Inform Health Soc Care, 2014; 39(2): 104–123 ! Informa UK Ltd. ISSN: 1753-8157 print / 1753-8165 online DOI: 10.3109/17538157.2013.858044
Knowledge and utilization of health information and communication technologies (HICTs) by health workers of the North-Eastern health zone of Ogun State, Nigeria Bosede Adebimpe Ajiboye,1 Adenike Jumoke Adekoya,2 Mariam Kehinde Alawiye,1 and Wuraola Janet Oyedipe3 1
Cataloguing and Classification Section, Nimbe Adedipe Library, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria, 2 Health Centre, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria, 3 Readers’ Services Section, University Library, Olabisi Onabanjo University, Ago-Iwoye, Ogun-State, Nigeria
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The study examines the use of health information and communication technologies (HICTs) by health workers in seven state hospitals and a private hospital in the NorthEastern Zone, Ogun State, Nigeria. The study adopted the descriptive and crosssectional survey design method using a 12-point questionnaire as the instrument for extracting information on the use of HICTs. The questionnaires were personally administered by the researchers; responses were collated, analyzed and presented using descriptive statistics, which includes frequency counts, percentages, tables as well as bars. The outcome shows that a large percentage of the respondents are aware of HICTs. However, only a few have adequate knowledge of and use HICTs for healthcare delivery in spite of its importance to healthcare services. A few have access to computers and HICTs resources relevant for effective healthcare delivery in their hospitals, and only one of the hospitals examined is connected to the internet and none has a website. The paper concludes with recommendations on the need for the management boards of the hospitals examined and the health workers to avail themselves of the opportunities that abound in the use of HICTs. Keywords: Health information and communication technologies, health workers, healthcare delivery, Nigeria
HIGHLIGHTS
The results on the knowledge and utilization of HICTs for healthcare delivery by health workers in Ijebu zone revealed that the doctors’ level of awareness of HICTs recorded the highest frequency as against the other categories of healthcare workers. Not all of those who claim to be aware of, and have adequate knowledge of HICTs’ usage make use of it for healthcare delivery. This is observed
Correspondence: Bosede Adebimpe Ajiboye, Federal University of Agriculture, Abeokuta, Cataloguing and Classification, PMB 2240, Alabata Road, Abeokuta, Abeokuta, Ogun State, Nigeria. E-mail: [email protected]
Knowledge and utilization of health information
in the response of the pharmacists; despite the fact that adequate knowledge of HICTs possessed by the pharmacists recorded the highest frequency; their utilization level was found to be low. The doctors reported the highest level of utilization. Other finding of this study also shows that 50% and 80% of the doctors have access to personal computers and modem, respectively, while the percentage of other categories of health workers who have access to personal computers were found to be very few. Furthermore, among those who possess personal computers, utilization level was found to be low. Other findings of this study show that only one of the hospitals examined is connected to the internet and none of them have a website. The main ICT resource used by a 100% of the respondents, which could not possibly enhance healthcare delivery significantly, is the mobile phone. This probably suggests that the only HICTs resource readily available to the entire sampled health workers is the mobile phone. Other result shows that the potential of HICTs to enhance and transform healthcare delivery by health workers in Ijebu zone is still not being fully utilized. It was also found in this study that two major constraints (that recorded the highest frequency) to the use of HICTs indicated by the respondents are non-availability of computers and insufficient internet connectivity.
INTRODUCTION The fact that economic health depends on medical health (borrowing a popular slogan that health is wealth) implies that healthcare needs to be accessible to all, including the rural communities. If compromised, this could undermine the socio-economic condition of the entire nation. It is a healthy citizenry that can be mobilized to participate in the developmental programme of the nation and pursue their own legitimate individual aspirations. In the past decade, there has been significant growth in Internet access in urban areas; healthcare workers now use it for communication, access to relevant healthcare information and international collaboration. In contemporary times, patients are able to acquire healthcare information through the internet, global systems of communications and the media, etc., resulting in smarter and well-informed patients with higher expectations and a demand for high-standard quality healthcare. The Wikipedia defines healthcare delivery as the systematic provision of personal and population-based preventive, curative and rehabilitative care services. This is provided at the primary, secondary or tertiary levels. For the purpose of this study, the health workers in focus and the healthcare service delivery being offered is at the secondary level. There have been considerable national and international discussions on the potential of information and communication technologies (ICTs) to make major impacts in improving the health and well-being of poor and marginalized populations, combating poverty and encourage sustainable development and governance (1).
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The result of the findings of Digital Health (2012) (2), which focuses on building better healthcare delivery, sought to address these needs of remote and poor communities and to fast track progress on Millennium Development Goals (MDGs) 4 (reduction in child mortality), 5 (improvement of maternal health) and 6 (combating HIV/AIDS, malaria and other diseases) in the Federal Capital Territory of Nigeria. The Mailafiya Health Program shows the positive impact that ICT can have on improving healthcare delivery. The result is that 426 rural populations are now receiving health services on a regular basis. The project is proving that ICT can play a critical role in building healthcare delivery capacity and enabling greater access to effective healthcare – which in turn can have far-reaching effects on social and economic strength Digital Health (2012) (2). With the significant burdens on limited healthcare resources set to increase even further, Ministries of Health, NGOs and public agencies tasked with accomplishing MDGs, especially in the third-world nations and particularly in Nigeria, must consider ICT as a strategic enabler and an essential element to help transform healthcare delivery. According to the World Health Organization (3), the use of ICTs in health is not merely about technology but is a means to reach a series of desired outcomes across the entire health system. Information technology (IT) has had a positive impact on healthcare delivery systems worldwide, particularly in the areas of disease control, diagnosis, patient management and teaching (1,4). Health information and communication technologies (HICTs) gadgets are defined as tools that facilitate communication and the processing and transmission of health information by electronic means, for the purpose of improving health promotion, human resources for health and health-service delivery. Brailer & Thompson (2004) (5) define HICTs gadgets as the application of information processing involving both computer hardware and software that deals with the storage, retrieval, storing and use of healthcare information, data and knowledge for communication and decision-making. This definition encompasses the full range of HICTs, from radio and television to telephones (fixed and mobile), computers, remote and on-line databases, read only memory compact disc (CD-ROM) and the Internet. HICTs have the potentials to offer less costly alternatives to traditional conferences, workshops and seminars where health workers must travel in order to meet and share experience. It also helps to reduce error in drug administration, most especially in paediatrics wards (6). HICTs are modern trends that are gradually being employed by the medical professions worldwide, but the rate of utilization seems to be a bit lower among health workers in the developing countries and particularly in Nigeria as revealed in the literature. This is also observed in the area of study. It is to this end that the researchers seek to assess the North Eastern Zone’s health workers knowledge and utilization of these tools for healthcare delivery with the aim of filling this gap in literature.
BACKGROUND INFORMATION OF THE TARGET POPULATION The Target population is the health workers of state hospitals and a private paediatric hospital in the North-Eastern Zone of Ogun State, Nigeria.
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Figure 1. Map of Nigeria showing the location of Ogun State.
Ogun State was created from the old Western State on 3 February 1976 and is located in South-Western Nigeria. Ogun State covers 16 762 square kilometers. It shares borders with Lagos State to the south, Oyo and Osun states to the north, Ondo State to the east and the Republic of Benin to the west (Figure 1). The Ogun State Hospitals Management Board was established in 1978 by Edict No. 6 as State Health Board with the functions of essentially managing human, financial and material resources as related to state-owned medical institutions. The headquarter of the board is located at Abeokuta, the state capital. There are five Health Zones, in the North-East, North-West, South-East, South-West and Central with each zonal office located at a designated State Hospital. The North-East Zone under review is made up of eight Local Governments with seven state hospitals and one private paediatric hospital. The report of the National Census of the year 2006 projected population of these local governments to be over one million (Figure 2). At the State Hospitals chosen for this study, only the senior officers have computers in their offices with no Internet access. However, some of the health workers have access to personal computers, modems, CDS and CD-ROMS on health and medical practice. The private paediatric centre is the first purpose-built private children’s hospital in Nigeria and the biggest individual philanthropic
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Figure 2. Map of Ogun State showing the Local Government Areas (LGAs) of the State.
initiative in the health sector designed to be at the apex of the nation’s child health system. This hospital acts as a catalyst to the nation’s drive toward the achievement of the MDG on infant and child survival. The hospital, built in 1994, had served as a tertiary referral centre for teaching, research and healthcare delivery for infants and children since it was commissioned in 2004. The paediatrics centre has a computer centre and a cyber cafe´ that service the hospital staff. The members of staff are given passwords free of charge on hourly basis to access the Internet; it also has a library stocked with compact disk and CD-ROMS on healthcare delivery and medical practise.
