18]. This may be partially explained by the fact that WhatsApp is the most popular social platform in African countries, with Kenya (77%), South Africa (49%), Nigeria (41%), and Ghana (39%), having the most subscribers [19]. Coincidentally, 53% of African immigrants in the US tends to be from these countries [20]. Also, within Africa, the high cost of internet subscriptions and economic conditions make WhatsApp an economical platform to communicate compared to mediums such as Instagram, Snapchat, and Facebook, which consume a lot of data due to the presence of images and video content on these platforms [16].

A new and emerging role of WhatsApp among African immigrants is its use to recruit participants for research [15, 21]. Yet, there are no studies in the published literature discussing the acceptability and the feasibility of using this platform. Further for underrepresented groups such as African immigrants, it is important to take extra care when conducting research to ensure that recruitment, data collection, and intervention delivery methods are inclusive, culturally sensitive, and appropriate. We conducted this study to provide an empirical perspective on the use of WhatsApp for participant recruitment and research. We document how WhatsApp was used in recruitment and data collection, as well as highlight the acceptability of WhatsApp for research among Ghanaian immigrants.

Methods

The data was derived from a mixed-methods study exploring HIV risk, acceptability of PrEP and psychosocial factors related to PrEP uptake among Ghanaian immigrants in the US [21, 22]. Our use of WhatsApp for recruitment and data collection yielded 40 participants for the qualitative arm [21, 23] and over 700 participants for the quantitative arm [22] of the mixed-methods study. The current manuscript focuses on findings from the interviews related to WhatsApp use. To meet the eligibility criteria for the interview study, participants were required to be at least 18 years of age, able to read in English, have and know how to use WhatsApp (to send a message, voice note, and/or make a call), able to access and complete a web-based survey, and be born in Ghana. The study was open to all genders and Ghanaian immigrants residing anywhere in the US, regardless of citizenship or documentation status. All study procedures were approved by the Social and Behavioral Research Support Office and the Institutional Review Board of the XXXX[BLINDED FOR REVIEW].

Recruitment

We used two strategies to recruit participants via WhatsApp. The first strategy involved posting a link on the WhatsApp status of the first author. A WhatsApp status is a brief message that users can put on their profile; the message is visible to all user’s WhatsApp contacts and disappears after 24 h. This was done each day for the duration of the study. The next strategy included sharing a tailored message and the study flyer containing the screening link to contacts and African immigrant groups on WhatsApp. Members of these groups were encouraged to share the flyer and messages with their networks. The link led participants to a few screening questions hosted on REDCap (a web-based research management application) and, when determined that they met eligibility criteria, participants were asked to provide their WhatsApp-activated telephone numbers (which may be different from the telephone number they use in the US), and select a day, and preferred time of day, to be reached for the interview.

Data Collection

Participants were contacted via a WhatsApp message at least 48 h before the date and time they indicated in their screening survey and provided with an information sheet. The information sheet contained details of the study, benefits, and risks, contact information of the IRB, and contact information for the principal investigator of the study. On the day of the interview, participants received a reminder via WhatsApp message and a voice note to remind them of the time to expect a call for the interview. A voice note is a short, recorded message sent over the WhatsApp platform. Voice notes are typically used as an alternative to typing messages when communicating in tandem. Before each interview, participants provided verbal informed consent. A total of 40 participants were individually interviewed through WhatsApp calls and voice notes (based on participant preference or availability) in March 2020. Interview lengths ranged between 45 and 60 min and were audio-recorded.

Qualitative Data Analysis

All audio (including voice notes) files were transcribed verbatim. All instances where local languages were used to express ideas and thoughts were translated into English. The transcripts were then uploaded, coded, and analyzed in NVivo 12 plus. The first author established an early coding system using emergent codes from a random selection of five study transcripts and existing literature. The first author and a trained research assistant separately coded ten more transcripts, adding new codes to the existing set. These codes were put into a codebook and refined, and inconsistencies in interpretation were resolved before coding the remaining transcripts, ensuring reliability. The codebook was updated as data analysis progressed. Codes with comparable concepts were merged and themes were determined. The coders had high intercoder reliability (Kappa = 0.94).

