Integration of mobile health technology-enabled activities in clinical settings of tertiary hospitals in Sub-Saharan Africa

Abstract

Mobile phone ownership and usage continues to increase exponentially throughout the world because of portability, facilitation of access to information, communication at any time and the ability to reduce or enhance mobility. These characteristics provide opportunities to integrate mobile phones into health information and communications technologies (ICTs) in order to support information accessibility during service delivery. Despite the rapid penetration of mobile-enabled technologies in lower- and upper-middle-income countries, there is limited empirical evidence of the usefulness of mobile health (mHealth) technologies and their effective use at points-of-care in tertiary healthcare settings. Lack of sufficient evidence impedes mHealth scale up such that healthcare professionals who are principal users of health information technologies (HITs) are unable to effectively perform their work activities because of time constraints and the inappropriateness of some technologies used. Ultimately, this affects the purpose of HITs to adequately enable execution of work activities and address performance inefficiencies experienced by healthcare professionals at points-of-care. This study takes into consideration the influence of the complexity of tasks and capabilities of technology on the behavioural intention of healthcare professionals to use (or not to use) HITs at points of-care during healthcare service delivery. The study adopted an interpretivist perspective and a qualitative approach to understand the work activities of healthcare professionals and how technology is used as an enabling tool by means of service design. The Double Diamond Model (DDM) was used to gain in-depth information from healthcare professionals. The techniques of inquiry selected were semi-structured interviews and a co-design activity. Purposive and snowball sampling were used to identify participants, who included healthcare professionals and senior managers. The qualitative data were analysed using the Activity Analysis and Development (ActAD) model as a lens to interpret findings associated with elements within the technology-enabled work activities executed by healthcare professionals in tertiary healthcare settings. The findings of this study show that implemented HITs enable access to patient information electronically and facilitate remote consultation and communication both within and outside healthcare institutions. An additional benefit attributed to the use of implemented HITs is information accountability. However, the mHealth application, VULA, developed by a clinician and used at medical facilities, is described by doctors as being disruptive during patient consultations at clinics. Nursing work activities require continuous report writing on paper; it becomes cumbersome, depending on the timeline of the patients’ journeys. The overall inference drawn from the co-design activity performed during this research, is that within the work activities of healthcare professionals in tertiary hospitals, there are touch points where machine agency influences human agency and vice versa. Ultimately, the study describes how the interplay between human agency and machine capabilities transform the outcome of technology-enabled clinical work activities in the process of healthcare service delivery. Overall, this study offers key considerations in the context of preparing to implement health ICTs and making efforts to optimise implemented HITs. The study describes the interplay between human actors and technology performance as a contributing factor to the development of an applicable framework used to design and evaluate mHealth technology-enabled work activities in tertiary healthcare of sub-Saharan Africa. This study contributes to the conversations about how cost-benefit analyses of automation result in a strengthened synergy between human agency and technology performance, particularly in the context of a hospital setting in Sub-Saharan Africa. The methodological contribution to the study is informed by the use of semi-structured interviews and co-design activities as tools of inquiry in a service design strategy to develop user journeys applicable to health informatics studies. The study offers conceptual considerations to negotiate the interplay between human agency and health ICT capabilities as informed by the activity analysis and development, particularly in tertiary hospital settings of Sub-Saharan Africa.