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Deciphering Barriers and Facilitators of eHealth Adoption in Uganda Using the Systems Thinking Approach - A Systematic Review

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Towards new e-Infrastructure and e-Services for Developing Countries (AFRICOMM 2022)

Abstract

Several studies have explored the barriers and facilitators of eHealth adoption in Uganda but hardly any literature investigating these factors using a Systems Thinking perspective, which is the purpose of this study. A search for articles was done in several databases and only 35 articles were fit for the study. Five group model-building sessions were conducted to synthesize the data. As a result, six causal loop diagrams were constructed to provide a theoretical insight of the causation between the different factors. The study revealed that training users in Information and Communication Technology (ICT) improves their digital literacy and general awareness about ICT, which improves their knowledge of telemedicine and subsequently changes their attitude towards the use of eHealth systems. The eHealth trajectory in Uganda is still in its infancy hence, it is imperative for key players in the sector to painstakingly consider the contextual barriers of eHealth and capitalize on the facilitators if eHealth ensue.

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References

  1. Silva, B.M., Rodrigues, J.J., de la Torre Díez, I., López-Coronado, M., Saleem, K.: Mobile-health: A review of current state in 2015. J. Biomed. Inf. 56, 265–272 (2015). https://doi.org/10.1016/j.jbi.2015.06.003

    Article  Google Scholar 

  2. Namatovu, H.K.: Enhancing antenatal care decisions among expectant mothers in Uganda Namatovu. Hasifah Kasujja Publisher’s PDF, also known as Version of record Publication date. University of Groningen, Groningen (2018)

    Google Scholar 

  3. Zanden, V.A.: WinSenga. Mobile Smartphone-based Electronic Foetal Heart Rate Monitor (2014). https://winsenga.wordpress.com

  4. Boyd: WinSenga. A Mobile Ear for Pregnancy Problems (2012)

    Google Scholar 

  5. Fazekas, R., Moffett, J.: Communication with Youth: Using the Internet and Mobile Phones in Reproductive Health Problems (2009)

    Google Scholar 

  6. Kiberu, V.M., Matovu, J.K., Makumbi, F., Kyozira, C., Mukooyo, E., Wanyenze, R.K.: Strengthening district-based health reporting through the district health management information software system: the Ugandan experience. BMC Med. Inf. Decis. Making 14(1), 1–9 (2014)

    Google Scholar 

  7. Kakaire, S., Mwagale, F.: Mobile Health Projects in Uganda - Narrative Report This report was completed for the inSCALE project by Sauda 2010 (2010)

    Google Scholar 

  8. Ministry of Health: Building a Strong and Interoperable Digital Health Information System for (2019)

    Google Scholar 

  9. Kiberu, V.M., Mars, M., Scott, R.E.: Barriers and opportunities to implementation of sustainable e-Health programmes in Uganda: a literature review. Afr. J. Primary Health Care Fam. Med. 9(1), 1–10 (2017). https://doi.org/10.4102/phcfm.v9i1.1277

    Article  Google Scholar 

  10. Farzianpour, F., Amirian, S., Byravan, R.: An investigation on the barriers and facilitators of the implementation of electronic health records (EHR). Health 7(12), 1665–1670 (2015). https://doi.org/10.4236/health.2015.712180

    Article  Google Scholar 

  11. Juma, K.: Current status of e-Health in Kenya and emerging global research trends. Int. J. Inf. Commun. Technol. Res. 2(1) (2012)

    Google Scholar 

  12. Alvarez, R.C.: The promise of e-Health–a Canadian perspective. ehealth Int. 1, 1–6 (2002)

    Article  Google Scholar 

  13. World Health Organization, WHO guideline (2019)

    Google Scholar 

  14. Alkhaldi, B., Sahama, T., Huxley, C., Gajanayake, R.: Barriers to implementing eHealth: a multi-dimensional perspective. e-Health Continuity Care 875–879 (2014)

    Google Scholar 

  15. Ministry of Health: Republic of Uganda Ministry of Health Uganda National eHealth Policy November 2016 (2016)

    Google Scholar 

  16. Kearney, A.: Improving the evidence for mobile health

    Google Scholar 

  17. Philbrick, W.C.: mHealth and MNCH : State of the Evidence (2013)

    Google Scholar 

  18. Al-Masri, R.A., Spyridopoulos, T., Karatzas, S., Lazari, V., Tryfonas, T.: A systems approach to understanding geopolitical tensions in the middle east in the face of a global water shortage. Int. J. Syst. Dyn. Appl. 10(4), 1–23 (2021). https://doi.org/10.4018/ijsda.289431

