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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 27-31

mHealth: Knowledge and use among doctors and nurses in public secondary health-care facilities of Lagos, Nigeria


Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria

Date of Web Publication23-Feb-2018

Correspondence Address:
Dr. Bukola Samuel Owolabi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_41_17

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  Abstract 


Objectives: Mobile health (mHealth) is gaining importance worldwide, changing and improving the way healthcare and services are provided, but its role is just emerging in Nigeria. This study aimed to assess the knowledge and use of mHealth among health workers and the provisions for its use in public secondary health-care facilities of Lagos State, Nigeria. Methods: The study was a descriptive cross-sectional study carried out among 65 doctors and 135 nurses selected using a two-staged sampling method. Data were collected with pretested self-administered questionnaires and analyzed with EpiInfo™ 7. Results: Majority (doctors 84.6%, nurses 91.1%) had not heard of the term “mHealth,” but most (doctors 96.9%, nurses 87.4%) were aware of the use of mobile phones in health-care delivery. Only three (27.3%) (health call centers/health-care telephone helpline, appointment reminders, and mobile telemedicine) out of 11 mHealth components listed were mostly known. Most doctors simply used patient monitoring/surveillance and mobile telemedicine, while nurses mainly used treatment compliance and appointment reminder services. Majority were willing to use more mHealth services if available in their hospital. All the doctors and 97% of nurses had mobile phones. However, only about one-quarter (27.5%) had smartphones with applications used for mHealth purposes. Conclusions: Knowledge, awareness, and use of mHealth services were low. Doctors and nurses should be enlightened and trained on ways to use mHealth services to improve health-care delivery, mHealth services should be made available in the hospitals, and use of smartphones encouraged as they portend better adaptability for mHealth use.

Keywords: Bioinformatics, electronic health, health workers, mobile health, mobile technology, Nigeria


How to cite this article:
Owolabi BS, Odugbemi TO, Odeyemi KA, Onigbogi OO. mHealth: Knowledge and use among doctors and nurses in public secondary health-care facilities of Lagos, Nigeria. J Clin Sci 2018;15:27-31

How to cite this URL:
Owolabi BS, Odugbemi TO, Odeyemi KA, Onigbogi OO. mHealth: Knowledge and use among doctors and nurses in public secondary health-care facilities of Lagos, Nigeria. J Clin Sci [serial online] 2018 [cited 2019 Sep 23];15:27-31. Available from: http://www.jcsjournal.org/text.asp?2018/15/1/27/226036




  Introduction Top


Mobile health (mHealth) is increasingly providing tools and knowledge required to improve healthcare, enabling solutions that benefit patients as well as health-care professionals and institutions in both the private and public sectors worldwide.[1] mHealth has emerged as an important subsegment of the field of electronic health (e-health). The World Health Assembly in 2005 identified e-health as the way to achieve cost-effective and secure use of information communication technologies for health and related fields and urged its member states to reach communities, including vulnerable groups, with e-health service.[2] Mobile communication is also an effective means of bringing health-care services to developing country citizens.

In recent years, the Global Observatory for e-health (GOe), an initiative by the World Health Organization (WHO), defines mHealth as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices.”[3] It involves the use of voice and short messaging service as well as more complex functionalities such as third-generation systems, global positioning systems, and Bluetooth technology.[3] The WHO's GOe categorized mHealth services into 14 categories: health call centers, emergency toll-free telephone services, managing emergencies and disasters, mobile telemedicine, appointment reminders, community mobilization and health promotion, treatment compliance, mobile patient records, information access, patient monitoring, health surveys and data collection, surveillance, health awareness raising, and decision support system.

In Nigeria, it has been reported that mHealth has been used to support health workers by collecting client data, monitoring clients, and giving counseling and health talks.[4] It also improves the patient–doctor communication and reduces waiting time; the medical and administrative costs on clients may be reduced by mHealth, thus promoting shared health management, assisting patients and communities to actively engage in their own care.[5],[6]

These benefits can be achieved by having adequate knowledge of the mHealth components which will further enable the effective utilization of mHealth services in health-care delivery.

This study assessed the knowledge and use of mHealth among health workers and the provisions for use in public secondary health-care facilities of Lagos State, Nigeria. Findings from this study will be useful in identifying gaps, providing data on preparedness for change from manual to digital technology for researchers, governments, and donors so as to adequately address provider needs for the developing mHealth industry in Nigeria and anticipate policy issues that will affect its development.


