Listen before you leap: Sri Lankan health professionals’ perspectives on m-health

Abstract

Given the increasingly widespread use of mobile phones in the developing world, the application of this technology for healthcare (also referred to as m-health) has tremendous potential. However, there is a need for more research on factors that influence the sustainable and scalable adoption of m-health in developing countries. To fill this gap, in this study, drawing on the theory of diffusion of innovation, we conducted in-depth interviews with 29 health professionals in Sri Lanka to understand their views on the benefits and barriers to adopting m-health. Participants had mixed views on the adoption of this technology. Reasons for m-health adoption included efficiency and usefulness in emergency situations. Barriers to adoption included risks for miscommunication/misinterpretation and lack of systems/policies for implementing m-health technology. With regard to the innovation-decision process, most participants appear to be in the stages of "persuasion" and "decision"; with regard to degree of innovativeness, interviewees comprise a mix of "early adopters" and "laggards." Assuming mobile health apps afford improvements in health outcomes for developing countries, contextual factors in each national setting should inform design and implementation of m-health interventions.

Understanding Clinicians’ Adoption of Mobile Health Tools: A Qualitative Review of the Most Used Frameworks

“…Geographically, 24% (12/50) of the studies were based in the United States [ 35 - 46 ], 10% (5/50) of the studies were based in the United Kingdom [ 47 - 51 ], and the rest were spread across many countries: Australia [ 52 , 53 ], Australia and the United Kingdom [ 15 ], Austria [ 54 ], Canada [ 55 - 57 ], Germany [ 58 - 60 ], Iran [ 61 ], Iraq [ 62 ], Japan [ 63 ], the Netherlands [ 64 ], the Netherlands, Spain, and the United Kingdom [ 65 ], Nigeria [ 66 ], Norway [ 67 , 68 ], South Korea [ 69 , 70 ], Spain [ 71 - 74 ], Spain Colombia and Bologna [ 75 ], Sri Lanka [ 76 ], Sweden [ 77 , 78 ], Switzerland [ 79 ], Taiwan [ 80 , 81 ], and Turkey [ 82 ].…”

“…DOI was used in 16% (8/50) of the studies [ 37 , 40 , 50 , 53 , 56 , 62 , 76 , 78 ], and UTAUT extensions were used in 12% (6/50) of the studies; some of these UTAUT extensions were based on the research context and previous research [ 64 , 66 , 84 ], and other included extensions from other frameworks such as the De Lone and McLean information success model [ 54 ], use of technology [ 65 ], and a combination of TAM, TPB, and DOI [ 82 ]. Furthermore, certain studies used a combination of the TAM and DOI frameworks (3/50, 6%) [ 42 , 43 , 59 ]; others used the consolidated framework for implementation research (CFIR; 3/50, 6%) [ 39 , 41 , 67 ] and the STS (2/50, 4%) [ 49 , 55 ].…”

“…Moreover, eight studies named increased efficiency or effectiveness (APEASE) as a facilitating factor, as it allows optimal use of staff time [ 47 , 50 ], but some also reported mixed views on whether such tools can really improve efficiency and the necessity of streamlining processes to enable such gains [ 35 , 52 ]. Similarly, eight studies specified communication; however, some saw it as a facilitator [ 42 , 47 , 50 ], and others reported the risk of miscommunication as a barrier [ 51 , 53 , 76 ], whereas six studies specified evidence (CFIR) or appraisal, showing that growing the evidence base and the positive stories about such tools can help increase adoption [ 39 , 48 , 53 ].…”

“…Similarly, if the tool is not integrated into or interoperable with the hospital or clinical systems, it becomes harder to adopt it as it usually creates an increased workload (eg, inputting data), and therefore, the potential for information to be lost [ 44 , 47 , 53 , 78 ]. Several studies also reported that an insufficient IT infrastructure could be a barrier [ 42 , 53 , 62 , 73 , 76 , 83 ] and some specified difficulties such as technical and connectivity issues that seem to be a common problem in some hospitals [ 50 , 62 , 67 , 68 , 79 ].…”

“…These are crucial in the health care setting, given their highly regulated nature but were hardly spelled out as specific constructs in most of the frameworks used, with the exception of CFIR. External policies (CFIR) and regulations were mentioned in eight studies and shed light on the importance of developing policies, clear guidelines, and legislative changes that would encourage adoption [ 15 , 35 , 39 , 53 , 62 , 76 , 78 , 85 ]. Reimbursement policies and funding were specifically mentioned in three studies [ 35 , 53 , 70 ], whereas two studies explained how the level of standardization in health care can facilitate or hinder adoption [ 58 , 78 ].…”