Emerging technologies, including the use of social media applications such as WhatsApp, are becoming more frequently used in higher education pedagogies; this is also true for the health sciences (Bozalek et al. 2015:2). In this technologically advanced era, it is difficult and sometimes challenging not to be ‘tech-savvy’ as an educator at a Higher Education Institution (HEI).

The global advancement in science and technology makes it difficult to remain indifferent to the presence of technology when individuals are singing the praises of the many technological gadgets that they are using on a daily basis. Madeira et al. (2009:2441), for example, report that emerging technologies afford students the opportunity to visualise and interact with learning content by using multimedia, rich graphics, animation, simulation, and virtual environments. Whilst some studies have been conducted about the use of social media for higher education pedagogies, little has been written with regard to the perspectives of learners about these tools. There is therefore a need to investigate the experiences of students in a WhatsApp discussion group to better ascertain how it might be used to enhance student learning.

This article set out to investigate undergraduate nursing students’ experiences of using WhatsApp to integrate theory and practice of the health assessment in a Primary Health Care Module. A discussion of the investigation follows.

Studies about the use of emerging technologies and mobile learning to improve student learning are becoming more prolific in higher education (Bozalek et al. 2015; Pimmer & Pachler 2014; Veletsianos 2010). Technology, such as mobile devices, has permeated our daily lives and provides inexhaustible access to communication and information. Educators and students use mobile technology in diverse contexts for a variety of teaching and learning purposes, for example discussion forums and distribution of content (Conejar & Kim 2014:193–197).An inter-institutional research project funded by the National Research Foundation in South Africa was initiated in 2011 at 22 public South African HEIs. The purpose of this was to explore the use of emerging technologies to transform teaching and learning interactions and paradigms (Gachago et al. 2013:95). As part of the study, the perceptions of the meaning that the term ‘emerging technologies’ had for both participants and the team of 16 researchers from South African HEIs were investigated. Seven characteristics of the concepts in relation to emerging technologies were identified as part of the study by the research team and research participants. One of these characteristics was particularly appropriate for this study about students’ experiences in relation to WhatsApp, namely Characteristic 7: ‘Emerging technologies provide personalized learning opportunities’ (Gachago et al. 2013:98).

Another study at the Faculty of Communication and Information Science at the National University of Science and Technology in Bulawayo, Zimbabwe investigated the extent of mobile phone access and usage to support information sharing amongst students (Dewah & Mutula 2013:150). The study concluded that most of the students acquired a mobile phone that had the ability to support their studies and their continued communication with their family members. It emerged that students’ phones had functionalities and services, including short messaging services (SMSs), Internet, memory card ports, multimedia messaging, as well as call waiting and forwarding services. Furthermore, the study reported that students used their mobile phones to share academic information with their peers and to make appointments with their educators to discuss academic work. However, the authors suggested that regulations have to be implemented for the use of mobile phones. Dewah and Mutula (2013:162) acknowledged that regulations have to be implemented for the use of mobile phones during lectures, tests, and examinations.

The potential for using WhatsApp as an instant messaging tool is particularly pertinent in resource-poor contexts, because it is currently one of the most commonly used applications on mobile phones and computers; it is a free service for one year with a minimal fee payable thereafter (Yeboah & Ewur 2014:157). Owing to affordability and accessibility, instant messaging has great potential for use in higher education for both formal and informal learning, particularly in resource-poor contexts such as the HEI where this study was undertaken (Bere 2012; Church & De Oliviera 2013; Ng’ambi & Bozalek n.d.). WhatsApp and other instant messaging applications have been found to be beneficial for learning because they increase student participation in both face-to-face and distant contexts between students, other students, and educators (Johnson et al. 2015; Makoe 2012; Nicholson 2002; Rambe & Bere 2013).

This study was theoretically positioned in John Dewey's (1944) theoretical contributions to learning and was guided by two approaches to learning within those broad theoretical parameters, namely authentic and flexible learning. Those approaches were used to provide a foundation for the pedagogical activities whilst using a social media application on a mobile device (Herrington et al. 2009:4).

The increased impact of constructivism as a philosophical approach to learning has prompted many educators at universities to implement more ‘authentic’ teaching and learning environments (Herrington & Herrington 2006:2–3). In this study, an ‘authentic’ teaching and learning environment was created by using a social media application, WhatsApp, to create learning opportunities for students that enabled them to benefit and tap into once they had left the learning institution to apply the theory at clinical practice facilities (Herrington, Reeves & Oliver 2010:14). The students focused on engaging in innovative and realistic tasks that afforded opportunities of complex collaborative actions for authentic learning to occur (Herrington et al. 2010:18).

