記住我
eHealth, or the secure and cost-effective application of information and communication technology (ICT) to support health and health-related sectors, includes, but is not limited to, the use of mobile wireless technologies for public health or mobile health (mHealth) [,]. Digital technologies are increasingly being used to deliver health care services and promote public health. mHealth technologies are particularly relevant due to their ease of use, broad reach, and wide acceptance []. Global health service delivery could change as a result of the use of mHealth to support the accomplishment of health objectives. This transformation is being fueled by a potent confluence of different elements. These include the quick development of mobile technologies and apps, the rise of new chances for incorporating mHealth into already existing eHealth services, and the ongoing expansion of mobile cellular network coverage [,].
In the literature, it has been shown that mHealth systems in the form of SMS text messages, apps, and telemedicine projects are being used efficiently in the developed world. mHealth solutions are advancing rapidly in these regions [-]. The reason for this is the fact that there are a number of enabling factors that facilitate or encourage the use and implementation of such systems. Today, a wide variety of barriers and enablers are present in the developing world that influence the use and implementation of mHealth systems [-].
The prevalence and exploitation of mHealth technologies are steadily rising, presenting a significant opportunity for their incorporation into clinical services as a means to enhance the provision of high-quality medical care. Recent data on mobile phone usage in Sub-Saharan Africa revealed that 51% of residents possess a mobile device []. The latest statistics on mobile service subscriptions suggest an ongoing upward trajectory, with expectations of further increases. As of the end of 2020, 495 million individuals, equivalent to 46% of the population in Sub-Saharan Africa, held active mobile service subscriptions. Projections anticipate that this figure will rise, with an estimated 50% of the population (equivalent to 619 million individuals) anticipated to subscribe to mobile services by the end of 2025. Presently, there are 303 million internet users in Sub-Saharan Africa, constituting 28% of the population, and this number is projected to increase to 474 million by 2025 [,]. These data underscore the widespread penetration of mobile technology in the region and lay a solid foundation for exploring the potential advantages and challenges associated with its integration into health care services.
Even though the mass penetration of mobile phones is a fact and a very substantial condition to adopt mHealth systems in such countries, there are a number of factors that need to be considered when designing and developing mHealth systems in developing countries. Most mHealth systems initiated in such countries remain in the proof of concept or pilot testing stage. The large implementation of such systems is not widely documented [,].
mHealth approaches are widely embraced, and the health care system heavily relies on them in developed regions. From patient management systems to individual patient-centered mobile apps, these initiatives have been operational for a considerable period, in contrast to their counterparts in developing nations. A minor portion of Sub-Saharan African countries, less than half of the total [,], are currently endeavoring to incorporate mHealth platforms into their health care systems. This underscores the requirement for additional development of mHealth technology in the region. Ethiopia is currently focusing on strengthening its health care system and aligning it with the Sustainable Development Goals []. With a largely rural population, the nation encounters difficulties in accessing essential services like health care among others. A potential path for improvement lies in the digitalization of health care services, offering the opportunity to enhance efficiency, accessibility, and overall health care outcomes [].
The implementation of digital health systems may encounter various challenges, and these challenges are generally context-specific. There is no universal solution that can address these challenges in all circumstances. Given the variation in challenges and the absence of a one-size-fits-all solution, success factors center on designing an mHealth platform that is specific to the context and the target population. This involves identifying these determining factors and incorporating sensitive design considerations to address unique needs []. Various studies have been performed for understanding technology adaption factors using various frameworks such as the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT) [-]. The research conducted by Liu et al [] using the UTAUT indicated that users’ intentions to adopt mHealth systems are positively influenced by factors such as effort expectancy, performance expectancy, subjective norm, and perceived ubiquitousness. Notably, privacy concerns exhibited a significantly negative impact only on perceived ubiquity, with no significant effects observed on effort expectancy, performance expectancy, subjective norm, and intention to adopt []. The study by Yang et al [] examined consumers’ intentions and behaviors related to the use of digital applications based on the UTAUT and provided valuable guidance for broadening the use of mHealth apps among consumers.