OBJECTIVES OF THE STUDY The general objective of this study is to assess how much knowledge health workers possess about the utilization of HICTs for healthcare delivery and the extent to which this procedure is already being used. To meet this objective, the study will focus on the following specific objectives; to:
identify the types of HICTs resources available to and made use of by the health workers; examine the level of the health workers’ awareness of HICTs and assess their knowledge of its usage;
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find out if the health workers’ awareness and knowledge of HICTs gadgets and its availability to them influences its utilization for healthcare delivery and also identify other reason(s); (apart from healthcare delivery) for using HICTs; identify the constraints to effective utilization of HICTs among the health workers in providing effective care to their patients and extract information that will help stakeholders in the health sector to exploit opportunities offered by HICTs in effective and efficient healthcare delivery.
REVIEW OF RELATED LITERATURE Healthcare is growing increasingly complex and most clinical research focus on new approaches to diagnosis and treatment. If major gains in quality healthcare are to be achieved, there must be transformation, and IT will play a key part. The following technologies have been identified as being potentially useful in alleviating barriers to rural access: satellite technology; wireless Internet connectivity; and cellular networks, mobile phones can also become ubiquitous and are already widely used by health workers (7). The Internet provides free access to abundant databases, reference materials and medical journals online, such as Medical Literature Analysis and Retrieval System (Medline), Health InterNetwork Access to Research Initiative (HINARI), web-medical doctor (Web-MD), etc., textbooks and the latest information on breakthroughs in medicine, encourages learning and research (8). The Internet has also given great value to connectivity across the regions of the world. These resources have brought huge benefits to tertiary healthcare institutions in the developing countries, specifically, Nigeria. It also provides opportunities to retrieve up-to-date information on different aspects of diseases, interact with colleagues via videoconferencing and enhance communication amongst colleagues in different continents. E-mail communication is the most common use of the Internet and is increasingly available to health professionals across the globe, keeping them in touch not only with one another for professional interaction, clinical advice and referrals but also with colleagues worldwide. Current telecommunications technologies have an extraordinary capacity for transmitting information. While the use of CD-ROM and interactive software packages have greatly contributed to dissemination of information among healthcare professionals, its use is still very limited in developing countries in Africa (9). The computer and IT offer the physician the ability to store and retrieve patients’ clinical and socio-demographic information, as well as laboratory results, which aid in the preparation of referral notes. It also aids the preparation of discharge summaries, clinic letters and financial statements of the hospital as well as delivery of laboratory results (10). IT can reduce the rate of medical errors in three ways: by preventing errors and adverse effects, by facilitating a more rapid response after an adverse event has occurred and by tracking and providing feedback about adverse effects. Data now show that IT can reduce the frequency of errors of
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different types and probably the frequency of associated adverse effects (11). The main classes of strategies for preventing errors and adverse effects include tools that can improve communication, make knowledge more readily accessible, require key pieces of information (such as the dose of a drug), assist with calculations, perform checks in real time, assist with monitoring and provide decision support. Solomon (2005) (12) in his study reported that Health information is identified as the key to successful partnership and sustainable health service delivery as well as the tool through which community involvement for ownership in health services can be based. Obijiofor et al. (2009) (13) undertook a study of a systematic review evidence on the effect of health IT on quality, efficiency and costs of healthcare, they also systematically searched the English language literature indexed in Medline (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects and the Periodical Abstracts Database and added studies identified by experts up to April 2005. Results show that of the institutions examined, four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. In their own study of the impact of new ICTs on socio-economic and educational development of Africa and the Asia-Pacific, Bates & Gawande (2003) (11) found that despite the high level of ICT awareness, only a few people have access to these technologies in Africa and Asia-Pacific regions. The reasons for this include ignorance, general poverty in the society, poor culture of maintenance and repair, poor infrastructural support base (inefficiency in electricity and telephone systems), lack of support from government, illiteracy and lack of basic computing skills. Furthermore, as reported in Albright Stone Bridge (2012) (14), health information systems was successfully launched in some parts of India to strengthen information practices within primary healthcare with the larger aim of improving processes concerning healthcare delivery for the rural community. A significant percentage of the rural population was found to be poor and reside in remote areas, hence directly depending on the effectiveness of health information systems for addressing the health problems of communities. The main objective of the system was to strengthen Healthcare delivery and develop the capacity of the health staff to work with computers and its related technologies with the ultimate aim that this would lead to better delivery of healthcare to the community. Bello et al. (2004) (15) reviewed the applications of telemedicine and felt that it may in fact have a more profound impact on developing countries than on developed ones. He noted that even in very remote and relatively underdeveloped communities such as the satellite stations in Uzbekistan, Cambodia and Kosovo, low bandwidth Internet reached into the most remote areas, despite their unstable political climate and poor socio-economic environments. Nazim & Saraf (2006) (16) conducted a survey on internet access and use for health information among people living with HIV-AIDS. They found that majority of people were not aware of the availability of health information on the net. This may be due to lack of awareness of same by their healthcare
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providers who ought to have been in position of making such available to them through healthcare delivery or services. Furthermore, not all of them who claim to be aware of the existence of and have adequate knowledge of HICTs’ usage make use of it for healthcare delivery. This is in consonance with Jegede (2005) (17) and Ajiboye (2009) (18) who submitted that awareness of and accessibility to computers (ICT) does not translate to utilization. In their own analysis of the benefits derivable from mobile health, West (2012) (8) concluded through his positive findings that mobile health has the ability to improve healthcare delivery and save money in health care. Centre for Medicare Advocacy Inc. (2010) (19) also reported that an integrated, patient-centred healthcare delivery system would allow multiple health providers in multiple settings to share information quickly, utilizing the latest health information technologies. Formal studies and preliminary project assessments in both the developed and developing world demonstrate that health workers are beginning to be aware and getting more and more accustomed to the use of mobile technology and electronic health to improve the efficiency of healthcare delivery and ultimately make healthcare more effective (20). Furthermore, report of the U.S. Public Health Service’s study on making a powerful connection between the health of the public and the national Information Infrastructure revealed that the National Information Infrastructure grants of the United States of America related to health have primarily supported applications of high performance computing and telemedicine to the delivery of medical care to individuals (21).
METHODOLOGY Descriptive and cross-sectional survey design was adopted. The target population was the state hospital health workers and health workers of one private paediatric hospital in the North-Eastern Zone of Ogun State (the private paediatric hospital was purposively chosen because of its high standard of operation). The health workers comprise of doctors, nurses, pharmacists, physiotherapists, dentists, laboratory technicians, health record officers and radiologists. The study was carried out over a period of three months and data collected between September and November 2011. The sample size composed of 500 health workers who were randomly drawn from different cadres of a total population of 1054 (a breakdown of which is as follows: 969 respondents from state hospitals and 85 respondents from the private paediatric hospital). The questionnaires were personally administered and collected by the researchers. The respondents were guided on the proper completion of the questionnaire after explaining the aim of the study and variables such as HICTs and healthcare delivery as used in the study to them. Since the population of the health workers in each of the hospitals was not evenly distributed, purposive sampling technique was used. A total of 421 copies of useable questionnaire were retrieved, which represents 84.2% response rate. The questionnaires were ascertained for completeness. They were collated, coded, fed into the computer and analyzed using descriptive statistics, which includes frequency counts, percentages, tables as well as bars.