Results

Participants were predominately male (57.1%), between ages 18–35 years (65.7%), college-educated (71.4%), and had been in the US for approximately 1–10 years (68.7%) (see Table 1). We identified three distinct themes from the interviews related to WhatsApp acceptability and feasibility: (1) WhatsApp is the preferred medium for communication; (2) African immigrants have a positive perception of WhatsApp; and (3) WhatsApp is a preferred strategy and medium for research including recruitment and data collection.

Table 1.

Socio-demographic characteristics of participants (N = 35)

Characteristic	Freq (%)
Age in years
18–35	23 (65.7)
36 +	8 (22.9)
Prefer not to answer	4 (11.4)
Gender
Male	20 (57.1)
Female	15 (42.9)
Education
High School Graduate	3 (8.6)
Some College	7 (20)
4 years College Graduate/ University	25 (71.4)
Marital Status
Divorced	1 (2.9)
Living together (Cohabitation)	16 (45.7)
Married	16 (45.7)
Widowed	2 (5.7)
Length of residence in the US
Less than a year	3 (8.6)
1–10 years	24 (68.7)
10 + years	8 (22.9)
Age of arrival in US
< 20	12 (34.3)
21 +	23 (65.7)
Employment Status
Full-time	22 (62.9)
Part-time	2 (5.7)
No	11 (31.4)
Annual income
Less than $20,000	6 (17.1)
$20,000 to $50,000	6 (17.4)
$50,000 to $100,000	11(31.4)
$100,000 or higher	8 (22.9)
I would prefer not to answer	4(11.4)
Health insurance
Public	3(8.6)
Private	30(85.7)
None (uninsured)	2(5.7)

There are missing data for some variables

WhatsApp Is the Preferred Medium for Communication

Overall, participants agreed that WhatsApp was an integral part of their lives. Participants spent a considerable amount of time (3 to 12 h each day) on WhatsApp. As one participant shared: “at least about 8 h every day. And that hours are spread over the whole working period. So, at least every hour I take a peep, every single hour, I take a peep.” (Participant 24).

Participants also described a variety of ways in which they used WhatsApp, broadly categorized under communication, information seeking, and social support. Under communication, WhatsApp remains the primary mode of communication between African immigrants and their friends and families both in the US and abroad. One participant explained: “Ghanaians, we have family back home, most of our family use WhatsApp. That's how we talk to our family back home, and our friends here too.” (Participant 109).

Related to communication, another participant described how ubiquitous WhatsApp is within the Ghanaian immigrant community: “A lot of Ghanaians use WhatsApp and if we are rating people in the US, I can say that almost every Ghanaian in the US uses WhatsApp because, you know, they are in touch with– in touch with people back home, they are talking to some friends when their phone is out– so WhatsApp is effective” (Participant 16).

WhatsApp is also used for information-seeking purposes. Participants shared that they belonged to and created WhatsApp groups to spread information about resources in the community, how to navigate the health system, existing job opportunities, and even providing detailed information on towns and cities that are more favorable and welcoming to African immigrants: most Ghanaian communities use that platform to either form groups or share information or do some other type of, you know, community information sharing about the American system, how to find jobs, visa, those things (Participant 35). Another participant explained their experience with using WhatsApp for seeking information: We have WhatsApp groups that most of the Ghanaian community we have here belong to and so if you put any information there; just as yesterday I had information there that the Corona virus that is going on, and they have this, this, this and that through the WhatsApp platform and then everybody try to read and they started sharing among the Ghanaian community (Participant 110).

Additionally, WhatsApp is also employed as a form of social support. It is used to connect recent immigrants with older immigrants within a community and, in this way, assist new immigrants in navigating challenges they may encounter.

