Mobile technology adoption by doctors in public healthcare in the Western Cape, South Africa

Doctors working in public healthcare in South Africa are faced with the unique resource constraints prevalent in a developing country. In this context, doctors can use information and communication technologies (ICTs) to obtain better information and decision support. However, the potential of ICTs to improve the healthcare sector will only be realised if individuals decide to adopt the new technologies. Therefore, an understanding of the factors that influence doctors’ use of a technology needs to be developed and the research efforts to identify these factors have been lacking in the South African public healthcare sector. This paper explores significant factors influencing the adoption of mobile devices by doctors in the public healthcare sector in the Western Cape, South Africa. The research methodology was shaped by qualitative enquiry and described through thematic analysis. Key adoption factors identified include those confirmed by prior research of: job relevance, usefulness, perceived user resources and device characteristics. Adoption factors that emerged during this research are support structures from national government and hospital administration, patient influence and unease in respect of malpractice legal suits

Evaluating a South African mobile application for healthcare professionals to improve diagnosis and notification of pesticide poisonings

Acute pesticide poisoning (APP) is a major global public health problem, particularly in low- and middle-income countries (LMICs) including South Africa. However, healthcare professionals (HCPs) worldwide have limited training in handling environmental health risks such as from pesticide exposures. Most HCPs lack basic training on APP and, this presents a challenge to HCPs when diagnosing and notifying pesticide-related poisonings. With a recent increase in mobile application technology, this gives a convenient platform to provide training support for HCPs in their clinical practice. An example is the integration of a South African pesticide notification guideline into an existing Emergency Medicine (EM) mobile application. This pesticide notification guideline (PNG) within the EM mobile application aims to provide an immediate point-of-care tool to help HCPs in diagnosis and notify pesticide poisoning cases. Despite this useful platform for training HCPs, there are limited studies that have evaluated mobile applications or technologies to promote HCPs training in LMICs. This study, therefore, aimed to evaluate the Centre for Environmental and Occupational Health Research (CEOHR)'s PGN adapted for the EM mobile application as a tool for improving HCP's ability to diagnose and report APPs. The protocol (Part A) provides information and a justification for the research study and, describes the methods used to gather and analyse the data. The extended literature review (Part B) provides an overview of studies assessing HCPs' knowledge of and training in pesticide poisonings and the role mobile health technologies play in improving HCPs' knowledge and training in clinical practice. Furthermore, the literature review illustrates the relevant theoretical frameworks and concepts that helps to understand HCPs' behaviour changes when using clinical guidelines or algorithms. The journal manuscript article (Part C) provides this study's research findings and how it could contribute to the body of knowledge. A total of 50 emergency medicine physicians and registrars participated in th

Integration of mHealth technologies to support service interaction moments in tertiary healthcare of Western Cape, South Africa

There is an increasing publication of scholar articles that describe the ubiquitous nature of mobile technologies as an enabler of mobility. However, there is limited empirical evidence that indicates the defined service interaction moments wherein mobile Health (mHealth) technologies could be useful and are actually used during the execution of work activities with minimal disruption in a clinical setting. The nature of healthcare professionals work activities often requires mobility and continuous management of information but the predominant use of paper-based systems and desktop computer workstations cause time and location constraints. This ultimately defeats the purpose of health information technologies to provide automation of work activities and enhance performance efficiency at points-of-care during service delivery. Hence, it is arguable that mHealth technologies could somewhat redress time and location constraints at points-of-care in clinical practice. The study adopts an interpretivist approach to understand work activities of healthcare professionals in relation to the integration of mHealth technologies, by means of service design as a strategy. Preliminary findings show that, there are specific forms of mHealth applications developed by clinicians but it can be disruptive during work activities while consulting with patients. Ultimately, the study indicates how the interplay between human and machine agencies influence work activities. Furthermore, mHealth technologies would integrate into workflow of professionals at points-of-care where coordinated care involves several professionals for communication purposes. The overall intended outcome of this study would contribute as groundwork on which future studies could design mHealth technologies specific to the work practices of healthcare professionals in sub-Saharan Africa public hospitals