A systematic research study by Jacob et al [] comprehending the sociotechnical factors influencing patients’ acceptance of mHealth tools proposed adopting a patient-centric strategy by ensuring that the tools seamlessly integrate into the overall patient journey and treatment plan. This involves giving priority to inclusive design and ensuring thorough patient education and support. Different frameworks have been used to evaluate the implementation of mHealth approaches, but they fall short of addressing all aspects comprehensively. In response, researchers have put forth a consolidated framework to address this limitation by incorporating various factors such as organizational and policy factors, social and personal factors, and technical and material factors [].
The digital divide, characterized by unequal access to digital technology, is another factor that may be worsened or improved through the adoption of mHealth [-]. Despite evidence showing increased access to mobile devices, there is insufficient implementation of mHealth in Sub-Saharan Africa. Accelerating the integration of digitalization into the heavily burdened health care system could help address the challenges associated with inadequate health care and contribute to narrowing the digital divide in the region. Sub-Saharan Africa presents a unique challenge when it comes to the implementation and scaling up of mHealth systems. In contrast to developed countries, the region faces significant barriers that hinder the adoption and effective use of these systems. However, despite the numerous obstacles facing mHealth adoption in Sub-Saharan Africa, there are also opportunities and enabling factors. Consequently, the design and implementation of mHealth interventions in Sub-Saharan Africa must be tailored to address these specific challenges. Ethiopia, a representative country of Sub-Saharan Africa, is considered as one of these nations with limited implementation and consumption of mHealth systems. Thus, there is a pressing need for a comprehensive study of the barriers and enablers for mHealth adoption in Sub-Saharan Africa in order to help guide the development of tailored mHealth interventions that are suited to the local context and can effectively address the unique challenges facing the region. For this, it is vital to investigate the determinants that could affect the use of mHealth approaches. mHealth strategies are tailored to diverse end users, with certain approaches adapted for organizational use, while others target health care professionals or patients, and sometimes both. The factors influencing each of these populations may exhibit overlaps, yet they are varied and complex, necessitating a comprehensive and separate investigation for each category.
The overall aim of this study was to identify the barriers and enablers from the perspectives of patients, physicians, and health care executives for using mHealth systems in Sub-Saharan Africa and to provide recommendations on mHealth system design and policy-making. The study’s anticipated outcome is a description of the elements that encourage or inhibit the use of mHealth approaches, along with suggestions for resolving these barriers and exploring the enablers. This study can be used as a primary step in undertaking a user-centered design study of mHealth platforms in the Sub-Saharan African context.
A multi-level and multi-actor in-depth semistructured interview was employed in order to identify the barriers and enablers of the use of mHealth systems.
Study Area and SamplingThe sample areas for this study included 1 city administration and 2 regions in Ethiopia, namely, Addis Ababa city administration, Oromia region, and Harari region. The study locations were selected based on the Human Development Index (HDI), which serves as a composite measure of a region’s average achievements in 3 fundamental aspects of human development, namely, health, knowledge, and standard of living []. Participants were recruited through nonprobability sampling, with a specific emphasis on purposive sampling techniques. For recruiting individuals, the snowball sampling technique [] was used by means of colleagues, organizational contacts, and initial participants.
ParticipantsData were collected from patients, physicians, and health care executives. For the health care executive group, individuals eligible for participation included decision-making persons and managers of health offices, hospitals, or similar organizations. For the physician group, individuals eligible for participation included health care professionals working at chronic disease outpatient departments (OPDs), who possessed the ability to communicate in Amharic. Lastly, for the patient group, individuals eligible for participation included chronic disease patients aged between 17 and 50 years who could communicate effectively in Amharic. These criteria were carefully defined to ensure that the selection of participants aligned with the specific characteristics and roles of each group within the study.
