Will Computer Literacy Affect Telemedicine Acceptance Among Health Care Workers? Liezel Cilliers
Stephen Flowerday
University of Fort Hare P.O. Box 7426 East London, 5200 +27 (0)83 518 4009
[email protected]
University of Fort Hare P.O. Box 7426 East London, 5200 +27 (0)43 704 7071
[email protected]
Abstract – This study investigates how e-skills affect the acceptance of Telemedicine among health care workers in the Eastern Cape Department of Health, South Africa. A quantitative survey design was used to investigate the computer literacy and acceptance of Telemedicine among health care workers in the Eastern Cape. The questionnaire was compiled making use of the Technology Acceptance and Unified Theory of Use and Acceptance of Technology Model. The self reported computer literacy rate was 73% while only 24% of the health care workers had received formal computer training. Computer literacy tested statistically significant for qualification, area of work and age. Although formal training for computer skills was poor, the majority of the health care workers did consider themselves computer literate. Training efforts need to be focused on rural health care workers with no degree qualification. How to cite this article: Cilliers, L., & Flowerday, S. (2011). Will computer literacy affect telemedicine acceptance among health care workers? ReSNES 2011. Presented at the Research Network for e-Skills Conference, Premier Hotel Regent, East London, South Africa. ISBN: 978-0-620-51804-8.
Keywords: Telemedicine, E-health, Critical Success Factors, Health care BACKGROUND Populations in developing countries are becoming increasingly ill due to the double burden of HIV/AIDS and lifestyle diseases (Kifle, Mbarika, Okoli, Tsuma, Wilkerson, and Tan, 2008). This means that health care workers specifically in the rural areas are challenged to coordinate medical services with limited resources while case management is becoming increasingly more complex. The isolation of these health care workers is often cited as the reason for poor service delivery in rural areas (Aderibigbe, Shonubi, Odusan, Oloruntoba, Agbahowe and Siddique, 2006). Other identified obstacles include lack of staff and specialist support in rural areas, high turnover of staff as well as a lack of educational opportunities for health care workers and long distances that must be travelled by patients to access health care (Telemedicine, 2002). Cullinan and Thom (2005) report that in South Africa the distribution of health care workers has always been highly inequitable. The highest concentration of health care workers
are found in the private sector, the richest provinces and urban areas. The private sector in South Africa employs half of the country’s health care workers and two-thirds of the doctors while only treating a fifth of the population (Medecins Sans Frontieres, 2007). E-skills are an emerging field within medical informatics making use of the Internet and related technologies to deliver or improve health services and information (Eysenbach, 2001). Within this field the World Health Organisation (WHO) has identified Telemedicine as a possible application to strengthen health systems and improve the quality of health care delivery in rural areas (Nwabueze, Meso, Kifle Okli and Chustz, 2009). Telemedicine is defined by the WHO (2004) as “…the practice of medical care using interactive audiovisual and data communications including medical care delivery, diagnosis, consultation and treatment, as well as education and the transfer of medical data.” Literature has identified several benefits that Telemedicine can provide to improve patient care. These include improved safety, quality and efficiency of health care as well as providing evidence and data to support clinical practice, research and policy making use of e-learning, knowledge management, disease surveillance and e-supported resource management (Pagliari, Sloan, Gregor, Sullivan, Detmer, Kahan, Oortwijn and MacGillivray, 2005; Nwabueze et al, 2009). The potential of Telemedicine to improve health services is well documented. Sorenson (2010) proposed that Telemedicine can be used to provide clinical services; expert consultations; distance education; health information to the health care workers and the public as well as peer support. It can be used to expand access to and improve primary, secondary and tertiary care thereby increasing the efficiency of these services while decreasing cost. The benefit of the increased access to specifically specialist care means that the geographical variability of health care is reduced (Heinzelman, Lugn and Kvedar, 2005). Education can be provided in various forms including continuing distance education, community health education for the public such as hygiene and family planning as well as medical information exchange between health care workers (Lemma, 2004). Many teaching hospitals in the developed world have reported a redistribution of skills as they can use case studies at developing world hospitals to teach students about pathologies that they may never encounter in their own
