Background
Methods
Study design and context
Participants and sampling procedure
Data generation tool and procedure
Data analysis
Trustworthiness
Results
Participants’ demographic descriptions
Item | Users N = 30 | Item | Providers N = 15 |
---|---|---|---|
Gender | Gender | ||
Male | 17 | Male | 10 |
Female | 13 | Female | 5 |
Education | |||
None | 16 | ||
Primary | 4 | ||
Secondary | 5 | ||
Tertiary | 5 | ||
Age (years) | Age (years) | ||
Below 20 | 1 | 21–30 | 8 |
21–30 | 7 | 31–40 | 5 |
31–40 | 17 | Above 40 | 2 |
Above 40 | 5 | ||
Occupation | Occupation | ||
Self-employed | 24 | Nurses 10 | |
Institutionally employed | 6 | Medical Assistants 5 | |
Average Monthly Income (₵) | Average Monthly Income (₵) | ||
Less than 250 | 21 | Less than 1000 | 1 |
More than 250 | 9 | 1000–2000 | 10 |
Above 2000 | 4 |
Summary of major themes and sub-themes
Low mHealth knowledge and awareness among healthcare users | |
High mHealth knowledge and awareness among healthcare providers | |
Low mHealth utilisation among healthcare users | |
High mHealth utilization among healthcare providers | |
Perceived benefits of mHealth in relation to reducing barriers to healthcare in rural areas • Reduce transportation problems • Reduce health care cost • Time saving • Reduce workload on professionals and pressure at health centres | |
Preferred mHealth service | |
Willingness to adopt/use mHealth | |
Perceived mHealth challenges • Illiteracy and technological incompetency • Network failures • Other fears and concerns |
Low mHealth knowledge and awareness among healthcare users
Another participant also related that:‘I do not know about mHealth and I have not heard about it before. We use our phones to make calls but we do not call doctors for health information even when we need it urgently, because we do not know’ [Female user].
However, few users were privy to the use of mobile phones for healthcare services. They understood that primary healthcare and health education messages could be delivered through mobile phones. They were aware of some existing mHealth services available for healthcare users. They specifically mentioned text messages delivered from phone operators or mass media:‘We make calls and text messages but we do not know we could also call doctors for treatment on phone. We know that if you are sick you have to walk all your way to the health centre to see the doctor’ [Female user].
In relation to this, another user also noted that:‘I sometimes receive message on my mobile phone to send some short code to a particular number for health tips’ [Male user].
‘With text messages, I regularly receive from the mobile network I use. They always send a message that I should text a message to a number for health information concerning my personal health’ [Male user].
High mHealth knowledge and awareness among healthcare providers
‘For us, we regularly call or text our colleagues for health information or treatment on phone and it is a common practice among us. We also search for personal health information with the use of our phones’ [Male provider].
‘Using a mobile phone for healthcare is part of the medical profession because we usually consult through phones. We the providers regularly seek healthcare information with the use of phones. However, the users hardly do it which I think it is because they are unware of such opportunity and even those who are aware hardly utilise it’ [Male provider].
Low mHealth utilisation among healthcare users
Another user also emphasised with doubt that:‘I have never used my mobile phone to access healthcare before. In the first place, I do not know I could use my phone for healthcare. I occasionally receive text message to get health tips by sending some code to a number but I have never done it before’ [Female user].
The few user participants who had used their mobile phones for healthcare shared their experiences. They described mHealth as an easy and simple way through which they can contact healthcare providers, especially during an emergency and outside the usual health provider hours:‘Using my mobile phone for healthcare ? How is it possible my brother? I doubt it. In fact, I have never used my phone for healthcare before, the same to any member in this household. We all go to the health centre for treatment whenever we are not well’ [Male user].
‘I once used my mobile phone to seek for health information on a personal health issue. The information I got really helped me to treat that health issue which worried me for a long period of time. I think using a mobile phone for healthcare is simple and easy’ [Male user].
‘Sitting at home and calling or texting a doctor for treatment is so simple and easy. Recently, I have begun to consult providers on phone without going to the health centre when I am not well and I think it is really helping. It is so simple and easy’ [Female user].
High mHealth utilisation among healthcare providers
‘I regularly use mobile phone for healthcare. I consult a colleague provider on phone for health information or treatment. Also, I occasionally seek health information online with my phone’ [Male provider].
‘With this profession, mobile phones have become indispensable. We consult here and there with the use of mobile phones. When I need any health information I consult a colleague or search it online mostly with the use of phone’ [Female provider].