The participants in the health care executive group had a variety of positions, including office and hospital directors, coordinators, and ICT heads in federal offices, health bureaus, and hospitals. Additionally, in-depth interviews were conducted with physicians working at chronic disease OPDs. Furthermore, patients who visited the selected health facilities for chronic disease follow-ups were involved in the study.
Data Collection and AnalysisSemistructured interviews [,] were selected for this study as they provide the required balance between flexibility and structure for our research. This approach offers the necessary room to explore a subject while maintaining sufficient structure to accomplish the objectives of the study. The interview guides for patients, physicians, and executives are presented in , , and , respectively. The interview guides were structured based on the consolidated framework of the factors impacting clinicians’ adaptation of mHealth []. All interviews were conducted in-person with the participants. Prior to conducting the interviews, participants received an information letter explaining the overall goal of the PhD research and this specific study. An oral explanation was also provided where necessary. Informed consent was obtained from each participant in written form, and their participation was voluntary. When confidentiality and privacy could be assured, interviews with patients were conducted in the waiting area of the hospital. Interviews with physicians and executives were conducted at their offices. No monetary compensation was provided to any of the participants. All of the interviews were carried out by a female researcher (author GTA), who is a biomedical engineer and a PhD student with a focus on the design and development of mHealth systems for Sub-Saharan Africa. The researcher has experience and training in various research methodologies, including qualitative study. The interviews were conducted in Amharic and were audio recorded. The audio recordings from the interviews were first transcribed verbatim and then translated to English. No automatic tool was used for transcription. Google Translate was used for translation, and the information was checked manually for correctness. The thematic analysis methodology described by Braun et al [] was employed for this study. The author GTA coded the interview transcripts and revised them with the 2 researchers JMA and GLS. NVivo software (QSR International) was used during the data analysis to code and categorize the data and to create a thematic framework. To report the study, we used the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist [], which has been provided in .
Ethical ConsiderationsEthical clearance was obtained from the KU Leuven Social and Societal Ethics Committee (SMEC) (G-2022-5491-R3(MIN)) and from the Jimma University Institute of Health Institutional Review Board (IRB) (JUIH/IRB/311/23).
A total of 48 interviewees participated in the one-to-one interviews. In the patient group, 17 patients (10 men and 7 women) were interviewed. Eight additional patients were approached, but they declined to be interviewed as they were in a hurry, were not willing to be interviewed, or were already frustrated with the system. The mean patient age was 33.9 years, and the mean interview duration was 6.25 minutes.
In the physician group, 19 physicians (12 men and 7 women) were interviewed. Six additional physicians were approached, but they declined to be interviewed as they had hectic schedules. The physicians included in the study were general practitioners who worked in chronic disease OPDs and had an average of 5 years of experience. In this group of individuals, the mean interview duration was 15.7 minutes.
In the health care executive group, 12 health care executives (10 men and 2 women) were interviewed. Owing to a scheduling conflict, 1 additional executive declined to be interviewed. In this group, the mean interview duration was 19.34 minutes. The executives had a variety of positions, including directors in the country’s health minister’s office, directors in city health administrative offices at the zonal and regional levels, hospital chief clinical officers, and ICT heads at hospitals. Owing to the limited number of key respondents in the health care executive group, the number of participants in our study was restricted. Nonetheless, we ensured that the interview process was comprehensive enough to address all crucial aspects, and we included all key informants while also exploring any new viewpoints that emerged.
The total sample size was established based on data saturation, which occurs when new data no longer provide additional perspectives or insights after a certain point. In this study, data saturation was reached following 48 interviews (17 patients, 19 physicians, and 12 health care executives), indicating that an adequate sample size had been achieved. provides an overview of the interview characteristics.
Table 1. Overview of the interview characteristics.VariablePatient group (n=17)Physician group (n=19)Health care executive group (n=12)Gender, n (%)aN/A: not applicable.
bICT: information and communication technology.