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Ethical considerations Ethical approval was granted by Ethics Review Committees of both the State Hospitals Management Board and the private Paediatric Centre. Permission was also sought from the authorities of the hospitals before administering the questionnaire on the respondents. However, the research followed principles in the Declaration of Helsinki. There was no risk associated with this research being a survey, and participation was completely voluntary (i.e. respondents chose to participate without being compelled or coaxed to do so). The data collected for the study would be used in recommending technology training intervention programmes that would be of benefit to health workers of the zone and consequently the state in order to enhance healthcare delivery. Informed consent was obtained from the participants, i.e. the participants’ consent was solicited and audience granted the researchers. The questionnaire used for this study was anonymous, i.e. the identity of the respondents was kept in confidence. Data presentation and analysis Table 1 shows the demographic data of the respondents. About half (50.4%) of the respondents are between the age range of 20 and 34 years, 33.5% between 35 and 44 years, while the remaining 16.2% are between 45 and 55 years. About 71.7% of them were female, while 28.3% were male. Eighty percent of them are either national diploma holders or registered nurses or registered midwives, 14% are either Bachelor of Science degree or higher national diploma holders, 5.2% are either holders of the MSc or MTech degrees, while a paltry percentage of 0.7% are Doctor of Philosophy holders. Table 2 reports the respondents’ awareness of HICTs. Result shows the following level of awareness by healthcare worker category in decreasing order of magnitude: doctors, 40 (100%); nurses, 236 (87.4%); pharmacists, 17 (85%); laboratory technicians, 44 (88%); physiotherapists, 4 (80%); Dentists, 10 (76.9%); record officers, 11 (73.3%); and radiologists, 3 (37.5%). Table 3 shows that all the respondents 421 (100%) possess a mobile phone, 127 (30.2%) respondents have access to computer in the office, 111 (26.4%) and 110 (26.1%) respondents have personal computers and modems, respectively, the 30 (7.1%) respondents who have access to the Internet in their offices are from the private Paediatric Centre, while none of the hospitals examined has a web site. Respondents were asked to rate their level of knowledge of HICTs. Table 4 shows the response of adequate knowledge of HICTs in decreasing order of magnitude 14 (70%) pharmacists, 34 (68%) laboratory technicians, 27 (67.5%) doctors, 3 (60%) physiotherapists, 8 (53.3%) record officers, 6 (46%) Dentists, 116 (43.0%) nurses and 2 (15%) radiologists. While the remaining respondents indicated that they either have average or poor knowledge of HICTs. Table 5 shows the type of HICTs resources made use of by the respondents. The e-mail has the highest number 154 (36.6%) of usage followed by search engines with 120 (28.5%) responses, CD-ROM records 94 (22.3%) responses, telemedicine has 59 (14.0%) responses, e-bulletin is made use of by 37 (8.8%) of the respondents, while the subject gateways/directories/online database (Web-MD, Medline, HINARI, etc.) have the lowest 29 (6.9%) number of usage.
20–34 35–44 45–55 Male Female Ph.D MSc/M.Tech B.Sc/higher national diploma(HND) National diploma (ND)/regmid wife Director Matron Others 15 104 151
261
–
16 – 24
153 87 30 6 264 – 5 4
6 23 11 36 4 3 9 28
Nurse (n = 27)
4 – 16
10
8 5 7 13 7 – 3 7
Pharmacists (n = 20)
Doctors (n = 40)
40 –
Awareness
Aware Not aware
236 33
Nurses (n = 270) 17 3
Pharmacists (n = 20) 44 6
– – 50
40
33 9 8 37 13 – 2 8
11 4
4 1
– – 5
–
1 2 2 3 2 – 1 4
3 5
8
–
7
– 5 3 6 2 – – 1
– – 13
7
4 7 2 9 4 – 1 5
Dentists (n = 13)
10 3
Dentists (n = 13)
Radiologists (n = 8)
Radiologists (n = 8)
Physiotherapist (n = 5)
Physiotherapists (n = 5)
– – 15
12
7 3 5 9 6 – 1 2
Health record officers (n = 15)
Record officers (n = 15)
Laboratory technicians (n = 50)
Laboratory technicians (n = 50)
Table 2. Level of awareness of HICTs by healthcare worker category.
Rank/status
Edu.
Gender
Age in years
Demographic information
Doctors (n = 40)
Table 1. Demographic data of respondents.
(50.4%) (33.5%) (16.2%) (28.3%) (71.7%) (0.7%) (5.2%) (14.0%)
366 (86.9%) 55 (13.1%)
Total (n = 421)
35 (8.3%) 104 (24.7%) 282 (67%)
337 (80.0%)
212 141 68 119 302 3 22 59
Total (n = 421)
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40 20 32 – 12 6
270 54 35 – 81 8
Nurses (n = 270) 20 7 9 – 6 4
Pharmacists (n = 20)
Doctors (n = 40)
27 8 5
Knowledge
Adequate Average Poor
116 20 134
Nurses (n = 270) 14 2 4
Pharmacists (n = 20)
Table 4. Knowledge of HICTs by healthcare category.
Mobile phone Personal computer Modem Hospital website Office computer Office internet
HICTs availability
Doctors (n = 40)
Table 3. Availability of HICTs gadgets to respondents.
34 11 5
Laboratory technicians (n = 50)
50 21 13 – 15 3
Laboratory technicians (n = 50)
8 3 4
Record officers (n = 15)
15 2 11 – 5 2
Record officers (n = 15)
3 1 1
Physiotherapists (n = 5)
5 2 3 – 2 2
Physiotherapist (n = 5)
2 1 5
Radiologists (n = 8)
8 2 2 – 2 2
Radiologists (n = 8)
6 3 4
Dentists (n = 13)
13 3 5 – 4 3
Dentists (n = 13)
(100%) (26.4%) (26.1%) (0%) (30.2%) (7.1%)
210 (49.9%) 49 (11.6%) 162 (38.5%)
Total (n = 421)
421 111 110 0 127 30
Total (n = 421)
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37 11 34 32 43 22
Highly utilized Averagely utilized Poorly utilized
HICTs utilization level
35 4 1
Doctors (n = 40)
86 134 30
Nurses (n = 270) 11 6 3
Pharmacists (n = 20)
Table 6. HICTs utilization level by healthcare category.
E-mail E-bulletin/news group CD-ROMS Telemedicine WWW browser (Google, Yahoo, etc.) Online database (Web-MD, Medline and HINARI)
HICTs resources made use of 46 14 25 23 33 –
22 11 17
Laboratory technicians (n = 50)
13 2 6 – 9 2
8 3 4
Record officers (n = 15)
31 3 17 – 23 –
3 1 1
Physiotherapists (n = 5)
9 3 4 – 6 1
3 1 2 1 2 2
3 2 3
Radiologists (n = 8)
4 2 2 – – –
6 4 3
Dentists (n = 13)
11 1 4 3 4 2
Laboratory Record Doctors Nurses Pharmacists technicians officers Physiotherapists Radiologists Dentists (n = 40) (n = 270) (n = 20) (n = 50) (n = 15) (n = 5) (n = 8) (n = 13)
Table 5. Types of HICTs made use of by respondents.
(36.6%) (8.8%) (22.3%) (14.0%) (28.5%) (6.9%)
162 (41.1%) 201 (47.7%) 93 (22.1%)
Total (n = 421)
154 37 94 59 120 29
Total (n = 421)
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Respondents were asked to rate their level of HICTs’ utilization vis-a`-vis their awareness and knowledge. As shown on Table 6, the responses of those who rated their utilization levels to be high are as follows: 35 (87.5%) doctors, 86 (31.9%) nurses, 11 (55%) pharmacists, 22 (44%) laboratory technicians, 8 (53.3%) record officers three each of physiotherapists and radiologists (60% and 37.5%), respectively, and 6 (46.2%) dentists. Others rated their level of utilization to be either average or poor. Information that will help determine the respondents’ purpose of using HICTs in addition to healthcare delivery was elicited. Responses illustrated by Figure 3 shows that the main objective that the study set out to achieve which is whether the health workers use HICTs for healthcare delivery or not records 95 (22.6%) responses, while 154 (36.6%) of the health workers who make use of HICTs use it for self-development. Closely related to the use of HICTs for healthcare delivery is for collaboration and professional networking, which has a total of 103 (24.5%), 41 (9.7%) respondents use it for social networking, while the remaining 28 (6.6%) make use of it out of curiosity. Respondents were asked to rate their level of HICTs’ usage for healthcare delivery viz-a-viz their level of awareness. Their responses are reported with Figure 4. Of the 366 respondents who are aware of HICTs, only 16% of them utilize it for healthcare delivery, while as many as 84% do not make use of it for healthcare delivery. Further analysis of the result shows that of the 210 respondents who have adequate knowledge of HICTs, only 59 (28.1%) of them make use of it for healthcare delivery, while as many as 151 (71.9%) of them are not using it for healthcare delivery. Furthermore, of the 49 who have average knowledge, only 36 of them use it for healthcare delivery, while the other 23 do not use it for healthcare delivery. As shown on Table 7, the constraint to the use of HICTs that records the highest frequency is non-availability of computers and insufficient internet connectivity, both of which have 360 (85.5%) responses each, followed by inadequate technical and institutional support 301 (71.5%), other reasons stated by the respondents include, lack of adequate knowledge of HICTs usage,
Figure 3. Respondents’ purpose of using HICTs.
Knowledge and utilization of health information
Figure 4. Respondents’ use of HICTs for healthcare delivery vis-a ` -vis their knowledge.
their work load, location (working in remote areas and role conflict), which has 298 (70.8%) responses, High cost of using modems comes next with 275 (65.3%) responses, while the least constraint indicated is lack of awareness of HICTs, which records 36 (8.6%) responses. Note: In some cases, total4n (421) and total percentage4100, because respondents were allowed to pick more than one option as applicable to them.
