Effectiveness of WhatsApp-based health education in enhancing knowledge and attitudes towards diabetes and its complications among university students in Lahore, Pakistan: A quasiexperimental study

Background Pakistan faces a diabetes epidemic affecting 33 million adults, with limited health education among youth. Digital platforms offer potential for scalable health promotion. This study evaluated the effectiveness of WhatsApp-based education in improving diabetes knowledge and attitudes among university students. Methods A quasiexperimental study was conducted with 148 nonmedical university students (mean age 20.5 ± 1.8 years, 45.3% female) from eight universities in Lahore, who were allocated to intervention (n = 74) and control (n = 74) groups. The intervention group received structured WhatsApp-based education, including infographics, videos, and interactive quizzes, over 14 days, whereas the control group received basic materials. Outcomes were assessed via the Diabetes Knowledge Questionnaire-Revised (DKQ-R) and adapted Diabetes Attitude Scale-3 (DAS-3), which measure knowledge, attitudes, subjective norms, perceived behavioural control (PBC), and behavioural intentions. Results The intervention group demonstrated significant improvements across all the domains. The knowledge scores increased from 2.33 ± 1.41 to 4.62 ± 1.56 (p < 0.001, d = 1.71), whereas no change was detected in the controls (2.14 ± 1.36 to 2.10 ± 1.39, p = 0.760). The attitude scores improved from 21.87 ± 3.25 to 26.39 ± 4.33 in the intervention group versus those in the control group (22.31 ± 2.34 to 20.12 ± 1.90, both p < 0.001). Between-group posttest comparisons revealed large effect sizes for knowledge (d = 1.71), attitudes (d = 1.87), subjective norms (d = 1.35), PBC (d = 0.98), and intentions (d = 2.30). Multiple regression analysis revealed that attitudes (β = 0.468, p < 0.001) and PBC (β = 0.185, p = 0.001) were significant predictors of behavioural intentions, explaining 46.8% of the variance. Gender disaggregation analysis revealed equitable improvements across male and female participants (p > 0.05 for all gender comparisons). Engagement was high in the intervention group (60.8% high engagement), with 94.6% retention. Conclusions WhatsApp-based health education significantly improved diabetes knowledge, attitudes, and behavioural intentions among university students, with equitable impacts across genders. This low-cost, scalable intervention offers a promising approach for diabetes prevention education in resource-limited settings. Integration into university health programs could address the growing diabetes burden in Pakistan.