A total of 137 determinants for using mHealth systems in Sub-Saharan Africa were identified from the perspectives of patients, physicians, and health care executives. Of the 137 determinants, 68 were barriers and 69 were enablers. Themes were derived from the data. Further categorization of these aspects in the study resulted in the identification of 3 major categories: organizational and policy, social and personal, and technical and material. These categories were based on the consolidated framework of the factors impacting clinicians’ adaptation of mHealth [], which takes into account the numerous factors influencing adoption of mHealth systems. The organizational and policy factors pertain to health care organizations’ internal workings, workflow, policies, regulations, patient-related factors, and user engagement. The technical and material factors pertain to system design, system usefulness, IT capabilities, compatibility, data management, user experiences, monetary factors, and ease of use. The social and personal factors include personal characteristics, social and cultural factors, and moderating factors.
Perspectives of PatientsAmong patients, after a detailed examination of the data, we identified 10 unique factors that could impede progress, which were referred to as barriers, and 8 unique factors that could facilitate progress, which were referred to as enablers. provides a comprehensive list of these barriers and enablers. Patients were assigned a code based on the study area as follows: those from Addis Ababa were coded “AP,” those from Harari were coded “HP,” and those from Jimma were coded “JP.”
Figure 1. Barriers and enablers for using mobile health (mHealth) systems: patients’ perspectives. BarriersAmong the 10 barriers hindering the adoption of mHealth systems, 6 were under the technical and material category. These challenges included system design, system usefulness, IT capabilities, compatibility, data management, user experiences, monetary factors, and ease of use. The remaining 4 barriers were under the social and personal category, which included personal characteristics, social and cultural factors, and moderating factors.
The majority of patients reported that they have never used mHealth systems. However, most of them reported that they would use mHealth systems if they had awareness and if they could access these systems in an affordable way.
More than half of the participants had no awareness about mHealth systems and how they could benefit them. However, upon a detailed explanation about mHealth systems and their importance, they reported that they recognize the usefulness of such tools. They reported that they would use these systems if they could get trustable systems and if recommended by their doctors.
Regarding the barriers associated with using mHealth approaches, the most frequently cited theme was a lack of awareness about mHealth systems.
I don't have the information about such things either. Apart from seeing the texts that come to me, I never installed the application and tried nothing.Patients also perceived the fact that mHealth systems are not readily available as a barrier to not using them. They reported that they browse Google or YouTube when they need to obtain information related to health.
I will download some stuff on YouTube. Video… I see…. I am downloading some video.The affordability of smart mobile phones, the requirement for a paid subscription, and the high cost of smart systems were identified as economic factors that can impede the adoption of mHealth systems. These factors are believed to create obstacles for individuals who may not have access to the necessary technology or cannot afford the associated costs.
Because this information is from the internet. It is not possible to access the internet if it is not purchased. Again, you can find that if you go to a place with internet. Even if I have a cell phone, it costs money.A lack of trustworthy mHealth systems is a significant obstacle to their adoption. Patients feared that the information and services provided by these systems may not be based on reliable evidence. This concern arose from the potential harm caused by inaccurate information or ineffective treatments.
I want it to be something secure. First is the issue of medication. Medical information is not something you can just throw away. Therefore, they have a question of credibility.Inconvenient features (presentation) of mHealth systems were also perceived as an obstacle to the use of these systems.
I think that a lot of data frustrates people. When you read more data, it is like an education. It needs your time. It needs your opinion. Anyone who is not in the health field may not have an interest in such things.Digital illiteracy, which refers to the lack of ability to effectively use digital technologies, such as computers, smartphones, and the internet, is a recognized barrier to the adoption of mHealth technologies. This challenge is believed to limit the ability to take advantage of the benefits provided by mHealth tools.
Lack of skill in using mobile phones. Configuring systems specially in IOS it is also same for android is difficult. Like Entering Personal Details. And because the app won't start without you doing it.Among the 8 enablers facilitating the adoption of mHealth systems, 5 were under the technical and material category and the remaining 3 were under the social and personal category.