DISCUSSION OF MAJOR FINDINGS The return rate of the questionnaire and the level of interest shown in this study among the health workers examined were overwhelming. The results on the knowledge and utilization of HICTs for healthcare delivery by health workers in North-Eastern Health Zone of Ogun State revealed that the doctors’ level of awareness of HICTs recorded the highest frequency. Furthermore, not all of those who claim to be aware of and have adequate knowledge of HICTs’ usage make use of it for healthcare delivery. This is observed in the response of the pharmacists; despite the fact that adequate knowledge of HICTs possessed by the pharmacists recorded the highest frequency, their utilization level was found to be low. This is in consonance with Jegede (2005) (17) and Ajiboye (2009) (18) who submitted that awareness of and accessibility to computers (ICT) does not translate to utilization. However, the doctors reported the highest level of utilization. Other findings of this study also show that 50% and 80% of the doctors have access to personal computers and modem, respectively, while the percentage of other categories of health workers who have access to personal computers were found to be very few. Furthermore, among those who possess personal computers, utilization level was found to be low. This is in agreement with findings in Bello et al. (2004) (15). They examined the knowledge and utilization of IT among healthcare professionals in a university town in South-West, Nigeria. Their finding shows that computer possession and utilization among healthcare professionals in a major university teaching hospital in Nigeria was low. But, computer possession was found to be higher among doctors when compared with the two other groups they examined. Other findings of this study also show that only one of the hospitals examined is connected to the internet and
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Non availability of computer Insufficient internet connectivity Inadequate technical and institutional support High cost of using modems Unaware of HICTs Others
Constraints to effective use of HICTs 27 33 28 31 – 13
246 234 201 170 13 225
15 17 12 14 3 13
43 43 33 32 11 27
10 11 10 11 2 7
3 3 3 2 – 3
7 8 4 6 5 2
9 11 10 9 2 8
Laboratory Record Doctors Nurses Pharmacists technicians officers Physiotherapists Radiologists Dentists (n = 40) (n = 270) (n = 20) (n = 50) (n = 15) (n = 5) (n = 8) (n = 13)
Table 7. Constraints to effective utilization of HICTs.
360 360 301 275 36 298
(85.5%) (85.5%) (71.5%) (65.3%) (8.6%) (70.8%)
Total (n = 421)
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none of them have a website. The main ICT resource used by 100% of the respondents, which could not possibly enhance healthcare delivery significantly, is the mobile phone. That is, the only HICTs resource readily available to the entire sampled health workers is the mobile phone. The study revealed that the potential of HICTs to enhance and transform healthcare delivery by health workers in North-Eastern Health Zone of Ogun State, Nigeria is still not being fully utilized. It was also found in this study that two major constraints (that recorded the highest frequency) to the use of HICTs indicated by the respondents are non-availability of computers and insufficient internet connectivity. This is in tandem with the findings of Ansari & Zuberi (2010) (22) and Owolabi et al. (2011) (23) who examined the use of computers and electronic resources among faculty members in Nigerian universities and Karachi Universities, respectively. They found that low connectivity, lack of access to personal computers and lack of computer facilities are the major constraints to faculty members’ use of computers and electronic resources.
CONCLUSION As found out by this study and as indicated in the literature reviewed, the benefits to be gained by making use of HICTs for healthcare delivery cannot be over-emphasized. HICTs improve the quality of health services and enhance a healthy populace. If the qualities of healthcare delivery must be improved especially in this technology era, then, there is a need to invest in HICTs and encourage its use among health workers in our nation. This is because the quality of healthcare delivery is based on the utilization of current and up-to-date information and technology. Regrettably, this study has established that the knowledge and utilization of HICTs for healthcare delivery at the Health Zone under study is on the average. Consequently, the state executive governor’s resolve as well as that of the Ogun State Government (2012) (24) towards giving the health sector in the state a facelift is good, but the factors required (of which HICTs is pivotal) to make it succeed should be of paramount concern.
RECOMMENDATIONS In recognition of a healthy populace served by technology-informed health workers and based on the outcome of this study, the following recommendations emanating from this study will be useful:
All state hospitals in the area of study should be connected to the Internet with fee-based on-line medical and health sciences data bases and online discussion groups subscribed to and paid for by the State Hospitals Management Board. At least one or two computer(s) should be acquired for each section/ department/unit of the state hospitals as this will facilitate access and utilization of the HICTs resources provided. This can be done through a policy statement and making sure that every state hospital has a functional HICTs laboratory.
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Health workers across the state should be encouraged to undertake HICTs skills training programme as short-course or refresher-course; such training can also be incorporated into their periodic professional workshops and conferences. Such courses will improve the health workers’ knowledge of HICTs and enhance its utilization for health care delivery. Continuous medical education training programs for all practicing physicians and health workers should be adopted. This would certainly assist in ensuring maximum utilization of the innumerable advantages offered by IT. Medicine is an ever-evolving and information-based discipline, and as such the provision of structured computer and IT training for all members of the health team would equip them with the skills they need to practice up-to-date and evidence-based medicine, which are essential to improving the quality of healthcare delivery. The State Hospitals Management Board should employ technical staff for her hospitals to maintain her HICTs resources and render immediate assistance when the need arises. Financial grants and interest-free loans should be given to the health workers to enable them procure HICTs resources such as personal computers and modems. This can also be procured and made available to them at subsidized prices. The State Hospitals Management Board should also involve itself actively in state policies that relate to healthcare services and strategic planning in order to give priority to HICTs. Attention should be given to the provision of HICTs and training the health workers towards the use of same. This will enable them to collaborate with professional colleagues across the globe and also have the knowledge of the current trends in healthcare delivery and be able to apply same to their services. In healthcare, the most vital elements are a highly trained, balanced and motivated workforce; current and accurate information; and technologies that enable providers to most effectively use resources the right way and at the right time. People, knowledge and the means for their application are the foundation upon which an efficient, high quality health system rests. The management of the state hospitals and private hospitals should consider working on this so as to improve the healthcare workers’ ability to perform their duties effectively.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
REFERENCES 1. Chetley A. ed. Improving health, connecting people: the role of ICTs in the health sector of developing countries. 2007. Available from: http://www.healthlink.org.uk/ PDFs/infodev_frame.pdf [last accessed 10 Mar 2012]. 2. Digital Health. Increasing healthcare delivery by 270% to underserved communities using a scalable ICT solution. A white paper by IntelÕ Health IT Value Model (HITVM) for Developing Nations IntelÕ AtomÔ Processor-Based Netbook PC. 2012.
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21. Lasker RD. Making a powerful connection: the health of the public and the national information infrastructure. A report of the U.S. Public Health Service Public Health Data Policy Coordinating Committee; 1995. 22. Ansari MN, Zuberi BA. Use of electronic resources among academics at the University of Karachi. Libr Philos Pract 2010. Available from: www.webpages. uidaho.edu/mbolin/html [last accessed 12 Mar 2012]. 23. Owolabi KA, Ajiboye BA, Lawal WO, Okpeh SC. Use of electronic information resources by faculty members in Nigerian universities. Int J Libr Sci 2011;4:142–8. 24. Ogun State Government. Excerpts from Senator Ibikunle Amosun’s 2011 campaign manifestoes. 2012. Available from: www.ogunstate.gov.ng [last accessed 24 Feb 2012].
APPENDIX 1. SURVEY QUESTIONNAIRE Dear Respondent, This questionnaire is designed to elicit information on the knowledge and utilization of Health Information and Communication Technology(ies) (HICTs) by the health workers of the Ijebu zone, Ogun State of Nigeria. We solicit your cooperation in completing this questionnaire objectively. Responses will be treated in confidence. Thanks (Ajiboye, Adekoya, Alawiye & Oyedipe).