Factors Influencing the Adoption of Clinical Informatics Tools among Medical Doctors in South Africa

The adoption of clinical informatics tools is not encouraging in many developing countries and a better understanding of the factors that influence their integration is expected to promote their effective utilisation. To shed more light on this phenomenon, the study employed the use of Universal Theory of Acceptance and Use of Technology (UTAUT) to identify the factors that influence the use of clinical informatics tools. The study employed a positivism research paradigm anchored on survey research design. Simple random sampling technique was used to select one hundred and five medical doctors in a tertiary hospital in South Africa. Data were collected with the use of a structured questionnaire. Structural equation modelling was used to analyse the data collected. Findings from the study reveal that effort expectancy was related to behavioural intention to use clinical informatics (β = 0.41, p< 0.05). Also, performance expectancy was related to behavioural intention to use clinical informatics (β = 0.47, p< 0.01). The study therefore recommends that the hospital management should create conducive environment that will promote effective use of clinical informatics tools and organise training programmes for effective use of the tools. The study also sees the need for technology producers to make the tools more user-friendly. Keywords: Adoption, clinical informatics, medical doctors, UTAUT and South Afric

Attitudes and perception of healthcare workers in health facilities with regards to the 'Intention to Use' of the Road to Health Booklet (RtHB)

Introduction: That low and middle income countries (LMICs) are plagued with high burdens of disease and limited health resources is well documented in the literature. These two realities necessitate the availability of good quality and reliable information to enable the efficient distribution of recourses and services. Growing recognition of the importance of health information has seen the introduction of numerous health information systems (HIS). The goal of these HIS is to attain preventative and curative treatment for those that need them, in adequate quantities, promptly, reliably and at equitable cost. Amongst the variety of HIS is the Road-to-Health Booklet (RtHB) in South Africa. This is a paper-based, patient-held medical record given to new mothers, intended to monitor all contact children have with the healthcare system. Due to the dearth of local research and increasing need for strong HIS, more research is needed in the implementation of the HIS and its use by healthcare workers (HCWs) in the African context. Methods: The aim of this study is to explore and understand the influence HCWs' attitudes and perceptions have on the implementation of the RtHB within the Khayelitsha Sub-District of Cape Town, South Africa. A qualitative case study was conducted utilising in-depth interviews, naturalistic observations, document review and mind mapping to explore HCWs' attitudes and perceptions on the RtHB. A combination of purposive and snowball sampling was used to identify participants with insights on the RtHB

Orthopaedic referrals using a smartphone app: Uptake, response times and outcome

Background. It is well established that South Africa (SA) suffers an immense burden of violence and injuries. The responsibility of providing care for these injuries falls mainly on public health services, resulting in overloading of the health system. Prior to a recent intervention, the large burden had been exacerbated by limitations in the traditional referral system that highlighted the need for a better referral system. Vula’s smartphone app was introduced at Tygerberg Hospital in August 2016. This study evaluated the uptake, response times and outcomes using this app.Objectives. The main objectives of the study were to describe: (i) the number of referrals; (ii) referral response times; (iii) referring facilities; and (iv) referral outcomes. Secondary objectives were to: (i) evaluate whether the referral outcome pathway was appropriate; and (ii) assess professional conduct and evidence of upskilling.Methods. This retrospective, descriptive study investigated Vula app referrals to the Division of Orthopaedic Surgery at Tygerberg Hospital between 1 August 2016 and 31 March 2017. Vula was advertised to key facilities in the hospital’s referral network. All referrals to the division during the study period were systematically included in the analysis of operational outcomes, although some were excluded from the subsequent referral outcome analysis. Operational outcomes included the number of referrals, referring facilities and referral response times. Referral outcome analysis included the clinical diagnosis, referral pathway, whether the referral was used for upskilling and whether it was conducted in a professional manner.Results. A total of 2 275 referrals from 39 different facilities were received during the study period from 238 individual users; 50% of referrals received a response within 11 minutes, while a small percentage received no response. Clinical and demographic characteristics of 1 985 patients included in the referral outcome analysis indicated that the majority of trauma and emergency referrals involved males, with closed fractures being the most frequent clinical presentation. Although the most common referral outcome was immediate transfer, one-third of the patients were treated at the referring hospital with advice only.Conclusions. The large volume of orthopaedic referrals received through the Vula app suggests that Vula represents a successful alternative to traditional referral methods. Referrals managed by advice only could suggest that Vula facilitates some relief for the overburdened trauma services. Future research could further explore Vula’s role in strengthening the public health system, including interventions for high-volume referral areas and upskilling of referring health workers.