Flexible learning is a set of educational philosophies and systems that seek to provide students with increased choice, convenience, and personalisation to suit each individual student. In particular, flexible learning provided students with choices about where, when, and how their learning occurred (Shurville, O’ Grady & Mayall 2008:74–84).With the advent of PHC, client care has shifted from a hospital to a community-based environment that requires educators to focus on new approaches and tools to support their teaching and learning in the autonomous and diverse practice environment, where resources are not readily accessible (Kenny et al. 2009:76). Because students in this study ‘worked’ at clinical facilities for two days per week, educators had to find ‘alternatives’ to their teaching strategies, with the aim of affording students the opportunity to learn where, when, and how they could manage their learning. Students were able to communicate questions in relation to their experiences at clinical facilities to get clarification from their educators when they were not present at the clinical facility. It gave them access to an ‘e-educator’ wherever, whenever and however clarification and guidance was needed.

John Dewey (1944), a realist and experiential learning theorist, emphasises the value for students who gain knowledge through personal experiences (Bruce, Klopper & Mellish 2011:169). This study afforded students an experience of using a social media application on their mobile devices to integrate their theory and clinical practice whilst doing the health assessment of the Primary Health Care Module. The experiential learning process allowed knowledge generation through the conversion of experiences in the WhatsApp discussion group (Lai et al. 2007:326).

This study explored the effectiveness of improving knowledge creation during experiential learning activities with the use of technology as a method of instruction in teaching (Lai et al. 2007:326; Pitler et al. 2007:2). The use of technology in teaching provided a learning platform that led to a dynamic and exciting learning environment for students who participated in this study (Pitler et al. 2007:2). The use of a social media application on mobile devices provided educators with scope to arrange a comprehensive variation of opportunities for learning to accommodate the different learning needs and capabilities of individual students (Pitler et al. 2007:3).

Reflection and reflective learning are an integral part of experiential learning (Bruce et al. 2011:198). Students experienced experiential learning in the WhatsApp discussion group because it was a method of communication which had not been used before at a school of nursing at a University, where the study was conducted. This was a pure trial and error experience for students who volunteered to be part of the study. The electronic reflections gave students the opportunity to reflect on what they had experienced whilst participating in the WhatsApp discussion group, which was aimed at enhancing the integration of theory and clinical practice for purposes of the health assessment in the Primary Health Care Module.

The study aimed at enhancing and promoting learning through the incorporation of a social media application, WhatsApp, as a mode of communication for enhancing the integration of theory and clinical practice. The study formed part of the health assessment of the Primary Health Care Module. The purpose was to assist participants in ‘real’ time when they were experiencing any challenges with the application, and required guidance from educators and peers whilst at clinical facilities.

A qualitative, explanatory, descriptive, and contextual design was applied to explore the integration of theory and clinical practice of the health assessment competency in the Primary Health Care Module of the third year undergraduate nursing programme by using WhatsApp, a social media application, on students’ personal mobile devices.

The research study was conducted in the context of an undergraduate nursing programme at an HEI in the Western Cape Province.

The accessible population of this study included students registered for the Primary Health Care Module, to whom the researcher had reasonable access and who met the inclusion criteria (Brink, Van Der Walt & Van Rensburg 2013:131). To be included in the study, students had to be:

A total of 40 students registered for the Primary Health Care Module in semester one in 2014 were invited to an information session to explain the purpose of the study. Twenty-nine students, who met the inclusion criteria and gave voluntary consent to be part of the study, made up the total population of this study.

Ethical approval (12/10/16) for this study was obtained from the Senate Higher Degrees Committee of the Faculty of Community Health and Sciences, the Registrar, and the Director of the School of Nursing at the University of the Western Cape prior to the implementation of the study. An information session was arranged with students before written informed consent was obtained. Participants were informed that participation was voluntary. Participants consented to have their cell phone numbers made available to the researcher, who undertook not share it with any other person, except with the research supervisor.

Four criteria: credibility, dependability, conformability and transferability are suggested by Lincoln and Guba (1985), as cited in Polit and Beck (2012:583), to develop trustworthiness in qualitative inquiry (Polit & Beck 2012:584) and as discussed in Table 1.

The main themes identified in the data analysis are presented in Table 2.

The use of WhatsApp, a social media application, provides students with a support structure to enhance the integration of their theory and clinical practice of the health assessment competency in the Primary Health Care Module. The reflections of students highlight their positive experiences of the enhancement of their learning as a result of the intervention. The intervention provides a virtual space for collaborative practice, sharing of course related information, and maintains academic support to enhance the teaching and learning process.

The findings of this study are a contribution towards the usage of social media applications in teaching and learning, with the purpose of enhancing the integration of theory and clinical practice. It could also guide the implementation of an original intervention which incorporates mobile devices and M-learning into a programme to enhance learning within health education.