Patients with chronic diseases had a need for easy and automated tools for health monitoring.
It's a matter of health. To control my blood sugar level, there are mandatory things that I have to do. So if there are things installed on my phone to help me with this, it helps.Patients recognized the availability of the internet as one of the facilitating factors of the use of mHealth systems as it could help them access such platforms.
At home, I have Wi-Fi, so it's easy.Another enabler was the perceived usefulness of mHealth as a convenient tool to access health information.
…. And it helps you to be proactive about your health. It means it prevents you from going to the hospital after something happens.Among physicians, we identified a total of 54 factors that were perceived to influence the adoption of mHealth systems. Of the 54 factors, 27 were identified as barriers that hinder the use of mHealth systems and 27 were identified as enablers that facilitate their adoption. The study further classified these factors into 3 main categories, namely, organizational and policy, social and personal, and technical and material. Physicians were assigned a code based on the study area as follows: those from Addis Ababa were coded “AD,” those from Harari were coded “HD,” and those from Jimma were coded “JD.”
BarriersSpecifically, among the 27 identified barriers, 7 were under the organizational and policy category, 11 were under the social and personal category, and 9 were under the technical and material category. displays the obstacles to the use of mHealth systems from the viewpoint of physicians.
Figure 2. Barriers for using mobile health (mHealth) systems: physicians’ perspectives. Physicians identified the lack of established mHealth systems as the primary reason for not using them. They acknowledged that their lack of exposure to these systems has prevented them from gaining experience in their use.
Actually, there is no such system or application based health care at the organization where I work.According to physicians, certain types of mHealth systems have been implemented in some organizations they work for. However, these systems are often interrupted and lack continuity. Physicians considered the discontinuity of established mHealth systems as one of the key barriers to the effective use of mHealth tools.
Around two years ago, this program was being popularized, but nobody in the middle was using it. It is not waited until we become experts. It was interrupted in the middle.Another barrier preventing the use of mHealth systems was the required extra time amidst an overloaded work schedule, especially for recommending such systems to patients.
And again, just because there is high patient load here; I don't have that kind of time. It does not allow to say use this or not. As one patient leaves, another enters. There is a load, and it doesn't allow us to have much contact with the patient. We are going to send by diagnosing and treating with what we already have.A further barrier to the adoption of mHealth systems was the lack of physicians’ awareness about mHealth systems for patients. Some physicians reported that they are not well-informed about these systems, and even for their own personal health and wellness, they rely on browsing the internet rather than using stand-alone health systems. This lack of knowledge and personal use can limit their ability to confidently recommend and implement mHealth tools in their practice, which in turn can hinder patient adoption and engagement. To overcome this barrier, there is a need for greater education and training programs for physicians on the benefits and effective use of mHealth systems, as well as efforts to increase physician engagement with these tools to help build their confidence and understanding.
Now, for example, I don't know anything personally, but for example, I don't know an app for diet. Honestly, now, in terms of exercise, I use YouTube downloads even for myself.Some physicians claimed that they have never given these systems any consideration.
From my point of view, there were no situations where we would recommend using this to my patients. Maybe, I have never thought about it.Another barrier was physicians’ concerns about patients’ mHealth capability. They acknowledged being worried that their patients do not have the necessary skills or access to technology to make the most of mHealth tools.
But as I said, it's not that the applications have problems; As I told you before, I don't think anyone will use it. It just doesn't feel like that to me.Physicians mentioned a further obstacle in the adoption of mHealth systems, namely, lack of trustworthy systems, which raises concerns about the potential risks of recommending them to patients.
People with chronic conditions are very bitter, so they search for something to escape. Sometimes there is information that takes you to stop taking medicine. So, this is the side effect of modern digital. It's not even called a limitation.Another barrier was the lack of readily available mHealth systems in the local context.
But it is not prepared at the app level in our country. It is better if we use this application prepared like this. We tell patients that they will find it on Google because it is not set up like that.Security and data confidentiality concerns were also perceived as barriers to the use of mHealth systems.