SECTION A: Demographic Information (1) (2) (3) (4) (5)
Name of Hospital: __________________________________________________ Health worker category (i.e. Doctor, Nurses, Pharmacy, etc.): ___________ Gender: Male ( ) Female ( ) Age range: 20–34 ( ) 35–44 ( ) 45–55 ( ) Education: National Dip./Reg.Nurse/Mid wife ( ) B.Sc/HND ( ) MSc/MTech ( ) Ph.D ( )
SECTION B: Awareness, knowledge, purpose, utilisation and challenges of using HICTs (6) Indicate your awareness or otherwise of HICTs aware ( ) not aware ( (7) Indicate the availability of the following HICTs gadgets to you Mobile phone Office computer Personal computer Office internet connectivity Personal modem Hospital website
HICTs resources
Available
Not available
)
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(8) Indicate your knowledge level of the use of HICTs gadgets and resources: adequate knowledge ( ) average knowledge ( ) poor knowledge ( ) (9) Indicate the type(s) of HICTs resources made use of for healthcare delivery: e-mail ( ) search engines ( ) CD-ROM ( ) telemedicine ( ) e-bulletin/ news group ( ) subject gateway/directory/online data base (web MD, Medline, Hinari, etc) ( )other(s). Please, specify_________________ (10) Rate your HICTs utilisation level highly utilised ( ) averagely utilisedpoorly utilised ( ) (11) Your purpose of using HICTs (check as many as applicable) healthcare delivery ( ) collaboration and professional networking ( ) self-development ( ) curiosity ( ) social networking ( ) other (s). Please, specify______________________________ (12) What is/are the constraint (s) faced in using HICTs? (check as many as applicable) lack of computer/HICTs gadgets ( ) lack of/insufficient internet connectivity ( ) inadequate technical/institutional support ( ) high cost of recharging the modem for internet connection ( ) not aware of HICTs ( ) other (s). Please, specify________________________________
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Knowledge and utilization of health information and communication technologies (HICTs) by health workers of the North-Eastern health zone of Ogun State, Nigeria Bosede Adebimpe Ajiboye,1 Adenike Jumoke Adekoya,2 Mariam Kehinde Alawiye,1 and Wuraola Janet Oyedipe3 1
Cataloguing and Classification Section, Nimbe Adedipe Library, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria, 2 Health Centre, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria, 3 Readers’ Services Section, University Library, Olabisi Onabanjo University, Ago-Iwoye, Ogun-State, Nigeria
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The study examines the use of health information and communication technologies (HICTs) by health workers in seven state hospitals and a private hospital in the NorthEastern Zone, Ogun State, Nigeria. The study adopted the descriptive and crosssectional survey design method using a 12-point questionnaire as the instrument for extracting information on the use of HICTs. The questionnaires were personally administered by the researchers; responses were collated, analyzed and presented using descriptive statistics, which includes frequency counts, percentages, tables as well as bars. The outcome shows that a large percentage of the respondents are aware of HICTs. However, only a few have adequate knowledge of and use HICTs for healthcare delivery in spite of its importance to healthcare services. A few have access to computers and HICTs resources relevant for effective healthcare delivery in their hospitals, and only one of the hospitals examined is connected to the internet and none has a website. The paper concludes with recommendations on the need for the management boards of the hospitals examined and the health workers to avail themselves of the opportunities that abound in the use of HICTs. Keywords: Health information and communication technologies, health workers, healthcare delivery, Nigeria
HIGHLIGHTS
The results on the knowledge and utilization of HICTs for healthcare delivery by health workers in Ijebu zone revealed that the doctors’ level of awareness of HICTs recorded the highest frequency as against the other categories of healthcare workers. Not all of those who claim to be aware of, and have adequate knowledge of HICTs’ usage make use of it for healthcare delivery. This is observed
Correspondence: Bosede Adebimpe Ajiboye, Federal University of Agriculture, Abeokuta, Cataloguing and Classification, PMB 2240, Alabata Road, Abeokuta, Abeokuta, Ogun State, Nigeria. E-mail: [email protected]
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in the response of the pharmacists; despite the fact that adequate knowledge of HICTs possessed by the pharmacists recorded the highest frequency; their utilization level was found to be low. The doctors reported the highest level of utilization. Other finding of this study also shows that 50% and 80% of the doctors have access to personal computers and modem, respectively, while the percentage of other categories of health workers who have access to personal computers were found to be very few. Furthermore, among those who possess personal computers, utilization level was found to be low. Other findings of this study show that only one of the hospitals examined is connected to the internet and none of them have a website. The main ICT resource used by a 100% of the respondents, which could not possibly enhance healthcare delivery significantly, is the mobile phone. This probably suggests that the only HICTs resource readily available to the entire sampled health workers is the mobile phone. Other result shows that the potential of HICTs to enhance and transform healthcare delivery by health workers in Ijebu zone is still not being fully utilized. It was also found in this study that two major constraints (that recorded the highest frequency) to the use of HICTs indicated by the respondents are non-availability of computers and insufficient internet connectivity.
INTRODUCTION The fact that economic health depends on medical health (borrowing a popular slogan that health is wealth) implies that healthcare needs to be accessible to all, including the rural communities. If compromised, this could undermine the socio-economic condition of the entire nation. It is a healthy citizenry that can be mobilized to participate in the developmental programme of the nation and pursue their own legitimate individual aspirations. In the past decade, there has been significant growth in Internet access in urban areas; healthcare workers now use it for communication, access to relevant healthcare information and international collaboration. In contemporary times, patients are able to acquire healthcare information through the internet, global systems of communications and the media, etc., resulting in smarter and well-informed patients with higher expectations and a demand for high-standard quality healthcare. The Wikipedia defines healthcare delivery as the systematic provision of personal and population-based preventive, curative and rehabilitative care services. This is provided at the primary, secondary or tertiary levels. For the purpose of this study, the health workers in focus and the healthcare service delivery being offered is at the secondary level. There have been considerable national and international discussions on the potential of information and communication technologies (ICTs) to make major impacts in improving the health and well-being of poor and marginalized populations, combating poverty and encourage sustainable development and governance (1).
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The result of the findings of Digital Health (2012) (2), which focuses on building better healthcare delivery, sought to address these needs of remote and poor communities and to fast track progress on Millennium Development Goals (MDGs) 4 (reduction in child mortality), 5 (improvement of maternal health) and 6 (combating HIV/AIDS, malaria and other diseases) in the Federal Capital Territory of Nigeria. The Mailafiya Health Program shows the positive impact that ICT can have on improving healthcare delivery. The result is that 426 rural populations are now receiving health services on a regular basis. The project is proving that ICT can play a critical role in building healthcare delivery capacity and enabling greater access to effective healthcare – which in turn can have far-reaching effects on social and economic strength Digital Health (2012) (2). With the significant burdens on limited healthcare resources set to increase even further, Ministries of Health, NGOs and public agencies tasked with accomplishing MDGs, especially in the third-world nations and particularly in Nigeria, must consider ICT as a strategic enabler and an essential element to help transform healthcare delivery. According to the World Health Organization (3), the use of ICTs in health is not merely about technology but is a means to reach a series of desired outcomes across the entire health system. Information technology (IT) has had a positive impact on healthcare delivery systems worldwide, particularly in the areas of disease control, diagnosis, patient management and teaching (1,4). Health information and communication technologies (HICTs) gadgets are defined as tools that facilitate communication and the processing and transmission of health information by electronic means, for the purpose of improving health promotion, human resources for health and health-service delivery. Brailer & Thompson (2004) (5) define HICTs gadgets as the application of information processing involving both computer hardware and software that deals with the storage, retrieval, storing and use of healthcare information, data and knowledge for communication and decision-making. This definition encompasses the full range of HICTs, from radio and television to telephones (fixed and mobile), computers, remote and on-line databases, read only memory compact disc (CD-ROM) and the Internet. HICTs have the potentials to offer less costly alternatives to traditional conferences, workshops and seminars where health workers must travel in order to meet and share experience. It also helps to reduce error in drug administration, most especially in paediatrics wards (6). HICTs are modern trends that are gradually being employed by the medical professions worldwide, but the rate of utilization seems to be a bit lower among health workers in the developing countries and particularly in Nigeria as revealed in the literature. This is also observed in the area of study. It is to this end that the researchers seek to assess the North Eastern Zone’s health workers knowledge and utilization of these tools for healthcare delivery with the aim of filling this gap in literature.
BACKGROUND INFORMATION OF THE TARGET POPULATION The Target population is the health workers of state hospitals and a private paediatric hospital in the North-Eastern Zone of Ogun State, Nigeria.
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Figure 1. Map of Nigeria showing the location of Ogun State.
Ogun State was created from the old Western State on 3 February 1976 and is located in South-Western Nigeria. Ogun State covers 16 762 square kilometers. It shares borders with Lagos State to the south, Oyo and Osun states to the north, Ondo State to the east and the Republic of Benin to the west (Figure 1). The Ogun State Hospitals Management Board was established in 1978 by Edict No. 6 as State Health Board with the functions of essentially managing human, financial and material resources as related to state-owned medical institutions. The headquarter of the board is located at Abeokuta, the state capital. There are five Health Zones, in the North-East, North-West, South-East, South-West and Central with each zonal office located at a designated State Hospital. The North-East Zone under review is made up of eight Local Governments with seven state hospitals and one private paediatric hospital. The report of the National Census of the year 2006 projected population of these local governments to be over one million (Figure 2). At the State Hospitals chosen for this study, only the senior officers have computers in their offices with no Internet access. However, some of the health workers have access to personal computers, modems, CDS and CD-ROMS on health and medical practice. The private paediatric centre is the first purpose-built private children’s hospital in Nigeria and the biggest individual philanthropic
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Figure 2. Map of Ogun State showing the Local Government Areas (LGAs) of the State.
initiative in the health sector designed to be at the apex of the nation’s child health system. This hospital acts as a catalyst to the nation’s drive toward the achievement of the MDG on infant and child survival. The hospital, built in 1994, had served as a tertiary referral centre for teaching, research and healthcare delivery for infants and children since it was commissioned in 2004. The paediatrics centre has a computer centre and a cyber cafe´ that service the hospital staff. The members of staff are given passwords free of charge on hourly basis to access the Internet; it also has a library stocked with compact disk and CD-ROMS on healthcare delivery and medical practise.