    Article  Google Scholar 

  19. Kizito, A., Semwanga, A.R.: Modeling the complexity of road accidents prevention. Int. J. Syst. Dyn. Appl. 9(2), 24–41 (2020). https://doi.org/10.4018/ijsda.2020040102

    Article  Google Scholar 

  20. Zelinka, D., Amadei, B.: A systems approach for modeling interactions among the sustainable development goals Part 2. Int. J. Syst. Dyn. Appl. 8(1), 41–59 (2019). https://doi.org/10.4018/ijsda.2019010103

    Article  Google Scholar 

  21. Zelinka, D., Amadei, B.: Systems approach for modeling interactions among the sustainable development goals Part 1. Int. J. Syst. Dyn. Appl. 8(1), 23–40 (2018). https://doi.org/10.4018/ijsda.2019010102

    Article  Google Scholar 

  22. Abdollahi, H., Ebrahimi, S.B.: Modeling and investigating the economy and production structure of iran public theater. Int. J. Syst. Dyn. Appl. 8(1), 60–78 (2018). https://doi.org/10.4018/ijsda.2019010104

    Article  Google Scholar 

  23. Shanbhag, N., Pardede, E.: The dynamics of product development in software startups. Int. J. Syst. Dyn. Appl. 8(2), 51–77 (2019). https://doi.org/10.4018/ijsda.2019040104

    Article  Google Scholar 

  24. Namatovu, H.K., Semwanga, A.R.: A systems dynamics approach to understanding the determinants of antenatal care utilization in low-and middle-income countries. Int. J. Syst. Dyn. Appl. 9(4), 111–128 (2020). https://doi.org/10.4018/ijsda.2020100106

    Article  Google Scholar 

  25. Bridgeland, D.M., Zahavi, R.: Business simulation. In: Business Modeling. A Practical Guide to Realizing Business Value, pp. 291–343. The MK/OMG Press (2009)

    Google Scholar 

  26. Pagoni, E.G., Patroklos, G.: A system dynamics model for the assessment of national public–private partnership programmes’ sustainable performance. Simul. Model. Pract. Theory 97, 101949 (2019)

    Article  Google Scholar 

  27. Angues, R.V., et al.: A real-time medical cartography of epidemic disease ( Nodding syndrome ) using village- based lay mHealth reporters. PLoS Negl. Trop. Dis. 12(6), 1–20 (2018)

    Google Scholar 

  28. Yagos, W.O., Tabo Olok, G., Ovuga, E.: Use of information and communication technology and retention of health workers in rural post-war conflict Northern Uganda: findings from a qualitative study. BMC Med. Inf. Decis. Making 17(1), 1–8 (2017). https://doi.org/10.1186/s12911-016-0403-3

    Article  Google Scholar 

  29. Muhaise, H., Kareyo, M., Muwanga-Zake, J.W.F.: Factors influencing the adoption of electronic health record systems in developing countries: A case of Uganda. Am. Sci. Res. J. Eng. Technol. Sci. (ASRJETS) 61(1), 160–166 (2019)

    Google Scholar 

  30. Olok, G.T., Yagos, W.O., Ovuga, E.: Knowledge and attitudes of doctors towards e-health use in healthcare delivery in government and private hospitals in Northern Uganda: A cross-sectional study. BMC Med. Inform. Decis. Mak. 15(1), 10 (2015). https://doi.org/10.1186/s12911-015-0209-8

    Article  Google Scholar 

  31. Destigter, K.: A Successful Obstetric Care Model in Uganda, pp. 41–44 (2012)

    Google Scholar 

  32. Isabalija, S.R., Mayoka, K.G., Rwashana, A.S., Mbarika, V.W.: Factors affecting adoption, implementation and sustainability of telemedicine information systems in Uganda. J. Health Inf. Dev. Countries 5(2), 299–316 (2011)

    Google Scholar 

  33. Kabukye, J.K., de Keizer, N., Cornet, R.: Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey. PLoS ONE 15(6), 1–17 (2020). https://doi.org/10.1371/journal.pone.0234711

    Article  Google Scholar 

  34. Namatovu, H.K., Oyana, T.J.: ICT uptake as a determinant of antenatal care utilization in Uganda. Int. J. ICT Res. Africa Middle East 10(1), 11–32 (2021). https://doi.org/10.4018/ijictrame.2021010102

    Article  Google Scholar 

  35. Wandera, S.O., et al.: Facilitators, best practices and barriers to integrating family planning data in Uganda’s health management information system. BMC Health Serv. Res. 19(1), 1–13 (2019). https://doi.org/10.1186/s12913-019-4151-9

