A framework for sustainable adoption of e-health tools in delivering digital mental health services at a selected South African University

Abstract

South African higher education institutions (SA HEIs) heavily depend on their staff to achieve their goals. However, the demanding nature of university work responsibilities, combined with the following factors: increased student enrolment; reduced job autonomy; increased pressure to improve national and international research publications; increased demands associated with postgraduate supervision; ineffective leadership and management; and increased administrative responsibilities, have contributed to the increase in mental health concerns among university staff (Kinman & Johnson, 2019:159; Gie, Slabbert & Haydam, 2017:11; Barkhuizen, Rothmann & Van de Vijver, 2014:330; Bezuidenhout & Cilliers, 2010:1). Furthermore, university staff experienced increased mental health issues as a result of the recent COVID-19 pandemic, highlighting the urgent need for support (Allen, Rowan & Singh, 2020:233). In SA HEIs, e-health tools emerged as a potential solution for delivering digital mental health services (DMHS) to university staff during the pandemic. However, research on the sustainable adoption of e-health tools in delivering DMHS within SA HEIs is limited. This study aimed to develop a framework for the sustainable adoption of e-health tools for DMHS at a selected university. The study adopted a case study, focusing on a single university in Cape Town, South Africa, and included an online survey with quantitative methods within a positivist paradigm. Voluntary response sampling technique was utilised to collect data from 348 participants. Data analysis employed frequency distribution, descriptive statistics, Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and Structural Equation Modelling (SEM). The study findings provide empirical evidence that factors influencing the sustainable adoption of e-health tools for DMHS directly lead to the development and implementation of effective strategies for their sustainable adoption. While the COVID-19 pandemic was a key driver for their initial adoption in SA HEIs, its impact on sustainability was limited. The findings further indicate that as the factors influencing adoption increased, the current level of adoption decreased, suggesting that initial enthusiasm was countered by implementation challenges during the pandemic. The study also provides empirical evidence that the mere existence of DMHS alone is insufficient for the sustainable adoption of e-health tools; instead, effective strategies are essential to improve and ensure their long-term use in the delivery of DMHS. The main output of this study is the development of a framework for the sustainable adoption of e-health tools in delivering DMHS at a selected university. Accordingly, this could potentially be applicable to similar university contexts, contributing to the achievement of Sustainable Development Goal 3 of the United Nations of ensuring good health and wellbeing.