  Methods Top


Lagos State is located in the southwestern part of Nigeria with an estimated population of 21 million persons making it the most populous city in Africa.[7] The general hospitals are distributed within the five administrative divisions of the State. This was a descriptive cross-sectional study of 200 health workers working in Lagos State General Hospitals. Only doctors and nurses were included in this study. The sample size determined using Cochran's formula n = z2pq/d2, where the estimated proportion (p) of health workers with access to health-related information through their cellphones based on a previous study, was 31%,[8]Z = 1.96, and margin of error (d) 5% = 283.4; since the total population of doctors and nurses in each hospital selected was <10,000, the formula Nf=n/(1+ n/N) with an additional 10% nonresponse rate was applied, hence resulting in a minimum sample size of 199 respondents. The respondents were selected using a two-staged sampling technique. Stage 1: A general hospital within each of the five divisions of Lagos State was selected using a simple random sampling (balloting) method. Stage 2: Using a stratified proportion to size sampling method based on the total number of doctors and nurses in the selected general hospitals, 65 doctors and 135 nurses were recruited. There are eight general hospitals in Lagos (Eko) division, 11 in Ikeja division, three in Ikorodu division, two in Badagry division, and two in Epe division. Surulere General Hospital was randomly selected from Lagos (Eko) division using the random sampling research selection method which has a total number of 18 medical doctors and 24 nurses. Mushin General Hospital was randomly selected from Ikeja division which has 25 medical doctors and 52 nurses. Agbowa General Hospital was randomly selected from Ikorodu division which has 18 medical doctors and 24 nurses. Badagry General Hospital was randomly selected from Badagry division which has 37 medical doctors and 97 nurses, and Epe General Hospital was randomly selected from Epe division which has 27 medical doctors and 61 nurses.

Data were collected using a pretested self-administered questionnaire with three sections which elicited information on the sociodemographic characteristics of the respondents and knowledge and use of mHealth in health-care delivery. Respondents were required to self-rate their health based on three categories which includes good, fair, and poor. Data collection took place from February to May 2014. Categories of mHealth were reclassified from 14 into 11 for the purpose of this study. Data entry and analysis were done using Epi Info™ 7 statistical software package, and data were presented as frequency tables and figures. Ethical approval was obtained from the Health Research and Ethics Committee of Lagos University Teaching Hospital. Permission was obtained from the hospital management of each selected hospital, and written informed consent was also obtained from each respondent.


  Results Top


The mean age of the doctors and nurses was 37.9 ± 6.9 years and 43.3 ± 8.1 years, respectively. The majority self-rated their health status as good (doctors [95.4%] and nurses [91.1%]) [Table 1].
Table 1: Sociodemographic characteristics of respondents

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Only 18.5% and 8.9% of the doctors and nurses, respectively, are familiar with the term mHealth. Collection of health data in the hospital as reported by over 80% of respondents was through the paper method (manual). The most common health-care delivery services provided by a mobile device that respondents were aware of include health call centers/health-care telephone helpline (doctors 78.5%, nurses 59.3%), appointment reminders (doctors 73.9%, nurses 54.1%), and mobile telemedicine (doctors 72.3%, nurses 55.6%). Common to both groups, the least known use of mobile device (mHealth) services by all respondents was in health surveys (doctors 27.7%, nurses 14.8%) and community mobilization (doctors 26.2%, nurses 16.3%). Of note are that only about one-third of all respondents knew of emergency toll-free telephone service (doctors 43.1%, nurses 32.6%), raising awareness on health issues (doctors 43.1%, nurses 29.6%), and electronic patient record (doctors 41.5%, nurses 28.9%) [Figure 1].
Figure 1: Knowledge of categories of mobile health services

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The majority of the doctors (86.2%) and nurses (73.3%) had made use of mHealth services for health-care delivery. The top three categories of mHealth services mostly used among the doctors include patients monitoring and surveillance (64.6%), mobile telemedicine in consultation with health-care colleagues (50.8%), and treatment compliance (47.7%). However, the categories of mHealth services mostly used by nurses were for treatment compliance (44.4%), appointment reminders (43.0%), mobile telemedicine (41.5%), and patients monitoring and surveillance (41.5%) [Figure 2].
Figure 2: Categories of mobile health service used

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In over 70% of cases, health information was mostly delivered to a colleague of the same profession, while doctors delivered health information to patients half the time (49.2%), nurses did in most cases (87.4%) [Figure 3]. All the doctors and 97% of nurses reported owning and using a mobile device [Table 1], almost all respondents are willing to use mHealth to deliver health information (doctors [95.4%] and nurses [88.9%]), while about one-third of the doctors (36.9%) and one-fifth of the nurses (23%) had a type of mHealth application on their mobile device.
Figure 3: Recipients to whom the health information was delivered