African Immigrants Have a Positive Perception of WhatsApp

Overall, participants held a positive perception of WhatsApp for use in their daily lives. Participants described the ways in which WhatsApp is intertwined with every aspect of their lives and their inherent trust in the app as well as it's utility: “[WhatsApp] is good because that is where most– my church for example, that is where most of the information concerning the church are sent for us to read. Before Sunday, most of the announcement will be sent for us to read so before we get to church, we know most of the announcement.” (Participant 110).

Other participants described the need for privacy when communicating and how WhatsApp provides privacy through user-to-user encryption. This provides a level of security when they are sharing sensitive information on WhatsApp, leading to a sense of trust when using the app for communication. As highlighted by one study respondent: “Every Ghanaian, I know has WhatsApp and I know that a lot of people are concerned about privacy and know that WhatsApp has encryption, so I think that a lot of people are more comfortable sharing and talking about confidential and intimate (laughs) things on WhatsApp too.” (Participant 20).

WhatsApp, according to participants, consists of humans (not bots, as on other social media platforms) and persons they may know in their network:

“To me, it's one of the best ways [to communicate]. At least on WhatsApp, you know whoever you are chatting with. You have an idea of who you are communicating with but if it's Facebook, it's a large population, you don't know who you are talking with, you don't know who you are giving out your information to. It becomes scary when you are on large platforms but on WhatsApp, if I give you my number– at least, even if it is a friend who introduced you to me the friend will make me feel safe with you. Yeah. So, I think WhatsApp is the best.” (Participant 88).

In several cases, participants discussed that knowing WhatsApp is made up of their networks created a system of trust and reliability. Thus, information sent on WhatsApp tends to be less scrutinized and more believable, as participants believe it to be coming from a credible source within their networks. As a participant succinctly shares: “Oh, for Africans in general living in America, WhatsApp is essential … you send anything through WhatsApp, it will be well received.” (Participant 43).

WhatsApp Is a Preferred Strategy and Medium for Research Including Recruitment and Data Collection

Among all the participants, WhatsApp was discussed as the preferred medium for recruitment for research studies, followed by Facebook. Participants felt that WhatsApp was more accessible, cheaper, more convenient, and offered privacy which they felt other platforms did not offer. In terms of accessibility, participants discussed the various formats (audio, video, text, voice notes) that are available for users to communicate. As conveyed by this participant: “The good thing about the platform is that you can send voice notes, images, documents, and then all that could be concentrated in one place, you know.” (Participant 27).

Additionally, participants discussed WhatsApp as a platform in which users did not have to be technology savvy or use the latest smartphone to be able to use. They thus believed that this made it quite easy to reach a large group of people on WhatsApp. One participant explained:

“The advantage of WhatsApp is, it crosses platforms, so when someone has an android, you have an old Nokia, whichever it is and that phone has internet access, you can send whatever information it is through WhatsApp. Unlike you sending weblinks and stuff like that, most people can't access that. If you send the information through WhatsApp, they can open it easily. Because you can send picture, you can send video, you can send text, so it's very, very accessible. It's good.” (Participant 69).

Participants also described WhatsApp as convenient for research because they did not have to travel and could be reached at a time most preferable to them: “It's a good platform because almost everybody has WhatsApp now and it's convenient and it's time– how do you say it?– It's time manageable. Yeah. I don't have to meet you somewhere to do this interview with you, but you just call me on WhatsApp and we are getting it done.” (Participant 1).

Overwhelmingly, participants highlighted the need for research, especially interviews, with this population to be less formal. They discussed how the interviews on WhatsApp felt informal and made them relaxed and comfortable to discuss their thoughts without feeling like a subject under scrutiny. This was explained well by one of the participants:

“So, like I'm talking to you right now, and we are having a normal conversation, but in actual fact you are gathering information for research. So, it's a good platform and I think that especially now that we are cutting all face-to-face meetings, even in the office nobody wants to do face-to-face anything. And if it's online, sometimes if you ask somebody to meet on Skype, Teams, Zoom, or even regular calling, it feels like it's too formal and too straight and, you know what I'm trying to say, trying to set people up like what kind of interview are you coming to do, is it a job interview, but if you do WhatsApp you put me in a relaxed mode and I'm not even anticipating that I'm going to even spend like 1 h on the interview I'm still relaxed about it and we keep going. So, when you put people in that relaxed mode using WhatsApp, you are able to also get answers from them like in a very raw and truthful way, compared to you putting them in a strict, like in a professional environment. I mean, it's a very good medium that you are using for this kind of interview.” (Participant 78).

