Access and use of clinical informatics among medical doctors in selected teaching hospitals in Nigeria and South Africa
Date
2017
Authors
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Journal ISSN
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Publisher
University of Zululand
Abstract
This study examined access and use of clinical informatics among medical doctors at University College Hospital, Nigeria and King Edward VIII Hospital, South Africa. The specific objectives of the study were to explain the purposes of using clinical informatics; determine the benefits of using clinical informatics in the selected teaching hospitals; ascertain the availability of clinical informatics infrastructure in the selected teaching hospitals; identify the clinical informatics facilities that are accessible to medical doctors in the selected teaching hospitals; determine the factors that influence the behavioural intention to use clinical informatics by medical doctors in the selected teaching hospitals; determine the policies that guide the effective accessibility and utilisation of clinical informatics among medical doctors in the selected teaching hospitals; and investigate the challenges that faced both the access to and the use of clinical informatics among medical doctors in the selected teaching hospitals. The study adopted the post-positivist paradigm which combines both qualitative and quantitative research methods. The study largely used a survey design. The sample for the study was drawn from medical doctors in two purposively selected teaching hospitals in Nigeria and South Africa. The teaching hospitals were King Edward V111 hospital, Durban, South Africa and University College Hospital, Ibadan, Nigeria. The two teaching hospitals were selected because they belong to the first generation of teaching hospitals in Nigeria and South Africa, among other reasons. It was believed that they would be well established in terms of funding towards infrastructure and human development in their respective countries. Convenience sampling was used to select the respondents for the study. The questionnaire was administered to 413 medical doctors, 258 (63%) of whom returned the questionnaire. Interviews were also conducted with the heads of the ICT units at the University College Hospital in Ibadan, Nigeria, and King Edward VIII Hospital in Durban, South Africa. The quantitative data aspect of the study was analysed using descriptive statistics and Statistical Package for Social Sciences (SPSS), while the qualitative aspect of the data was analysed through the use of qualitative contents analysis. The study was guided by the Unified theory of acceptance and use of technology (UTAUT). The essence of using this theory is to identify the factors that influence the use of clinical informatics. The finding of the study reveals that there was an association between the demographic variables and the use of clinical informatics. It was established that there was a significant association between the medical department and the use of electronic medical records. An assessment of the socio-demographic characteristics and the use of the Clinical Decision Support System revealed that there was a significant association between the years of medical practice and the use of Clinical Decision Support System. The finding also revealed that social demographic variables such as age, years of practice and position were all significant related with the use of diagnostic image archiving. Furthermore, the surveyed medical doctors stated that their main purpose of using clinical informatics is for medical diagnosis. It was also discovered that there is association between the teaching hospitals and the use of clinical informatics for knowledge sharing. In addition, clinical informatics was found to influence the spirit of team work amongst the medical doctors through knowledge sharing with their professional colleagues and their medical students. Similarly, there were association between the teaching hospitals treatment of patients and effective healthcare delivery. In addition, the major benefit of using clinical informatics in the two hospitals was to reduce medical errors.
The most available clinical informatics tools in the selected teaching hospitals were the Diagnosis Image Archiving and Clinical Decision Support System. Performance expectancy and effort expectancy were identified as the factors from the UTAUT that influenced the medical doctors’ behavioural intention to use clinical informatics resources in the selected teaching hospitals. The non-availability of clinical informatics resources was identified as the main challenge facing the effective access to and use of clinical informatics. In addition, the two hospitals relied on the ICT policies of other institutions and did not have their own ICT policies, which was problematic.
The study concluded that the clinical informatics environments in the two teaching hospitals are inadequate and there is poor access to clinical informatics resources among medical doctors in the selected teaching hospitals. Major recommendations of the study include the need to establish ICT policies and increase investment in clinical informatics resources at the surveyed teaching hospitals in order to promote effective and value-based healthcare delivery. In addition, the hospital management should create awareness on the importance and benefits of clinical informatics particularly for the medical doctors through informal and continuing education and training such as workshops and short courses. Moreover, the hospital managements need to partner with relevant stakeholders such as government, corporate bodies, and departments of health. This is for the provision of adequate and suitable environment to support the access and use of clinical informatics. Further studies on the various types of health informatics such as nursing informatics, pharmacy informatics and veterinary informatics are recommended. It is also suggested that the study should be extended to other regions of Africa. The study is significant and makes tangible contributions to technology acceptance and use in clinical medicine from developing country contexts such as Nigeria and South Africa giving the increasing role of information and communication technology in diagnosis, prescription, treatment, monitoring and overall management of patient care in an environment characterized by complex diseases. The study has the potential to inform policy, practises, and also contribute to this research in the general area of social information in Africa.
Description
A dissertation submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor of Philosophy (Library and Information Studies) in the Department of Information Studies at the University Of Zululand, 2017
Keywords
clinical informatics-- health informatics -- social informatics -- teaching hospitals -- Nigeria -- South Africa