JMIR Publications

ABSTRACT

Background:

Digital technologies are increasingly being used to deliver healthcare services and promote public health. Mobile wireless technologies or mHealth are particularly relevant, due to their ease of use, broad reach and wide acceptance. Unlike developed countries, Sub-Saharan Africa (SSA) experiences more challenges and obstacles when it comes to deploying, using, and expanding mobile health (mHealth) systems. In addition to the barriers, there are enabling factors that could be exploited for the design, implementation and scaling up of mHealth systems. Because SSA may require tailored solutions that address the specific challenges facing the region.

Objective:

The overall aim of this study is to identify the barriers and enablers from the perspectives of patients, physicians and healthcare executives for using mHealth systems in SSA.

Methods:

Multi-level and multi-actor in-depth semi-structured interview was employed to qualitatively explore the barriers and enablers to use of mHealth systems. The data were collected from patients, physicians and healthcare executives. The interviews were audio-recorded, transcribed verbatim, translated and coded. Thematic analysis methodology and NVIVO software was used for the data analysis.

Results:

Through this rigorous study, a total of 137 determinants were identified. Of these determinants 68 are barriers and 69 are enablers. Perceived barriers in patients include lack of awarness about mHealth systems and language barriers. Perceived enablers in patients include need for automated tool for health monitoring and increasing literacy level of the society. According to physicians perception, barriers include lack of available digital health systems in local context and physicians are concerned about patient’s mHealth capability. Enablers include the perceived usefulness in reducing workload and healthcare service quality as well as the availability of mobile devices and internet in its simplicity and accessibility. As perceived by healthcare executives, barriers include competing priorities alongside digitalization in the health sector and lack of interoperability and full digitalization of implemented digital health systems. Enablers include the perceived usefulness of digitalization as a matter of survival for the highly loaded healthcare and the abundance of educated manpower specialized in technology.

Conclusions:

mHealth systems in SSA are hindered and facilitated by various factors. Common barriers and enablers are also identified by patients, physicians, and healthcare executives. To promote uptake, all relevant stakeholders must actively mitigate these barriers. This study finds promising outlook for mHealth in SSA, despite present barriers. Opportunities exist for successful integration into healthcare systems and a user-centered design is identified crucial for maximum uptake.