Diffusion of e-health innovations in ‘post-conflict’ settings: a qualitative study on the personal experiences of health workers

Human Resources for Health

Alexander Finlayson²  Andrew Leather⁵  Brian Godman¹  Preeti Patel⁶  Jibril Handuleh⁷  Molly Fyfe⁴  Aniek Woodward³ 

[1] Srathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK;Green Templeton College and Department of Primary Care, University of Oxford, Oxford, UK;London School of Hygiene & Tropical Medicine, Keppel Street, London, UK;Department of Education, King’s College London, London, UK;King’s Centre for Global Health, King’s College London and King’s Health Partners, Weston Education Centre, London, UK;The Department of War Studies at King’s College London, The Strand Campus, London, UK;Amoud University, Boroma, Somaliland

关键词: Somaliland;    Sierra Leone;    West Bank and Gaza;    Liberia;    Post-conflict;    Perceptions;    Health workforce;    E-health;    Diffusion of innovation;   

Others  :  821757
DOI  :  10.1186/1478-4491-12-22

 received in 2013-07-09, accepted in 2014-03-31,  发布年份 2014

【 摘 要 】

Background

Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging ‘post-conflict’ contexts. However, analyses on the adoption of technology for health (that is, ‘e-health’) and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations.

Methods

This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger’s diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis.

Results

All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination.

Conclusions

Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users.

