End Users' Initial Perceptions of mHealth in Nigeria: An Investigation of Primary Healthcare Workers' Attitudes to the IMPACT App

End Users' Initial Perceptions of mHealth in Nigeria: An Investigation of Primary Healthcare Workers' Attitudes to the IMPACT App

Grace Fox (Irish Institute of Digital Business, Dublin City University, Ireland), Yvonne O'Connor (University College Cork, Ireland), Emmanuel Eze (University College Cork, Ireland), Edmund Onyemaechi Ndibuagu (Department of Community Medicine and Primary Health Care, Enugu State University of Science and Technology, Nigeria), and Ciara Heavin (University College Cork, Ireland)
Copyright: © 2020 |Pages: 15
DOI: 10.4018/IJEHMC.2020100104
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Abstract

Mobile health (mHealth) is perceived as a “silver bullet” solution to many of the existing healthcare delivery issues in developing regions. However, the design, development, piloting, implementation, and maintenance activities associated with mHealth are significant. Fundamental to the success of mHealth is stakeholder support within the healthcare system. A qualitative exploratory approach using interviews, presentations, and focus groups was pursued to investigate primary healthcare (PHC) workers' initial perceptions of the proposed IMPACT app to support the assessment of sick young children in the community in Nsukka, Enugu State, Nigeria. PHC workers welcomed the prospect of using the IMPACT app. However, they were keen to highlight local infrastructural challenges and lack of access to training as barriers to the wider rollout of the IMPACT app. Through investigating PHC workers' initial perceptions, mHealth projects may be better designed to positively influence end users' commitment and motivation to use mHealth as part of their roles in the future.
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1. Introduction

The use of mobile Health or ‘mHealth’ continues to grow exponentially in both developed and developing regions of the world. Software applications (apps) for smartphones are available for a variety of health-related tasks including symptom assessment, psychoeducation, resource location, and tracking of treatment progress (Luxton, et al., 2011). Since the establishment of the Millennium Development Goals (MDG) in 2000 and the Sustainability Development Goals (SDG) in 2016 the healthcare sector in developing countries has experienced the introduction of mHealth technologies (Franz-Vasdeki, et al., 2015; Lee, et al., 2016). There has been significant investment in resourcing mHealth to support expectant mothers (Kazi et al., 2017), to promote health education (Lupton, 2013), and to support the health assessment of communicable diseases such as HIV (Catalani, et al., 2013), Ebola (Akaninyene, Bassey, Okey, & Egbe, 2016), and malaria (Mangam et al., 2016).

Despite the increased investment from Non-Government Organisations (NGOs), governments, and other funding bodies, in conjunction with and the reported benefits associated with mHealth (Leon, Schneider, & Daviaud, 2012), the number of mHealth solutions operating in developing countries remains extremely low (Källander et al., 2013). There are many possible reasons for the low levels of mHealth including resistance among end users and stakeholders and failure to adequately communicate the aims and benefits of mHealth solutions (Klöcker, Bernnat, & Veit, 2015). It is argued that there exists a limited body of empirical mHealth research in the context of developing countries (Franzen et al., 2017; Hossain, Goyder, Rigby, & El Nahas, 2009).

It is therefore imperative that we capture end users’ impressions when initially introduced to mHealth projects. This is important to explore, as research suggests that early impressions formulated by various end users impact their attitude towards technology (O'Connor, Eze, & Heavin, 2016). That is, through these early impressions end users formulate their perceptions about the project (ibid), and this directly influences their attitudes towards the project. Subsequently, the objective of this research is to investigate end users’ initial perceptions of the proposed mHealth artefact. This paper seeks to explore the first impressions perceived by Primary healthcare (PHCs) workers when initially introduced to an mHealth app, namely the IMPACT app, in Enugu State, Nigeria. Following a qualitative analysis approach, it was evident that PHC workers were positively predisposed to considering the adoption of mHealth as part of their roles in the delivery of healthcare services in the rural community. Broadly speaking, the proposed introduction of mHealth was deemed a welcome initiative that has the potential to create new opportunities for healthcare delivery in this jurisdiction. However, PHC workers were keen to elucidate the challenges associated with the potential implementation of mHealth. These included resourcing and infrastructural challenges, as well as the significant training needs of healthcare workers in the use of mHealth. By better understanding end users’ initial impressions, our aim is to develop new interventions, i.e. training and ongoing support, to positively influence end users in their adoption and use of the proposed mHealth app.

The paper is structured as follows – the next section considers the existing body of mHealth literature. Section 3 presents the conceptual model of end users’ attitudes toward mHealth adoption proposing four hypotheses for further exploration. Following this, section 4 outlines the research approach undertaken. The findings from our field study are considered in section 5. The results are discussed in section 6 and the conclusions from the study are presented in section 7. Finally, opportunities for further research are outlined.

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