Perceived benefits of mHealth in relation to reducing barriers to healthcare in rural areas
Reduce transportation problems
‘I think using mobile phone to call for help from a doctor will save us the cost involved in going to the health centre personally. You see, the health centres in this district are very far from us and it takes high cost to reach the centres. Moreover, I believe you have witnessed the kind of road network you used when coming? It is very bad. So, if I sit at home to call a doctor on phone to tell him/her about my problems for solution, I think all the transport problems will be reduced’ [Male user].
‘I think it is a great idea for our healthcare users who reside in rural areas to use their mobile phones to access healthcare by way of either calling or texting for us to provide them with the needed help. It will help reduce their cost involved in getting to the health centre. Most of the users come from very remote areas and this takes a lot of money from them. Also, the road network is very terrible and most of them go through a lot of difficulties before they get here. So, I think the use of mobile phones to reach us for health assistance will help reduce both transport cost as well as the hustle they go through because of the bad roads’ [Female provider].
Reduce healthcare cost
‘I do not like going to the health centre when I am sick because of money issues. When you go, they even ask for card fees and other charges. So, I think using mobile phones to call the nurses to prescribe medicine for you without you going to the health centre will reduce the cost of seeking health care from health centres. With this, I do not need to pay any card fees’ [Female user].
‘One thing I have observed in this community is that most people do not come to the health centre because of financial issues. So, most of the people prefer going to local practitioners for treatment than the health centres. Some of the people do not have money for transport and also cannot afford the hospital charges. With mHealth, the person can sit at home and preferably use the transport cost to buy the prescribed drugs’ [Male provider].
Time-saving
‘To me, I think it will save time. The time for travelling and waiting hours at the health centre, all will be saved’ [Female user].
‘I believe the use of mobile phones for healthcare will save our time and the users as well. The users can be saved with time to be here and waiting time as well. With mHealth, they can sit at home and access healthcare without wasting time to be here’ [Male provider].
Reduce workload on professionals and pressure at health centres
‘I think mHealth will reduce our workloads and pressure at the health centre. You see, we are very limited here serving a larger population. With mHealth, not everyone will prefer to come to the health centre, definitely some will choose to call for treatment and as a result, reduce pressure and workload. Also, with mHealth, I think access to healthcare will be expanded since anyone who calls will get treatment unlike the situation where people come and leave unattended to’ [Male provider].
Preferred mHealth service
‘I like the calling because it will be easy and simple. All that I will need is the number of the provider. Dialing the number would not be difficult for me as messaging because I cannot read. With calling, I can write the number somewhere so anytime I need help then I call the doctor’ [Female user].
‘We like the calling because it is simple and easy. For calls, we all make calls every day so we can do it but for other services such as messaging most of us cannot do because we cannot write and read’ [Male user].
Willingness to adopt/use mHealth
‘I am ever ready and willing to use mHealth. I think it is a good technology which will help us to have access to healthcare in this community. When we use this, all the transportation cost and problems will be reduced. I am looking forward for that’ [Male user].
‘For us in the health sector, we use mHealth a lot. However, we hardly use it among the users in this community. I think it is high time we started using it with the users. When it is done that way, various forms of healthcare barriers will be lessened. We are all for mHealth’ [Male provider].
Perceived mHealth challenges
Illiteracy and technological incompetency
‘I think the writing, sending and reading of messages will be our problem. Most of the people here do not know how to send text messages, especially we the adults. Personally, I do not know how messaging is done’ [Female user].
‘With mHealth service which involves reading, it will be very difficult for some of us to use. This is because we cannot read nor write, so we will hardly get the message that will be sent to us. I always delete any message I receive as soon as it comes because I cannot read’ [Male user].
Network failures
‘The network in this community is very poor. When you want to call someone, it will take you a number of hours or days to get network to make the call. We have some identified place where the network is somehow good that we stand there always to make calls. But when you move from that place you will go out of reach and I think that would not be good for mHealth’ [Male user].
‘One challenge I think will work against mobile phone usage for accessing health care among rural dwellers is poor and unreliable mobile network at their residence. Most of the people live in areas which are very difficult to reach them on phone and I think that will be a challenge when using mHealth’ [Female provider].
Other fears and concerns
‘My issue has to do with language. Is the person who will communicate with us going to speak our local language? If not then how would the person understand us and vice versa? It will work best if local language is used for the communication between us and the providers’ [Male user].
On the other hand, the providers expressed their concerns about prescribed medicine, since they believe most patients from rural areas are not being able to understand the name of the drugs they need to buy and prescribed medicine sometimes not being available in remote areas:‘My concern is how would I know that I am speaking to the right person since I cannot see the doctor?’ [Male user].
‘One concern is about how the users can get the prescribed drugs correctly and use them as indicated. One thing is that the drugs that we may prescribe on phone for the patients may not be available in the rural area’ [Female provider].