I usually log in with my Google account. I have already accepted my Google account. And I have doubts. I am not sure. As I don't have details about the system. I don't know much about server security. Some app says you can accept or not about personal issue when you open an app. It may be exposed. I'm not sure about the data security and confidentiality.Another barrier was the inconvenient features of some mHealth systems. Most mHealth systems that physicians can use do not have an offline option, and many of these systems work online.
The biggest problem is that they are all online. They don't have offline. And you absolutely need data.A lack of reliable internet and electricity was an additional obstacle.
After all, if there is no internet, we cannot get this information. The main obstacle is the internet. Most mHealth applications are internet-based, so information cannot be accessed when the internet is down.Among the 27 enablers that facilitate the adoption of mHealth systems, 14 were under the organizational policy category. These factors pertain to health care organizations’ internal workings, workflow, policies, regulations, patient-related factors, and user engagement. Moreover, 4 enablers were under the personal and social category involving personal characteristics, cultural factors, and moderating factors. Furthermore, 16 enablers were under the technical and material category encompassing mHealth system design, IT capability, compatibility, user experience, data-related factors, ease of use, and monetary aspects. Physicians’ perspectives on factors that facilitate the use of mHealth systems are depicted in .
Figure 3. Enablers for using mobile health (mHealth) systems: physicians’ perspectives. Physicians perceived usefulness in promoting easy information storage, access, and retrieval as one of the enablers of the use of mHealth systems. Despite limited exposure to these systems, physicians believed that they represent a convenient way to manage patient data, with the advantages of avoiding loss of information and enabling reliable information retrieval.
On the positive side, there is no such thing as loss of information such as manual cards and paper, papers can be torn and lost. Patients can also be abused. But if we use mHealth systems such as EMR, it will not disappear because we will simply be here and send all the investigations. Whether the data is from this year or before, I can check many things about the patient. It makes it easier for me because I have everything I need there.Another enabler was the perceived usefulness in reducing workload and improving health care quality. According to physicians, using mHealth systems has the potential to lessen the strain of health care personnel while also raising the standard of care.
The first reason for not providing quality service is the workload and if something reduces that load, if there are supportive things like this, I think the quality will improve.Physicians mentioned that mHealth systems allow for better access to health information for patients. Some believed that providing patients with access to various health-related information at their fingertips will empower them.
Using mHealth in general allows to get better information and updated information. Especially when it comes to health. It helps to live a healthy life by getting new information every day.Another enabler was the need for a chronic disease management support tool. Physicians recognized the potential benefits of digital automated tools for patients having chronic diseases, as consultations and visits to their office alone may not suffice. To promote healthy lifestyle changes and provide necessary support, it is imperative to equip patients with user-friendly tools that can be integrated into their daily routine.
First, when there is a patient like this... there are chronic ones, for example, diabetic, hypertensive, heart failure. Because they need not only medication but also life modification, they may not achieve what we have told them in one day. But everything how to modify their lifestyle detail is there, so when they get access, they can easily remember what we told them and continue their life. Beyond medication, by the way, also cares about their lifestyle.Availability of phones and the internet was also perceived as a facilitator. According to physicians, availability of phones and the internet has tremendously facilitated the adoption of mHealth systems in a variety of ways. First, regardless of location or the time of day, users may readily access health information and services via their mobile phones. Second, health professionals can use digital tools to gather, preserve, and share patient data, which can improve the quality and efficiency of health care services. The increasing use of mobile phones and the internet in Sub-Saharan Africa has created an opportunity to use these platforms to deliver health information and services to individuals who may have limited access to traditional health care services.
This is because there is internet access and broadband, so everyone works connected to the network. Without that, this simple system wouldn't exist.Physicians who have experienced mHealth systems recognized that these systems are easy to understand and operate. They declared that for users who are familiar with technology, these systems are easy to use.