countries. In the same way the health care workers in rural areas are supported and provided with new skills making use of Telemedicine as the teaching medium (Heinzelman et al, 2005). Traditionally the developing world has had little success with Telemedicine. This can be attributed to the high costs associated with Internet connectivity, high-end videoconferencing systems and sophisticated medical devices (Bukachi and Pakenham-Walsh, 2007). A second reason for the poor uptake of Telemedicine is human and cultural factors. Change to resistance as well as a lack of basic computer literacy has been singled out as potential reasons (WHO, 2004). Technological advances in the health care sector are made daily and in order to keep up with these advances health care workers do need computer literacy skills. Very often daily duties such as electronic health records include general computer literacy skills which increase the efficiency and effectiveness of health care in general. This is especially true in Telemedicine as health care workers must be able to use the equipment and software with reasonable ease and efficiency (Bhattacherjee, 2001). Horsley and Forster (2005) report that the major barriers for physicians to accept new technology are cost and time. The additional time spent operating new technology is singled out as the most significant factor and some studies found that certain Information Systems would require more time to operate than the more traditional paper based methods (Overhage, Perkins, Tierney and McDonald, 2001). Computer literacy until recently has not been emphasised in tertiary institutions making the expense and learning curve a barrier to introducing computer networks in health care. A consequence of this insufficient computer literacy is that it still takes about fourteen to seventeen years for medical breakthroughs to become standard practice (Stepankova and Engoya, 2006). Continuing education has been identified as an opportunity to increase the computer literacy skills of health care workers and has been implemented in South Africa as a requirement for the annual registration of health care workers. The objective of this study is to investigate then what role the exposure to e-skills of Information Technology have on the user and if it can predict the likelihood of Telemedicine being adopted and used by health care workers in the Eastern Cape Department of Health METHODOLOGY The research methodology applied to this study is positivistic, quantitative research making use of a survey research design. The questionnaire used was compiled making use of the published questionnaires designed by Davis (1989) and Venkatesh, Morris, Davis, Davis (2003). Both these questionnaires have been published previously and used extensively in other studies to test the acceptance and use of new technology by users in different settings (Venkatesh et al, 2003). The study population of this research project was defined as any health care worker for a multidisciplinary team
employed at an Eastern Cape Department of Health Telemedicine site around the province. A pilot study was conducted prior to the main study to validate the questionnaire. The questionnaires were distributed in a hardcopy format to participants working in 6 hospitals and 25 clinic sites situated around the Eastern Cape. In order to perform statistical analysis, the raw data gathered from the questionnaire was processed using Statistical Package for the Social Sciences (SPSS). The chisquare statistical test was used to determine if observed data deviated from those expected under the particular hypothesis. Validation of the final results was conducted by 4 experts in Telemedicine and technology acceptance in general. Feedback from these experts was then incorporated into the final recommendations and conclusions of the project. Exclusion criteria for this study included technology issues directly associated with Telemedicine as well as budget and other financial constraints faced by the implementers of the technology. Telemedicine used in the private sector was also excluded from the study. RESULTS Seventy five questionnaires were distributed of which 76% were returned. The majority of the study population consisted of women (86%). A third of the participants were younger than 30 years of age while almost half of the participants were older than 40 years of age. The study participants indicated that 43,9% worked in a urban setting and 56,2% in a rural area. The highest qualifications obtained by the participants can be divided as follow: 22,8% completed grade 12; 29,8% completed a nursing diploma; 33,3% of the participants obtained a degree and 14% indicated that they had not obtained a Grade 12 qualification. Almost half of the participants (43,8%) considered themselves confident about their knowledge of Telemedicine while 31,6% indicated they were somewhat knowledgeable about the technology and 21,8% considered themselves not knowledgeable. 1. PC LITERACY The computer literacy among the study population is self reported at 73,7%. Those who considered themselves computer illiterate totalled 27,3%. Different tasks that can be performed making use of IT were investigated. Most of the participants indicated that they made use of e-mail (59,6%) and a digital camera (64,9%). The majority also made use of either Microsoft Word (61,4%) or Excel (54,4%). The perceived level of computer literacy tested statistically significant for qualification (Χ2=16,781; p