The role of culture in mobile application adoption amongst diabetes patients in previously disadvantaged communities in the Western Cape

Magister Commercii - MComIntroduction: Diabetes mellitus is a global health problem with a high mortality rate. Self-management is an essential part of diabetes management and it includes self-care behaviour tasks such as healthy eating, being active and taking prescribed medication. In the current digital age, the use of technology for self- management of the disease is an important consideration. As a first step towards this, individuals have to first accept and use the technology. However, the literature indicates low levels of technology use amongst diabetic patients in environments with low socio- economic indicators and amongst minority groups. Previous studies suggest that there are many factors that influence technology acceptance such as economic, social and cultural factors. Mobile health (m-health) received recognition in healthcare literature in recent years and are known for delivering effective and efficient interventions to patients with chronic conditions such as diabetes. An investigation into m-health acceptance for diabetes management is vital as it impacts the achievement of development goals, including the United Nations’ SDG 3. This research posits that the culture of patients is a possible reason for the low acceptance and use of technology. Research based on the proliferation of culture as a determinant for diabetes self-management at an individual level is limited, especially in the South African context. The main research question pursued in the study reported in this thesis is How does culture influence m-health acceptance of diabetic patients in disadvantaged communities? Research design and methodology: Using an interpretivist paradigm, a case study research design provided the basis to collect data from 20 diabetes patients in Mitchells Plain and Strandfontein. The theoretical model that was used as a lens for investigation comprised a juxtaposition of Hofstede’s cultural dimensions and Unified- Theory of Acceptance and Use of Technology 2 (UTAUT2). The analysis of the qualitative data was undertaken with Atlas Ti, using a thematic content analysis process. Results: Eight themes emerged from the data and key results of the study indicate that opinions towards medical practitioners, which reflects power distance has a positive impact on users and non-users. Diabetic patients comply with the opinions of their doctors as they fear disagreeing with them. As such, this may result in having a positive influence on a participant’s ability to adopt and use mobile applications. Caregiver influence, which reflects femininity, has a negative influence on users as a result of diabetic patients being responsible for taking care of their family and others are both home carers and providers for their families. This indicates that patients are more concerned with the quality of their life and family than with the adoption mobile applications. Future work: It is recommended that research should be conducted in other areas in the Western Cape, specifically in the Cape flats to see whether the same sorts of results will be achieved in different communities. This could help policymakers and application developers tailor mobile applications for this target population

Investigating factors that hinder the adoption and use of primary healthcare information systems (phcis) in the western cape of South Africa

Magister Commercii (Information Management) - MCom(IM)In the past, the Western Cape Department of Health had no formal or technologically enabled system for patient administration. This resulted in an administrative burden, increased waiting times for patients and doctors who needed results back from other sections, and missing patient files within the community health institutions such as clinics and hospitals. The Primary Healthcare Information System (PHCIS) was developed to solve this problem. However, it was later discovered that even though the PHCIS had been installed across the Western Cape clinics, there was a limited adoption and use of the PHCIS. Hence, the aim of this study was to investigate the factors that hinder the adoption and use of PHCIS by healthcare workers in the public healthcare clinics in the Khayelitsha sub-district in the Western Cape Provinc

Telemedicine in Primary Health: The Virtual Doctor Project Zambia

This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]