So you need to know how to access the systems. They are mostly easy. There is nothing difficult unless you are someone who is not familiar with technology to use it. You can search. You can log in and access what you want. I don't have anyone who says it's a challenge.Among health care executives, we identified 65 factors that were perceived to influence the adoption of mHealth systems. Of these 65 factors, 31 were classified as barriers and the remaining 34 were classified as enablers. Further categorization of these aspects in the study resulted in the identification of 3 major categories: organizational and policy, social and personal, and technical and material. Health care executives were assigned a code based on the study area as follows: those from Addis Ababa were coded “AA,” those from Harari were coded “HA,” and those from Jimma were coded “JA.”
BarriersAmong the 31 barriers, 14 were under the organizational and policy category involving elements like the internal working environment of health care organizations, workflow-related challenges, policies and regulations, patient-related factors, and user engagement issues. Moreover, 6 barriers were under the social and personal category involving aspects like social and cultural norms, personal traits, and moderating factors. Furthermore, 11 barriers were under the technical and material category involving difficulties with usefulness, IT capability, compatibility, data-related factors, user experiences, financial factors, and ease of use of mHealth systems. Health care executives’ viewpoints on obstacles to the use of mHealth systems are presented in .
Figure 4. Barriers for using mobile health (mHealth) systems: health care executives’ perspectives. From the perspectives of executives, one of the challenges of implementing mHealth systems in Sub-Saharan Africa is the availability of competing priorities alongside digitalization in the health sector. There are competing demands for resources and attention, such as investing in health care infrastructure, improving health care workforce capacity, and addressing immediate health needs.
We are facing multiple health challenges, including infectious diseases as well as non-communicable diseases like diabetes and hypertension. Additionally, the health sector faces critical issues such as inadequate infrastructure, a shortage of skilled healthcare workers, and limited financial resources. Because there are competing priority areas in the sector that require money. From all of them, it is assigned to this sector and these are taken as a challenge not to work completely with hands.High initial investment required for mHealth technologies was also perceived as a barrier by executives. The cost of implementing mHealth systems includes not only the purchase of hardware and software, but also the cost of training health care workers, adapting existing health care workflows, and establishing new data management and privacy protocols.
As a problem in supply, mHealth technology is expensive. Not being able to avail of all of them is an issue.Another barrier was that some donor-initiated mHealth systems previously implemented in health care facilities lack government takeover plans after contract expiry. These mHealth systems involving donor support do not have clear take over and exit strategies for ensuring sustainability of the projects.
A project has a lifecycle. It comes up with a project by donors and be started that way.. It won't be owned when it is done. It will not be owned by the government.Skill gap in basic computer literacy was also perceived as a barrier. These skill gaps can be partly attributed to limited exposure or access to digital devices such as computers.
Computer access is limited. The smaller the access, the less likely it is to use mHealth activities. So there is an obvious skill gap. So does the professional.Another barrier was inefficient use of technology.
Efficiently manipulating those technologies if we had them; Proper use of data; One of the challenges is not using technologies properly. We should use them properly and take the appropriate value from them.The absence of individual patient–focused mHealth system implementation was perceived as another barrier to the adoption and implementation of mHealth systems in health care.
While some health care facilities have implemented mHealth initiatives, these initiatives are more focused on the institution rather than the individual patient.
The one that we are using on ART is not to be used by the individual patients. It is an application more with professionals on the periphery than with patients.A further barrier was that implemented mHealth systems lack interoperability and full digitalization. Although attempts to implement mHealth are sparse in health care facilities, lessons can be borrowed from implementation challenges in other areas, such as electronic medical records (EMRs). Some facilities have deployed EMR systems. EMR systems are not fully digitized, with most of them involving a combination of manual and digital systems. Some health care executives also reported that due to mismatch or lack of integration between some medical devices, they are unable to deploy fully digital systems.
There is a lot of fragmented stuff.Another barrier was the difficulty of staff to quickly and easily adapt to mHealth systems.