However, there were concerns by a few participants about using WhatsApp for research in relation to the literacy gap and the use of written text messages. Participants shared that there were individuals within the community who were unable to read or write in any of the Ghanaian languages or English; thus, relying on text-based messaging or information for research would exclude such people. Participants suggested that research targeting Ghanaian immigrants should use other WhatsApp formats beyond text, as well as multiple languages. As described by this participant: “There are people who are actually uneducated, not that literate who use WhatsApp, you have the voice option where you can send messages and stuff, and share pictures and stuff, so use that instead. And, assuming the person doesn't really read or write much of English or Twi, then that will be a limitation. So, I feel like the audience that if you want to use WhatsApp for research, like the audience of all Ghanaians, then use different methods like audio, video, and languages including English.” (Participant 35). This participant’s suggestion highlights the importance of considering different communication methods and languages when conducting research with Ghanaian immigrants.

Discussion

African immigrants are underrepresented in health research, contributing to persistent health disparities and equities in the US. One reason this population is underrepresented is due to difficulties in recruiting participants for research. Thus, identifying effective recruitment strategies among minority groups and their subpopulations is critical to address the issue. This study is the first to explore the feasibility, acceptability, and perceptions of WhatsApp for research among Ghanaian immigrants and, by extension, provide information that can be used to improve recruitment of other African immigrants in the US. Findings show that for this population, WhatsApp plays a significant role and is intertwined with personal and professional lives, creating a symbiotic relationship. Our participants’ felt WhatsApp was a credible platform and were open to the use of WhatsApp for research, highlighting the platform as their preferred method of being reached. This research adds to our limited knowledge of successful recruitment strategies for African immigrants, beyond traditional recruitment efforts.

WhatsApp remains a critical communication, information-seeking, and social support tool for African immigrants in the US. In this study, participants discussed how WhatsApp is used to disseminate news, resources, and health information. This finding is consistent with the extant literature on using WhatsApp for recruitment among this population [15]. The key features of the communication platform, including the low cost and ease of navigation, makes this platform attractive for African immigrants. In addition, the diverse ways of messaging (voice, text, etc.) make it effective to communicate with both the educated and non-educated members of the family. Through WhatsApp, immigrants can maintain family and kinship contacts across long distances, thus maintaining strong family ties [24]. Cultural values and norms are also reinforced through communication [24].

Findings from this study also highlight the need for culturally relevant and targeted methods of recruitment. Credibility and trust have been highlighted as critical in research among African immigrants [11, 15, 25]. For participants in this study, WhatsApp was viewed as credible due to the networked nature of the app. WhatsApp functioned like the informal, traditional word-of-mouth approach, which is common among African communities [26], except this time it was happening through the help of technology. Within Africa, the medium of communication is as important as the message and messenger [27]. Within WhatsApp groups, there are often designated administrators, referred to as “group admins,” who are responsible for inviting and accepting members, maintaining order within the group, facilitating discussions, and serving as gatekeepers. These admins are often akin to elders within a community and are typically trusted as reliable sources of information [9]. Therefore, it is crucial for researchers utilizing WhatsApp to gain the support and approval of both the admins and the group as a whole.

Recruitment strategies may be affected by the research topic and the extent to which researchers are seeking sensitive or stigmatized information. Findings suggest that participants in this study were comfortable sharing sensitive information over WhatsApp. The broader study focused on HIV risks, prevention, and the acceptability of PrEP. Studies among African immigrants have consistently highlighted the challenges with African immigrant groups’ unwillingness and discomfort in discussing sex, sexuality, and sexual health [28–30]. Participants highlighted that by using WhatsApp, which they considered an informal platform, they felt comfortable discussing issues related to HIV and its risks.