OBJECTIVES OF THE STUDY The general objective of this study is to assess how much knowledge health workers possess about the utilization of HICTs for healthcare delivery and the extent to which this procedure is already being used. To meet this objective, the study will focus on the following specific objectives; to:
identify the types of HICTs resources available to and made use of by the health workers; examine the level of the health workers’ awareness of HICTs and assess their knowledge of its usage;
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find out if the health workers’ awareness and knowledge of HICTs gadgets and its availability to them influences its utilization for healthcare delivery and also identify other reason(s); (apart from healthcare delivery) for using HICTs; identify the constraints to effective utilization of HICTs among the health workers in providing effective care to their patients and extract information that will help stakeholders in the health sector to exploit opportunities offered by HICTs in effective and efficient healthcare delivery.
REVIEW OF RELATED LITERATURE Healthcare is growing increasingly complex and most clinical research focus on new approaches to diagnosis and treatment. If major gains in quality healthcare are to be achieved, there must be transformation, and IT will play a key part. The following technologies have been identified as being potentially useful in alleviating barriers to rural access: satellite technology; wireless Internet connectivity; and cellular networks, mobile phones can also become ubiquitous and are already widely used by health workers (7). The Internet provides free access to abundant databases, reference materials and medical journals online, such as Medical Literature Analysis and Retrieval System (Medline), Health InterNetwork Access to Research Initiative (HINARI), web-medical doctor (Web-MD), etc., textbooks and the latest information on breakthroughs in medicine, encourages learning and research (8). The Internet has also given great value to connectivity across the regions of the world. These resources have brought huge benefits to tertiary healthcare institutions in the developing countries, specifically, Nigeria. It also provides opportunities to retrieve up-to-date information on different aspects of diseases, interact with colleagues via videoconferencing and enhance communication amongst colleagues in different continents. E-mail communication is the most common use of the Internet and is increasingly available to health professionals across the globe, keeping them in touch not only with one another for professional interaction, clinical advice and referrals but also with colleagues worldwide. Current telecommunications technologies have an extraordinary capacity for transmitting information. While the use of CD-ROM and interactive software packages have greatly contributed to dissemination of information among healthcare professionals, its use is still very limited in developing countries in Africa (9). The computer and IT offer the physician the ability to store and retrieve patients’ clinical and socio-demographic information, as well as laboratory results, which aid in the preparation of referral notes. It also aids the preparation of discharge summaries, clinic letters and financial statements of the hospital as well as delivery of laboratory results (10). IT can reduce the rate of medical errors in three ways: by preventing errors and adverse effects, by facilitating a more rapid response after an adverse event has occurred and by tracking and providing feedback about adverse effects. Data now show that IT can reduce the frequency of errors of
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different types and probably the frequency of associated adverse effects (11). The main classes of strategies for preventing errors and adverse effects include tools that can improve communication, make knowledge more readily accessible, require key pieces of information (such as the dose of a drug), assist with calculations, perform checks in real time, assist with monitoring and provide decision support. Solomon (2005) (12) in his study reported that Health information is identified as the key to successful partnership and sustainable health service delivery as well as the tool through which community involvement for ownership in health services can be based. Obijiofor et al. (2009) (13) undertook a study of a systematic review evidence on the effect of health IT on quality, efficiency and costs of healthcare, they also systematically searched the English language literature indexed in Medline (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects and the Periodical Abstracts Database and added studies identified by experts up to April 2005. Results show that of the institutions examined, four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. In their own study of the impact of new ICTs on socio-economic and educational development of Africa and the Asia-Pacific, Bates & Gawande (2003) (11) found that despite the high level of ICT awareness, only a few people have access to these technologies in Africa and Asia-Pacific regions. The reasons for this include ignorance, general poverty in the society, poor culture of maintenance and repair, poor infrastructural support base (inefficiency in electricity and telephone systems), lack of support from government, illiteracy and lack of basic computing skills. Furthermore, as reported in Albright Stone Bridge (2012) (14), health information systems was successfully launched in some parts of India to strengthen information practices within primary healthcare with the larger aim of improving processes concerning healthcare delivery for the rural community. A significant percentage of the rural population was found to be poor and reside in remote areas, hence directly depending on the effectiveness of health information systems for addressing the health problems of communities. The main objective of the system was to strengthen Healthcare delivery and develop the capacity of the health staff to work with computers and its related technologies with the ultimate aim that this would lead to better delivery of healthcare to the community. Bello et al. (2004) (15) reviewed the applications of telemedicine and felt that it may in fact have a more profound impact on developing countries than on developed ones. He noted that even in very remote and relatively underdeveloped communities such as the satellite stations in Uzbekistan, Cambodia and Kosovo, low bandwidth Internet reached into the most remote areas, despite their unstable political climate and poor socio-economic environments. Nazim & Saraf (2006) (16) conducted a survey on internet access and use for health information among people living with HIV-AIDS. They found that majority of people were not aware of the availability of health information on the net. This may be due to lack of awareness of same by their healthcare
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providers who ought to have been in position of making such available to them through healthcare delivery or services. Furthermore, not all of them who claim to be aware of the existence of and have adequate knowledge of HICTs’ usage make use of it for healthcare delivery. This is in consonance with Jegede (2005) (17) and Ajiboye (2009) (18) who submitted that awareness of and accessibility to computers (ICT) does not translate to utilization. In their own analysis of the benefits derivable from mobile health, West (2012) (8) concluded through his positive findings that mobile health has the ability to improve healthcare delivery and save money in health care. Centre for Medicare Advocacy Inc. (2010) (19) also reported that an integrated, patient-centred healthcare delivery system would allow multiple health providers in multiple settings to share information quickly, utilizing the latest health information technologies. Formal studies and preliminary project assessments in both the developed and developing world demonstrate that health workers are beginning to be aware and getting more and more accustomed to the use of mobile technology and electronic health to improve the efficiency of healthcare delivery and ultimately make healthcare more effective (20). Furthermore, report of the U.S. Public Health Service’s study on making a powerful connection between the health of the public and the national Information Infrastructure revealed that the National Information Infrastructure grants of the United States of America related to health have primarily supported applications of high performance computing and telemedicine to the delivery of medical care to individuals (21).
METHODOLOGY Descriptive and cross-sectional survey design was adopted. The target population was the state hospital health workers and health workers of one private paediatric hospital in the North-Eastern Zone of Ogun State (the private paediatric hospital was purposively chosen because of its high standard of operation). The health workers comprise of doctors, nurses, pharmacists, physiotherapists, dentists, laboratory technicians, health record officers and radiologists. The study was carried out over a period of three months and data collected between September and November 2011. The sample size composed of 500 health workers who were randomly drawn from different cadres of a total population of 1054 (a breakdown of which is as follows: 969 respondents from state hospitals and 85 respondents from the private paediatric hospital). The questionnaires were personally administered and collected by the researchers. The respondents were guided on the proper completion of the questionnaire after explaining the aim of the study and variables such as HICTs and healthcare delivery as used in the study to them. Since the population of the health workers in each of the hospitals was not evenly distributed, purposive sampling technique was used. A total of 421 copies of useable questionnaire were retrieved, which represents 84.2% response rate. The questionnaires were ascertained for completeness. They were collated, coded, fed into the computer and analyzed using descriptive statistics, which includes frequency counts, percentages, tables as well as bars.