【 授权许可】

   
2014 Woodward et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Horton R: North and South: bridging the information gap. Lancet 2000, 355:2231-2236.
• [2]Leather A, Ismail EA, Ali R, Abdi YA, Abby MH, Gulaid SA, Walhad SA, Guleid S, Ervine IM, Lowe-Lauri M, Parker M, Adams S, Datema M, Parry E: Working together to rebuild health care in post-conflict Somaliland. Lancet 2006, 368:1119-1125.
• [3]Pavignani E: Human resources for health through conflict and recovery: lessons from African countries. Disasters 2011, 35:661-679.
• [4]Smith J, Kohlemainen-Aitken R-L: Establishing human resource systems for health during postconflict reconstruction. Manag Sci Heal 2006, 3:9-12.
• [5]Varpilah ST, Safer M, Frenkel E, Baba D, Massaquoi M, Barrow G: Rebuilding human resources for health: a case study from Liberia. Hum Resour Health 2011, 9:11. BioMed Central Full Text
• [6]Anand S, Bärnighausen T: Human resources and health outcomes: cross-country econometric study. Lancet 2004, 364:1603-1609.
• [7]Gates S, Nyga VM: Development consequences of armed conflict. World Dev 2012, 40:1713-1722.
• [8]Pinstrup-Andersen P, Shimokawa S: Do poverty and poor health and nutrition increase the risk of armed conflict onset? Food Policy 2008, 33:513-520.
• [9]Rogers E: Diffusion of Innovations. 5th edition. New York, NY: The Free Press; 2003.
• [10]Macrae J, Zwi A, Forsythe V: Aid policy in transition: a preliminary analysis of “post”-conflict rehabilitation of the health sector. J Int Dev 1995, 7:669-684.
• [11]WHO: E-Health. http://www.who.int/trade/glossary/story021/en/ webcite
• [12]Baroud RM: How Ready are the Stakeholders in the Palestinian Health Care System in the Gaza Strip to Adopt e-Health?. Calgary: University of Calgary, Department of Community Health Sciences; 2008. [PhD Thesis]
• [13]Ismail FM: Patience and Care: Rebuilding Nursing and Midwifery in Somaliland. London: African Research Institute; 2011.
• [14]Georgia Tech and the Carter Center’s Innovative Collaboration for Mental Health in Liberia. http://psychcentral.com/blog/archives/2011/12/13/georgia-tech-and-the-carter-centers-innovative-collaboration-for-mental-health-in-liberia/ webcite
• [15]Navein J, Fisher A, Geiling J, Richards D, Roller J, Hagmann J: Portable satellite telemedicine in practice. J Telemed Telecare 1998, Suppl 1:25-28.
• [16]Bengtsson L, Lu X, Thorson A, Garfield R, von Schreeb J: Improved response to disasters and outbreaks by tracking population movements with mobile phone network data: a post-earthquake geospatial study in Haiti. PLoS Med 2011, 8:e1001083.
• [17]Tsoto C, Maponga C, Gwata D: Developing a computer database for registering and monitoring patients on chronic drug therapy to determine drug consumption: a pilot study. Cent Afr J Med 2001, 47:191-196.
• [18]Finlayson A: Information communication technology to strenghten health systems. In Glob Heal Secur Heal as a Peace Divid. Stockholm: SIPRI & Sida; 2011.
• [19]Venkatesh V, Davis FD: A theoretical extension of the technology acceptance model: four longitudinal field studies. Manage Sci 2000, 46:186-204.
• [20]Thompson RL, Higgins CA, Howell JM: Personal computing: toward a conceptual model of utilization. MIS Q 1991, 15:125-143.
• [21]Stebbins RA: Exploratory Research in the Social Sciences. London: SAGE; 2001.
• [22]Reeves S, Albert M, Kuper A, Hodges BD: Why use theories in qualitative research? BMJ 2008, 337:631-634.
• [23]Ajzen I: The theory of planned behavior. Organ Behav Hum Decis Process 1991, 50:179-211.
• [24]Venkatesh V, Morris MG, Davis GB, Davis FD: User acceptance of information technology: toward a unified view. Manag Inf Syst Q 2003, 27:425-478.
• [25]Mac Ginty R, Muldoon OT, Ferguson N: No War, No peace: northern Ireland after the agreement. Polit Psychol 2007, 28:1-11.
• [26]Richards P: No Peace, No War. Anthropology of Contemporary Armed Conflicts. Oxford: James Currey; 2005.
• [27]National Institute for Health and Clinical Excellence: How to Change Practice: Understand, Identify and Overcome Barriers to Change. London: NICE; 2007.
• [28]Google Groups. https://groups.google.com/ webcite
• [29]HINARI Access to Research in Health Programme - About HINARI. http://www.who.int/hinari/about/en/ webcite
• [30]MedicineAfrica - What We do. http://www.medicineafrica.com/index.php?about webcite
• [31]OxPal Medlink - About us. http://oxpal.org/about/ webcite
• [32]UpToDate. http://www.uptodate.com/home webcite