First of all, sometimes when new things come, there are problems of getting used to that digital thing quickly and not keeping up with it.Another barrier was the lack of awareness among staff members. Going fully digital requires a great deal of work to create awareness, as mHealth technologies are relatively new in the region and many health care workers may not be familiar with them.
As a challenge, we still need a lot of attention for technology in general by the government. We are still in the early stages of our own user experience.The above issue is further exacerbated by the fact that the barrier is related with staff’s reluctance to transition from traditional to digital systems. This lack of awareness and knowledge can lead to resistance or hesitancy in adopting mHealth systems, even if they have the potential to improve patient outcomes and operational efficiency. Health care staff may be unsure of how to use mHealth tools and systems, or they may not understand the benefits of using them.
People who are used to paper work often don't want to be told that we are going to do digital work.Among the 34 factors that facilitate the adoption of mHealth systems, 14 were under the organizational and policy category. These factors pertain to health care organizations’ internal workings, workflow, policies, regulations, patient-related factors, and user engagement. Moreover, 4 enablers were under the personal and social category involving personal characteristics, cultural factors, and moderating factors. Additionally, 16 enablers were under the technical and material category encompassing mHealth system design, IT capability, compatibility, user experiences, data-related factors, ease of use, and monetary aspects. Health care executives’ viewpoints on enablers of the use of mHealth systems are presented in .
Figure 5. Enablers for using mobile health (mHealth) systems: health care executives’ perspectives. From the perspectives of executives, the health ministry’s plan to digitalize the health care system is one of the main facilitators or enablers of the use of mHealth systems.
There is a direction according to the government. To use such technologies in most cases; It is for online use. The ministry itself has a strategic plan. To digitalize the healthcare system. It is a priority.The executives emphasized that the plan is not just a matter of execution but also of giving priority and actively pursuing it.
And now technology is making a big contribution to the health sector. And the ministry understands what a great advantage we have; Departments in the Ministry of Health are working with great initiative using mobile technology.Another factor that enables the implementation of mHealth systems is the existence of governance frameworks. Such frameworks were nonexistent a few years ago. However, now, in order to regulate and promote the adoption of mHealth systems, the health ministry has developed a framework that is currently being deployed. Furthermore, a dedicated directorate office has been established to oversee and manage the adoption and implementation of mHealth systems.
Therefore, it is mandatory to create favorable conditions. Facilitating conditions on the ground such as governance frameworks are required. We are working on it. Standards guidelines are required. In addition to this, data standards have also been developed. Now, for example, there are disease codes. A standardized health data access policy has been developed. All these guides the mobile health and govern mHealth as a whole.Another enabler is the recognition that digitalization is crucial for the survival of the heavily burdened health care system in Sub-Saharan Africa. Hospital executives strongly believed that the failure to digitalize the entire health care system within the facility will ultimately lead to its downfall.
But now, considering the complexity of the treatment and the number of patients we see, the staff is now demanding digital solutions. It is understood that we cannot survive if we do not digitize. We have to digitize the entire operation of the hospital. As I said before, it is a matter of survival. It is a hospital where three thousand four thousand people come and go every day. We have 250,000 to 300,000 outpatients per year. We treat about 20000 people. About 170,000 to 180,000 people will come for emergency. We perform surgery on 15000 people. So this process it is huge process. If this process is not digitized, we cannot provide a smooth service. Because it is causing problems for the patient. As a hospital, we have an assessment that it is increasing the number of deaths.According to the executives, another enabler is efforts made toward maximizing the necessary infrastructure provision required for the implementation of mHealth systems. Executives at all levels within the organization realized the importance of providing the required infrastructure, such as ICT and hardware or software resources, to support the deployment of mHealth systems.
In terms of infrastructure... the main thing for digitalization is the internet. They have been given internet access in all nine districts. In terms of computers, they have computers. All adequate internet access to the DHIS health information system, capable computers, and PCs are available at all health centers in the district.Another enabler is the growing societal familiarity with digital technologies, including social media and financial systems. As more individuals become
留言 (0)