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The mHealth services reported by most doctors to be unavailable include “mobile access to patient information through a mobile device” 63 (96.9%) and “use of activity sensors and webcams to monitor patients during hospital admission” 63 (96.9%). However, 52 (80%) of the doctors agreed that the use of electrodes and sensors to monitor patients' vital signs (e.g., electrocardiography) was available in the hospitals [Table 2]. The mHealth services most doctors are willing to use include “use of activity sensors and webcams to monitor patients during hospital admission” 63 (96.9%), “mobile communication with patients (e.g., via text message)” 62 (95.4%), and “mobile receipt of referrals to health organization in other health organization” 62 (95.4%), while the mHealth service that doctors least reported as willing to use is the “use of activity sensors and webcams to monitor patients during hospital admission” 56 (86.2%) [Table 2].
Table 2: Nonavailability and willingness to use mobile health services in selected general hospitals reported by doctors (n᠕)

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  Discussion Top


The potential advantages of integrating mobile technologies into the health-care service delivery model includes new tools for consumers to manage their day-to-personal health; better quality of care for a larger number of patients; more easily standardized care through centralization and information technology developments; new opportunities for physicians to monitor and provide care to patients remotely; and greater collaboration to provide integrated care by sharing patient data with all parties involved.[9]

It was observed that most of the health workers (doctors [84.6%], nurses [91.1%]) are not familiar with the term mHealth or mobile health. This is due to the fact that the term “mHealth” is an emerging term used to describe the use of mobile phones to facilitate the delivery of health-care services.[10] Overall, the number of respondents who knew about most of the components of mHealth was low [Figure 1] despite findings which showed an increase in the use of mobile phones for health-care services.[11],[12],[13] However, the most common health-care delivery service provided by a mobile device that at least seven out of ten doctors and five of ten nurses were aware of was health call centers/health-care telephone helpline; other well-known were appointment reminders and mobile telemedicine. This conforms with the report of the global observatory for eHealth where it was deduced that the most frequently reported types of mHealth initiatives globally were health call centers/health-care telephone helpline.[3]

Other globally reported main uses are emergency toll-free telephone services and mobile telemedicine,[3] but only one-third of all respondents knew of mobile device use for emergency toll-free telephone service and raising awareness on health issues. The low number of respondents (doctors 18 [27.7%], nurses 20 [14.8%]) who knew of mobile device use for raising awareness on health issues could be due to the fact that most respondents do not have smartphones and are not privy to health or social media apps which support and enable such. The use of emergency toll-free telephone service in the statewide and countrywide is recently being formalized and coordinated; its awareness is limited as the information is not often heard, received on mobile networks, or displayed in public places. The major use of both services (emergency toll-free telephone service and raising awareness on health issues) recently was in the 2014 Ebola outbreak in the country. Although mHealth technologies have an enormous potential, their effectiveness as epidemiological and community interventional tool is still limited.[14]

In previous studies, applications, such as internet, e-mail, word processor, PowerPoint, and computer received higher levels of use among health-care professional.[15],[16] This is due to the fact that health-care professionals have moved to the more secure and faster mobile phones and e-mail applications on smartphones or computers to communicate among health-care professionals and patients.[11] In this study, despite that all the doctors and 97% of nurses reported owning and using a mobile device with more than four-fifth (doctors [95.4%] and nurses [88.9%]) of the respondents willing to use mHealth to deliver health information [Table 1], only about one-third of the doctors (36.9%) and one-fifth of the nurses (23%) had a mHealth application on their mobile device by individual decision-making.

Common to both groups, the least known use of mobile device (mHealth) services was in health surveys and community mobilization similar to other reports which included limited use for surveillance, awareness raising, and decision support systems.[3] Over 80% of the doctors agreed to the use and were willing to use mHealth/mobile technology for referrals, laboratory diagnostic test orders/prescriptions, communication with patients (e.g., via short mail messages and receiving of clinical results, assist in making diagnostic and treatment decisions). This shows a high level of willingness to use and awareness on how mHealth can help in the delivery of health services among the doctors in Lagos State General Hospitals. Studies have reported that doctors have no idea of what applications are in circulation and hence lack knowledge about what kinds of mHealth applications available and therefore not using or recommending it.[17]

In the coming years, mHealth will assist in revolutionizing the way healthcare is being delivered. From text message campaigns disseminating information on healthy lifestyles to the use of smartphones as medical devices capable of diagnostics and remote monitoring, mobile technology will permeate every aspect of global health systems. In the process, this technology will cut the costs associated with provision, while maintaining and improving quality of care and reaching patients for whom access to healthcare have until now been limited.


  Conclusions Top


The knowledge, familiarity with the term “mHealth,” and the use of mHealth was low among the doctors and nurses. Hence, there is need for more awareness and training on ways to use mHealth services to improve healthcare delivery, and also, the use of smartphones should be encouraged among the doctors and nurses as they portend better adaptability for mHealth use.