• [33]Kwankam SY, Pablos-Mendez A, Kay M: E-health: information and communication technologies for health. In ICT4D Inf Commun Technol Dev. Edited by Unwin T. Cambridge: Cambridge University Press; 2009.
• [34]Blaya JA, Fraser HSF, Holt B: E-health technologies show promise in developing countries. Health Aff 2010, 29:244-251.
• [35]WHO: mHealth: New Horizons for Health through Mobile Technologies, Volume 3. Geneva: Second Global Survey on eHealth; 2011.
• [36]Awases M, Gbary AR, Nyoni J, Chatora R: Migration of Health Professionals in Six Countries: a Synthesis Report. Geneva: WHO; 2004.
• [37]Eastwood JB, Conroy RE, Naicker S, West PA, Tutt RC, Plange-Rhule J: Loss of health professionals from sub-Saharan Africa: the pivotal role of the UK. Lancet 2005, 365:1893-1900.
• [38]Mullan F, Frehywot S, Omaswa F, Buch E, Chen C, Greysen SR, Wassermann T, Abubakr DEE, Awases M, Boelen C, Diomande MJ-MI, Dovlo D, Ferro J, Haileamlak A, Iputo J, Jacobs M, Koumaré AK, Mipando M, Monekosso GL, Olapade-Olaopa EO, Rugarabamu P, Sewankambo NK, Ross H, Ayas H, Chale SB, Cyprien S, Cohen J, Haile-Mariam T, Hamburger E, Jolley L, et al.: Medical schools in sub-Saharan Africa. Lancet 2011, 377:1113-1121.
• [39]Wurie AT: Education reconstruction in post-conflict Sierra Leone. Commonw Educ Partnerships 2007, 2007:61-64.
• [40]WHO: Transformative Scale-up of Health Professional Education: An Effort to Increase the Numbers of Health Professionals to Strengthen Their Impact on Population Health. Geneva: WHO; 2011.
• [41]Nguyen L, Ropers S, Nderitu E, Zuyderduin A, Luboga S, Hagopian A: Intent to migrate among nursing students in Uganda: measures of the brain drain in the next generation of health professionals. Hum Resour Health 2008, 6:5. BioMed Central Full Text
• [42]Shoaid SF, Mirza S, Murad F, Malik AZ: Current status of e-health awareness among healthcare professionals in teaching hospitals of Rawalpindi: a survey. Telemed e-Health 2009, 15:347-352.
• [43]Curioso WH, Mechael PN: Enhancing “M-health” with south-to-south collaborations. Health Aff 2010, 29:264-267.
• [44]Yellowlees P, Marks S, Hilty D, Shore JH: Using e-health to enable culturally appropriate mental healthcare in rural areas. Telemed e-Health 2008, 14:486-492.
• [45]Greenhalgh T, Robert G, MacFarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004, 82:581-629.
• [46]Pehrson B, Nungu A, Mohamed A, Barry B, Ngarambe D, Ntagwirumugara E, Akorli F, Rai I, Gustafsson LL, Zennaro M, Oaiya O, Mangheni P, Kyalo V, Taylor SJE: A First Mile Initiative. Promoting the adoption of broad-band friendly practice and policies. http://wireless.ictp.it/Papers/FirstMileInitiative.pdf webcite
• [47]Pakenham-Walsh N, Bukachi F: Information needs of health care workers in developing countries: a literature review with a focus on Africa. Hum Resour Health 2009, 7:30. BioMed Central Full Text
• [48]Miller KE, Rasmussen A: War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med 2010, 70:7-16.
• [49]Thara R: Using mobile telepsychiatry to close the mental health Gap. Curr Psychiatry Rep 2012, 14:167-168.
• [50]Hilty DM, Yellowlees PM, Cobb HC, Bourgeois JA, Neufeld JD, Nesbitt TS: Models of telepsychiatric consultation-liaison service to rural primary care. Psychosomatics 2006, 47:152-157.
• [51]Frueh BC, Monnier J, Yim E, Grubaugh AL, Hamner MB, Knapp RG: A randomized trial of telepsychiatry for post-traumatic stress disorder. J Telemed Telecare 2007, 13:142-147.
• [52]Keynejad R, Ali F, Finlayson A, Handuleh J, Adam G, Bowen J, Leather A, Little S, Whitwell S: Telemedicine for peer-to-peer psychiatry learning between U.K. and Somaliland medical students. Acad Psychiatry 2013, 37:182-186.
• [53]Abdi YA, Elmi JY: Internet based telepsychiatry: a pilot case in Somaliland. Med, Confl Surviv 2011, 27:145-150.
• [54]Crean KW: Accelerating innovation in information and communication technology for health. Health Aff 2010, 29:278-283.
• [55]Alliance GHW: Health Workforce Innovation: Accelerating Private Sector Responses to the Human Resources for Health Crisis. Geneva: WHO; 2012.
• [56]Jäckle A, Roberts C, Lynn P: Telephone Versus Face-to-Face Interviewing: Mode Effects on Data Quality and Likely Causes: Report on Phase II of the ESS-Gallup Mixed Mode Methodology Project, ISER Working Paper 2006-41. ISER: Colchester; 2006.
• [57]Hage E, Roo J, van Offenbeek M, Boonstra A: Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review. BMC Health Serv Res 2013, 13:19. BioMed Central Full Text