JMIR Publications

ABSTRACT

Background:

Management of diabetes is a growing healthcare challenge worldwide. E-health can revolutionise diabetes care, the success of which depends on end user acceptance.

Objective:

This study intended to understand a) readiness and acceptance of E-health services for diabetes care among the general population, b) perceived advantages and disadvantages of e-health, and c) factors associated with e-health readiness and acceptance in a multi-ethnic Asian country.

Methods:

In this cross-sectional epidemiological study, participants (n=2895) were selected through disproportionate stratified random sampling, from a population registry. Those who are citizens or permanent residents of Singapore above 18 years, were recruited and the data was captured through Computer-assisted Personal Interviews (CAPI). An E-health questionnaire was administered in either one of the four local languages (English, Chinese, Malay, or Tamil), as preferred by the participant.

Results:

The sample comprised participants with (n=436) and without (n=2459) diabetes. E-health readiness was low, with 47.3% of the overall sample and 75.7% of the diabetes group endorsing that they are not ready for e-health (P <.001). The most acceptable e-health service overall was 'booking appointments', while there was a significantly higher preference in the diabetes group for face to face sessions for consultation with clinician (Non-diabetes: 83.5% vs Diabetes: 92.6%, P <.001), getting prescriptions (61.9% vs 79.3%, P <.001), referrals to other doctors (51.4% vs 72.2%, P <0.001), and receiving health information (34.0% vs 63.4%, P <.001). Majority felt that e-health requires computer literacy of the user (90.5% vs 94.3%diabetes group), 'doesn't build clinician-patient rapport compared to face to face sessions (77.5% vs 81.0%) and might not be credible (56.8% vs 64.2%, P =.03). Those aged 35 years and above and those with lower education status had lower odds of e-health readiness. Age (≥35 years), ethnicity (Indian), lower education status (Junior college, diploma, Primary school), Body Mass Index (BMI, being underweight) and marital status (being single) were associated with lower e-health acceptance. Longer duration of diabetes (4-18 years), higher education (degree or above) and younger age (23-49 years) were associated with e-health readiness in diabetes sample while younger age with higher income (S$2,000-3,999) was associated with acceptance.

Conclusions:

Overall, an unfavourable attitude towards e-health was seen with significantly higher number of participants with diabetes unwilling to use these services for their diabetes care. Deployment of technology needs to be carefully considered taking into account 'individuals' capabilities, preferences and concerns. This should be discussed at an organisational level and communicated to the target users to give them the assurance that their needs/preferences are considered before implementing the e-health services. The sociodemographic factors associated with acceptance and readiness identified a group of people that was unlikely to accept the technology and thus need to be targeted for e-health literacy programmes to avoid health care disparity. Clinical Trial: NA