Most of the doctors delivered health-related information to their colleagues, while the nurses mostly deliver information to patients; health call centers/health-care telephone helpline and appointment reminders were components of mHealth services mostly known. Therefore, there is need for the provision of mHealth services and support systems in these public health facilities.

Most doctors reported that mHealth services were not available in their hospital and if provided were willing to use the services. To serve as a frame work for the adaptation and utilization of mHealth services by both public and private hospitals, mHealth policy should be formulated. Health workers should partner with mobile technology/network providers for effective mHealth platforms and services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
International Telecommunication Union. Implementing e-Health in Developing Countries; Guidance and Principles, International Telecommunication Union (ITU), Geneva, Switzerland; 2008.  Back to cited text no. 1
    
2.
World Health Organization; 2005. Available from: http://www.who.int/goe/en/. [Last accessed on 2014 Feb 25].  Back to cited text no. 2
    
3.
World Health Organization mHealth: New Horizons for Health through Mobile Technologies: Based on the Findings of the Second Global Survey on eHealth (Global Observatory for eHealth Series, Volume 3) 2011; 25 February, 2014.  Back to cited text no. 3
    
4.
United States Agency for International Development. mHealth Compedium, Volume 2, Technical Report; May, 2013. p. 10-54.  Back to cited text no. 4
    
5.
Scher DL. Should you Recommend Health Apps? Medscape Business of Medicine; 07 May, 2013. Available from: http://www.medscape.com/viewarticle/803503. [Last accessed on 2015 Jan 28].  Back to cited text no. 5
    
6.
Protiviti, mHealth: How Mobile Apps Can Help Health Plans Improve Consumer Engagement and Facilitate Behavior Change; 2014. Available from: http://www.protiviti.com/mobile/Documents/White-Papers/Industries/mHealth-Improve-Consumer- Engagement-Health-Plans-Protiviti.pdf. [Last accessed on 2016 Jul 01].  Back to cited text no. 6
    
7.
World Population Review; 2016. Available from: http://www.worldpopulationreview.com/world-cities/lagos-population/. [Last accessed on 2016 Jul 01].  Back to cited text no. 7
    
8.
Pew Research Center, Internet, Science and Tech; Health Fact Sheet; December, 2013. Available from: http://www.pewinternet.org/2012/11/08/mobile-health-2012/. [Last accessed on 2014 Feb 25].  Back to cited text no. 8
    
9.
Ruder Finn: MHealth Report; 2013. p. 3. Available from: http://www.ruderfinn.com. [Last accessed on 2014 Feb 25].  Back to cited text no. 9
    
10.
The Royal Academy of Engineering, UK Focus for Biomedical Engineering Policy Briefing. MHealth-Mobile Phones and Healthcare; November, 2010. Available from: http://www.raeng.org.uk/publications/reports/mhealth-briefing. [Last accessed on 2014 Feb 25].  Back to cited text no. 10
    
11.
Olok GT, Yagos WO, Ovuga E. Knowledge and attitudes of doctors towards e-health use in healthcare delivery in government and private hospitals in Northern Uganda: A cross-sectional study. BMC Med Inform Decis Mak 2015;15:87.  Back to cited text no. 11
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12.
Koehler N, Vujovic O, McMenamin C. Healthcare professionals' use of mobile phones and the internet in clinical practice. J Mob Technol Med 2013;2 Suppl 1:3-13.  Back to cited text no. 12
    
13.
Nilseng J, Gustafsson LL, Nungu A, Bastholm-Rahmner P, Mazali D, Pehrson B, et al. A cross-sectional pilot study assessing needs and attitudes to implementation of information and communication technology for rational use of medicines among healthcare staff in rural Tanzania. BMC Med Inform Decis Mak 2014;14:78.  Back to cited text no. 13
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14.
Fiordelli M, Diviani N, Schulz PJ. Mapping mHealth research: A decade of evolution. J Med Internet Res 2013;15:e95.  Back to cited text no. 14
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15.
Kipturgo MK, Kivuti-Bitok LW, Karani AK, Muiva MM. Attitudes of nursing staff towards computerisation: A case of two hospitals in Nairobi, Kenya. BMC Med Inform Decis Mak 2014;14:35.  Back to cited text no. 15
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16.
Samuel M, Coombes JC, Miranda JJ, Melvin R, Young EJ, Azarmina P, et al. Assessing computer skills in Tanzanian medical students: An elective experience. BMC Public Health 2004;4:37.  Back to cited text no. 16
    
17.
QuantiaMD Poll Finds Physician are Split on Use of Medical Apps and 42% Believe More Regulation; 2014. Available from: http://www.prlog.org/12286663-quantiamd-poll-finds-physicians-are-split -on-use-medical-apps-and-42-believe-more-regulation.html. [Last accessed on 2014 Nov 06].  Back to cited text no. 17
    


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