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Ethical considerations Ethical approval was granted by Ethics Review Committees of both the State Hospitals Management Board and the private Paediatric Centre. Permission was also sought from the authorities of the hospitals before administering the questionnaire on the respondents. However, the research followed principles in the Declaration of Helsinki. There was no risk associated with this research being a survey, and participation was completely voluntary (i.e. respondents chose to participate without being compelled or coaxed to do so). The data collected for the study would be used in recommending technology training intervention programmes that would be of benefit to health workers of the zone and consequently the state in order to enhance healthcare delivery. Informed consent was obtained from the participants, i.e. the participants’ consent was solicited and audience granted the researchers. The questionnaire used for this study was anonymous, i.e. the identity of the respondents was kept in confidence. Data presentation and analysis Table 1 shows the demographic data of the respondents. About half (50.4%) of the respondents are between the age range of 20 and 34 years, 33.5% between 35 and 44 years, while the remaining 16.2% are between 45 and 55 years. About 71.7% of them were female, while 28.3% were male. Eighty percent of them are either national diploma holders or registered nurses or registered midwives, 14% are either Bachelor of Science degree or higher national diploma holders, 5.2% are either holders of the MSc or MTech degrees, while a paltry percentage of 0.7% are Doctor of Philosophy holders. Table 2 reports the respondents’ awareness of HICTs. Result shows the following level of awareness by healthcare worker category in decreasing order of magnitude: doctors, 40 (100%); nurses, 236 (87.4%); pharmacists, 17 (85%); laboratory technicians, 44 (88%); physiotherapists, 4 (80%); Dentists, 10 (76.9%); record officers, 11 (73.3%); and radiologists, 3 (37.5%). Table 3 shows that all the respondents 421 (100%) possess a mobile phone, 127 (30.2%) respondents have access to computer in the office, 111 (26.4%) and 110 (26.1%) respondents have personal computers and modems, respectively, the 30 (7.1%) respondents who have access to the Internet in their offices are from the private Paediatric Centre, while none of the hospitals examined has a web site. Respondents were asked to rate their level of knowledge of HICTs. Table 4 shows the response of adequate knowledge of HICTs in decreasing order of magnitude 14 (70%) pharmacists, 34 (68%) laboratory technicians, 27 (67.5%) doctors, 3 (60%) physiotherapists, 8 (53.3%) record officers, 6 (46%) Dentists, 116 (43.0%) nurses and 2 (15%) radiologists. While the remaining respondents indicated that they either have average or poor knowledge of HICTs. Table 5 shows the type of HICTs resources made use of by the respondents. The e-mail has the highest number 154 (36.6%) of usage followed by search engines with 120 (28.5%) responses, CD-ROM records 94 (22.3%) responses, telemedicine has 59 (14.0%) responses, e-bulletin is made use of by 37 (8.8%) of the respondents, while the subject gateways/directories/online database (Web-MD, Medline, HINARI, etc.) have the lowest 29 (6.9%) number of usage.
20–34 35–44 45–55 Male Female Ph.D MSc/M.Tech B.Sc/higher national diploma(HND) National diploma (ND)/regmid wife Director Matron Others 15 104 151
261
–
16 – 24
153 87 30 6 264 – 5 4
6 23 11 36 4 3 9 28
Nurse (n = 27)
4 – 16
10
8 5 7 13 7 – 3 7
Pharmacists (n = 20)
Doctors (n = 40)
40 –
Awareness
Aware Not aware
236 33
Nurses (n = 270) 17 3
Pharmacists (n = 20) 44 6
– – 50
40
33 9 8 37 13 – 2 8
11 4
4 1
– – 5
–
1 2 2 3 2 – 1 4
3 5
8
–
7
– 5 3 6 2 – – 1
– – 13
7
4 7 2 9 4 – 1 5
Dentists (n = 13)
10 3
Dentists (n = 13)
Radiologists (n = 8)
Radiologists (n = 8)
Physiotherapist (n = 5)
Physiotherapists (n = 5)
– – 15
12
7 3 5 9 6 – 1 2
Health record officers (n = 15)
Record officers (n = 15)
Laboratory technicians (n = 50)
Laboratory technicians (n = 50)
Table 2. Level of awareness of HICTs by healthcare worker category.
Rank/status
Edu.
Gender
Age in years
Demographic information
Doctors (n = 40)
Table 1. Demographic data of respondents.
(50.4%) (33.5%) (16.2%) (28.3%) (71.7%) (0.7%) (5.2%) (14.0%)
366 (86.9%) 55 (13.1%)
Total (n = 421)
35 (8.3%) 104 (24.7%) 282 (67%)
337 (80.0%)
212 141 68 119 302 3 22 59
Total (n = 421)
Knowledge and utilization of health information
113
40 20 32 – 12 6
270 54 35 – 81 8
Nurses (n = 270) 20 7 9 – 6 4
Pharmacists (n = 20)
Doctors (n = 40)
27 8 5
Knowledge
Adequate Average Poor
116 20 134
Nurses (n = 270) 14 2 4
Pharmacists (n = 20)
Table 4. Knowledge of HICTs by healthcare category.
Mobile phone Personal computer Modem Hospital website Office computer Office internet
HICTs availability
Doctors (n = 40)
Table 3. Availability of HICTs gadgets to respondents.
34 11 5
Laboratory technicians (n = 50)
50 21 13 – 15 3
Laboratory technicians (n = 50)
8 3 4
Record officers (n = 15)
15 2 11 – 5 2
Record officers (n = 15)
3 1 1
Physiotherapists (n = 5)
5 2 3 – 2 2
Physiotherapist (n = 5)
2 1 5
Radiologists (n = 8)
8 2 2 – 2 2
Radiologists (n = 8)
6 3 4
Dentists (n = 13)
13 3 5 – 4 3
Dentists (n = 13)
(100%) (26.4%) (26.1%) (0%) (30.2%) (7.1%)
210 (49.9%) 49 (11.6%) 162 (38.5%)
Total (n = 421)
421 111 110 0 127 30
Total (n = 421)
114 B. A. Ajiboye et al.
37 11 34 32 43 22
Highly utilized Averagely utilized Poorly utilized
HICTs utilization level
35 4 1
Doctors (n = 40)
86 134 30
Nurses (n = 270) 11 6 3
Pharmacists (n = 20)
Table 6. HICTs utilization level by healthcare category.
E-mail E-bulletin/news group CD-ROMS Telemedicine WWW browser (Google, Yahoo, etc.) Online database (Web-MD, Medline and HINARI)
HICTs resources made use of 46 14 25 23 33 –
22 11 17
Laboratory technicians (n = 50)
13 2 6 – 9 2
8 3 4
Record officers (n = 15)
31 3 17 – 23 –
3 1 1
Physiotherapists (n = 5)
9 3 4 – 6 1
3 1 2 1 2 2
3 2 3
Radiologists (n = 8)
4 2 2 – – –
6 4 3
Dentists (n = 13)
11 1 4 3 4 2
Laboratory Record Doctors Nurses Pharmacists technicians officers Physiotherapists Radiologists Dentists (n = 40) (n = 270) (n = 20) (n = 50) (n = 15) (n = 5) (n = 8) (n = 13)
Table 5. Types of HICTs made use of by respondents.
(36.6%) (8.8%) (22.3%) (14.0%) (28.5%) (6.9%)
162 (41.1%) 201 (47.7%) 93 (22.1%)
Total (n = 421)
154 37 94 59 120 29
Total (n = 421)
Knowledge and utilization of health information
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Respondents were asked to rate their level of HICTs’ utilization vis-a`-vis their awareness and knowledge. As shown on Table 6, the responses of those who rated their utilization levels to be high are as follows: 35 (87.5%) doctors, 86 (31.9%) nurses, 11 (55%) pharmacists, 22 (44%) laboratory technicians, 8 (53.3%) record officers three each of physiotherapists and radiologists (60% and 37.5%), respectively, and 6 (46.2%) dentists. Others rated their level of utilization to be either average or poor. Information that will help determine the respondents’ purpose of using HICTs in addition to healthcare delivery was elicited. Responses illustrated by Figure 3 shows that the main objective that the study set out to achieve which is whether the health workers use HICTs for healthcare delivery or not records 95 (22.6%) responses, while 154 (36.6%) of the health workers who make use of HICTs use it for self-development. Closely related to the use of HICTs for healthcare delivery is for collaboration and professional networking, which has a total of 103 (24.5%), 41 (9.7%) respondents use it for social networking, while the remaining 28 (6.6%) make use of it out of curiosity. Respondents were asked to rate their level of HICTs’ usage for healthcare delivery viz-a-viz their level of awareness. Their responses are reported with Figure 4. Of the 366 respondents who are aware of HICTs, only 16% of them utilize it for healthcare delivery, while as many as 84% do not make use of it for healthcare delivery. Further analysis of the result shows that of the 210 respondents who have adequate knowledge of HICTs, only 59 (28.1%) of them make use of it for healthcare delivery, while as many as 151 (71.9%) of them are not using it for healthcare delivery. Furthermore, of the 49 who have average knowledge, only 36 of them use it for healthcare delivery, while the other 23 do not use it for healthcare delivery. As shown on Table 7, the constraint to the use of HICTs that records the highest frequency is non-availability of computers and insufficient internet connectivity, both of which have 360 (85.5%) responses each, followed by inadequate technical and institutional support 301 (71.5%), other reasons stated by the respondents include, lack of adequate knowledge of HICTs usage,
Figure 3. Respondents’ purpose of using HICTs.