Privacy concerns have been discussed widely among researchers as one of the key challenges of social media research [31–33] and among African immigrants [34–36]. WhatsApp however, due to its lack of advertisements is less inclined to share user data than other social media platforms [37]. Social media platforms may have specific rules concerning the privacy of their users that may be at odds with what researchers or ethical boards allow [32, 38]. Further, users of social media may agree to the platform’s terms and conditions without fully grasping the terms to which they are agreeing [32, 33]. The above issues make it important for a researcher to dedicate attention to privacy concerns when using WhatsApp and other social media platforms. Researchers and interventionists must be knowledgeable of the relevant privacy regulations, handle personal information responsibly, and never disclose sensitive information without explicit permission from participants, even if this information has already been made publicly available through social media [31]. Participants in this study revealed the importance of privacy and highlighted how WhatsApp’s end-to-end user encryption afforded them such privacy. WhatsApp’s end-to-end user encryption keeps personal messages and calls between the user and people they choose [19]. End-to-end user encryption on WhatsApp covers text and voice messages, audio and video calls, photos, videos and documents, location sharing, and status updates [39].

It is critical to note that when creating recruitment plans researchers must utilize methods and strategies that place less burden on participants. The use of passive methods that do not require extra effort on the part of participants, such as downloading and using a new app, is effective in yielding high recruitment among African immigrants. In addition, participants do not have to travel to specific locations to meet researchers and have the option of participating in the research at their convenience. These findings underscore the need for appropriate and flexible methods to aid in recruitment of this population.

Our findings should be examined in the context of some study limitations. First, the study was conducted among one African immigrant sub-population and may not represent the views of the entire African diaspora living in the US. Also, when working with linguistically and culturally diverse populations such as African immigrants, one recruitment strategy may not always fit all. Further, our study had mostly adult participants (18–35 years accounted for 65.7%), which may limit the transferability of our conclusions to older age groups within the Ghanaian immigrant population. While our findings provide insights into the acceptability and feasibility of WhatsApp as a research tool among the adult participants we interviewed, it is crucial to recognize that the perspectives and experiences of older African immigrants may vary. Despite these limitations, we were able to engage and access a “hard-to-reach” and vulnerable population not typically included in research. African immigrants are highly marginalized and difficult to access through conventional recruitment strategies. Future research will continue to use WhatsApp to build trust in African immigrant communities.

New Contributions to Literature

Challenges exist in engaging African immigrants in research; however, our study demonstrates that opting for methods and strategies preferred by the community is more likely to be effective. The present study is one of the first to demonstrate the utilization of WhatsApp for data collection and participant recruitment. Additionally, it offers insights into the community’s perspectives on the use of WhatsApp for research purposes. Our findings also highlight the potential for incorporating a commonly used technology into research while addressing concerns related to privacy and confidentiality.

Authors Contribution

The authors confirm contribution to the paper as follows: study conception and design: Gloria Aidoo-Frimpong, R. Lorraine Collins, LaRon E. Nelson; data collection: Gloria Aidoo-Frimpong; analysis and interpretation of results: Gloria Aidoo-Frimpong, R. Lorraine Collins DeAnne Turner, Wale Ajiboye, Kafuli Agbemenu; draft manuscript preparation: Gloria Aidoo-Frimpong; draft manuscript revision and finalization: Gloria Aidoo-Frimpong, R. Lorraine Collins, DeAnne Turner, Wale Ajiboye, Kafuli Agbemenu, and Laron E. Nelson. All authors reviewed the results and approved the final version of the manuscript.

Data Availability

The datasets generated and/or analyzed during the current study are not publicly available due to it still being used for primary analyses but are available from the corresponding author on reasonable request.

Declarations

Ethics Approval

This work is in accordance with the ethical standards of the University at Buffalo’s institutional review board and with the 1964 Helsinki declaration and its later amendments.

Consent to Participate

Informed consent was obtained from all participants.

Competing Interests

The authors declare no competing interests.