Knowledge and utilization of health information
Figure 4. Respondents’ use of HICTs for healthcare delivery vis-a ` -vis their knowledge.
their work load, location (working in remote areas and role conflict), which has 298 (70.8%) responses, High cost of using modems comes next with 275 (65.3%) responses, while the least constraint indicated is lack of awareness of HICTs, which records 36 (8.6%) responses. Note: In some cases, total4n (421) and total percentage4100, because respondents were allowed to pick more than one option as applicable to them.
DISCUSSION OF MAJOR FINDINGS The return rate of the questionnaire and the level of interest shown in this study among the health workers examined were overwhelming. The results on the knowledge and utilization of HICTs for healthcare delivery by health workers in North-Eastern Health Zone of Ogun State revealed that the doctors’ level of awareness of HICTs recorded the highest frequency. Furthermore, not all of those who claim to be aware of and have adequate knowledge of HICTs’ usage make use of it for healthcare delivery. This is observed in the response of the pharmacists; despite the fact that adequate knowledge of HICTs possessed by the pharmacists recorded the highest frequency, their utilization level was found to be low. This is in consonance with Jegede (2005) (17) and Ajiboye (2009) (18) who submitted that awareness of and accessibility to computers (ICT) does not translate to utilization. However, the doctors reported the highest level of utilization. Other findings of this study also show that 50% and 80% of the doctors have access to personal computers and modem, respectively, while the percentage of other categories of health workers who have access to personal computers were found to be very few. Furthermore, among those who possess personal computers, utilization level was found to be low. This is in agreement with findings in Bello et al. (2004) (15). They examined the knowledge and utilization of IT among healthcare professionals in a university town in South-West, Nigeria. Their finding shows that computer possession and utilization among healthcare professionals in a major university teaching hospital in Nigeria was low. But, computer possession was found to be higher among doctors when compared with the two other groups they examined. Other findings of this study also show that only one of the hospitals examined is connected to the internet and
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Non availability of computer Insufficient internet connectivity Inadequate technical and institutional support High cost of using modems Unaware of HICTs Others
Constraints to effective use of HICTs 27 33 28 31 – 13
246 234 201 170 13 225
15 17 12 14 3 13
43 43 33 32 11 27
10 11 10 11 2 7
3 3 3 2 – 3
7 8 4 6 5 2
9 11 10 9 2 8
Laboratory Record Doctors Nurses Pharmacists technicians officers Physiotherapists Radiologists Dentists (n = 40) (n = 270) (n = 20) (n = 50) (n = 15) (n = 5) (n = 8) (n = 13)
Table 7. Constraints to effective utilization of HICTs.
360 360 301 275 36 298
(85.5%) (85.5%) (71.5%) (65.3%) (8.6%) (70.8%)
Total (n = 421)
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Knowledge and utilization of health information
none of them have a website. The main ICT resource used by 100% of the respondents, which could not possibly enhance healthcare delivery significantly, is the mobile phone. That is, the only HICTs resource readily available to the entire sampled health workers is the mobile phone. The study revealed that the potential of HICTs to enhance and transform healthcare delivery by health workers in North-Eastern Health Zone of Ogun State, Nigeria is still not being fully utilized. It was also found in this study that two major constraints (that recorded the highest frequency) to the use of HICTs indicated by the respondents are non-availability of computers and insufficient internet connectivity. This is in tandem with the findings of Ansari & Zuberi (2010) (22) and Owolabi et al. (2011) (23) who examined the use of computers and electronic resources among faculty members in Nigerian universities and Karachi Universities, respectively. They found that low connectivity, lack of access to personal computers and lack of computer facilities are the major constraints to faculty members’ use of computers and electronic resources.
CONCLUSION As found out by this study and as indicated in the literature reviewed, the benefits to be gained by making use of HICTs for healthcare delivery cannot be over-emphasized. HICTs improve the quality of health services and enhance a healthy populace. If the qualities of healthcare delivery must be improved especially in this technology era, then, there is a need to invest in HICTs and encourage its use among health workers in our nation. This is because the quality of healthcare delivery is based on the utilization of current and up-to-date information and technology. Regrettably, this study has established that the knowledge and utilization of HICTs for healthcare delivery at the Health Zone under study is on the average. Consequently, the state executive governor’s resolve as well as that of the Ogun State Government (2012) (24) towards giving the health sector in the state a facelift is good, but the factors required (of which HICTs is pivotal) to make it succeed should be of paramount concern.
RECOMMENDATIONS In recognition of a healthy populace served by technology-informed health workers and based on the outcome of this study, the following recommendations emanating from this study will be useful:
All state hospitals in the area of study should be connected to the Internet with fee-based on-line medical and health sciences data bases and online discussion groups subscribed to and paid for by the State Hospitals Management Board. At least one or two computer(s) should be acquired for each section/ department/unit of the state hospitals as this will facilitate access and utilization of the HICTs resources provided. This can be done through a policy statement and making sure that every state hospital has a functional HICTs laboratory.
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Health workers across the state should be encouraged to undertake HICTs skills training programme as short-course or refresher-course; such training can also be incorporated into their periodic professional workshops and conferences. Such courses will improve the health workers’ knowledge of HICTs and enhance its utilization for health care delivery. Continuous medical education training programs for all practicing physicians and health workers should be adopted. This would certainly assist in ensuring maximum utilization of the innumerable advantages offered by IT. Medicine is an ever-evolving and information-based discipline, and as such the provision of structured computer and IT training for all members of the health team would equip them with the skills they need to practice up-to-date and evidence-based medicine, which are essential to improving the quality of healthcare delivery. The State Hospitals Management Board should employ technical staff for her hospitals to maintain her HICTs resources and render immediate assistance when the need arises. Financial grants and interest-free loans should be given to the health workers to enable them procure HICTs resources such as personal computers and modems. This can also be procured and made available to them at subsidized prices. The State Hospitals Management Board should also involve itself actively in state policies that relate to healthcare services and strategic planning in order to give priority to HICTs. Attention should be given to the provision of HICTs and training the health workers towards the use of same. This will enable them to collaborate with professional colleagues across the globe and also have the knowledge of the current trends in healthcare delivery and be able to apply same to their services. In healthcare, the most vital elements are a highly trained, balanced and motivated workforce; current and accurate information; and technologies that enable providers to most effectively use resources the right way and at the right time. People, knowledge and the means for their application are the foundation upon which an efficient, high quality health system rests. The management of the state hospitals and private hospitals should consider working on this so as to improve the healthcare workers’ ability to perform their duties effectively.
DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
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APPENDIX 1. SURVEY QUESTIONNAIRE Dear Respondent, This questionnaire is designed to elicit information on the knowledge and utilization of Health Information and Communication Technology(ies) (HICTs) by the health workers of the Ijebu zone, Ogun State of Nigeria. We solicit your cooperation in completing this questionnaire objectively. Responses will be treated in confidence. Thanks (Ajiboye, Adekoya, Alawiye & Oyedipe).
SECTION A: Demographic Information (1) (2) (3) (4) (5)
Name of Hospital: __________________________________________________ Health worker category (i.e. Doctor, Nurses, Pharmacy, etc.): ___________ Gender: Male ( ) Female ( ) Age range: 20–34 ( ) 35–44 ( ) 45–55 ( ) Education: National Dip./Reg.Nurse/Mid wife ( ) B.Sc/HND ( ) MSc/MTech ( ) Ph.D ( )
SECTION B: Awareness, knowledge, purpose, utilisation and challenges of using HICTs (6) Indicate your awareness or otherwise of HICTs aware ( ) not aware ( (7) Indicate the availability of the following HICTs gadgets to you Mobile phone Office computer Personal computer Office internet connectivity Personal modem Hospital website
HICTs resources
Available
Not available
)
Knowledge and utilization of health information
(8) Indicate your knowledge level of the use of HICTs gadgets and resources: adequate knowledge ( ) average knowledge ( ) poor knowledge ( ) (9) Indicate the type(s) of HICTs resources made use of for healthcare delivery: e-mail ( ) search engines ( ) CD-ROM ( ) telemedicine ( ) e-bulletin/ news group ( ) subject gateway/directory/online data base (web MD, Medline, Hinari, etc) ( )other(s). Please, specify_________________ (10) Rate your HICTs utilisation level highly utilised ( ) averagely utilisedpoorly utilised ( ) (11) Your purpose of using HICTs (check as many as applicable) healthcare delivery ( ) collaboration and professional networking ( ) self-development ( ) curiosity ( ) social networking ( ) other (s). Please, specify______________________________ (12) What is/are the constraint (s) faced in using HICTs? (check as many as applicable) lack of computer/HICTs gadgets ( ) lack of/insufficient internet connectivity ( ) inadequate technical/institutional support ( ) high cost of recharging the modem for internet connection ( ) not aware of HICTs ( ) other (s). Please, specify________________________________
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