    Article  Google Scholar 

  36. Uganda Ministry of Health: Uganda National eHealth Policy:Ministry of Health, p. 35 (2016)

    Google Scholar 

  37. Kiberu, V.M., Mars, M., Scott, R.E.: Development of an evidence-based e-health readiness assessment framework for Uganda. Health Inf. Manage. J. 50(3), 140–148 (2021). https://doi.org/10.1177/1833358319839253

    Article  Google Scholar 

  38. Meyer, A.J., et al.: Implementing mhealth interventions in a resource-constrained setting: case study from Uganda. JMIR mHealth uHealth 8(7), 10 (2020). https://doi.org/10.2196/19552

    Article  Google Scholar 

  39. Cargo, K., Merry, M., Viljoen, P.: Mobile for Development (2015)

    Google Scholar 

  40. Konduri, N., et al.: Digital health technologies to support access to medicines and pharmaceutical services in the achievement of sustainable development goals. Digit. Health 4, 1–26 (2018). https://doi.org/10.1177/2055207618771407

  41. Huang, K., et al.: Use of technology to promote child behavioral health in the context of pediatric care: a scoping review and applications to low- and middle-income countries. Front. Psychiatry 10, 806 (2019). https://doi.org/10.3389/fpsyt.2019.00806

    Article  Google Scholar 

  42. Roberts, S., Birgisson, N., Julia Chang, D., Koopman, C.: A pilot study on mobile phones as a means to access maternal health education in eastern rural Uganda. J. Telemed. Telecare 21(1), 14–17 (2015). https://doi.org/10.1177/1357633X14545433

    Article  Google Scholar 

  43. Mangwi Ayiasi, R., Atuyambe, L.M., Kiguli, J., Orach, C.G., Kolsteren, P., Criel, B.: Use of mobile phone consultations during home visits by community health workers for maternal and newborn care: community experiences from Masindi and Kiryandongo districts Uganda global health. BMC Publ. Health 15(1), 1–13 (2015). https://doi.org/10.1186/s12889-015-1939-3

    Article  Google Scholar 

  44. Namatovu, H.K., Oyana, T.J., Sol, H.G.: Barriers to eHealth adoption in routine antenatal care practices: Perspectives of expectant mothers in Uganda–A qualitative study using the unified theory of acceptance and use of technology model. Digit. Health 7(1–20), 2021 (2021). https://doi.org/10.1177/20552076211064406

    Article  Google Scholar 

  45. Huang, F., Blaschke, S., Lucas, H.: Beyond pilotitis: Taking digital health interventions to the national level in China and Uganda. Global. Health 13(1), 1–11 (2017). https://doi.org/10.1186/s12992-017-0275-z

    Article  Google Scholar 

  46. Baryashaba, A., Musimenta, A., Mugisha, S., Binamungu, L.: Metadata of the chapter that will be visualized in online. In: Information and Communication Technologies for Development. Strengthening Southern-Driven Cooperation as a Catalyst for ICT4D (2009)

    Google Scholar 

  47. Matin, S.B., et al.: Feasibility of a mobile health tool for mothers to identify neonatal illness in rural Uganda: acceptability study. JMIR mHealth uHealth 8(2), e16426 (2020). https://doi.org/10.2196/16426

    Article  MathSciNet  Google Scholar 

  48. Ggita, J.M., et al.: Patterns of usage and preferences of users for tuberculosis-related text messages and voice calls in Uganda. Int. J. Tuberc. Lung Dis. 22(5), 530–536 (2019). https://doi.org/10.5588/ijtld.17.0521.Patterns

    Article  Google Scholar 

  49. Campbell, J.I., et al.: The technology acceptance model for resource-limited settings (TAM-RLS): a novel framework for mobile health interventions targeted to low-literacy end-users in resource-limited settings. AIDS Behav. 21(11), 3129–3140 (2017). https://doi.org/10.1007/s10461-017-1765-y

    Article  Google Scholar 

  50. Isabalija, S.R., Mbarika, V., Kituyi, G.M.: A framework for sustainable implementation of E-medicine in transitioning countries. Int. J. Telemed. Appl. 2013 (2013). https://doi.org/10.1155/2013/615617

  51. Larocca, A., Moro Visconti, R., Marconi, M.: Malaria diagnosis and mapping with m-Health and geographic information systems (GIS): evidence from Uganda. Malar. J. 15(1), 1–12 (2016). https://doi.org/10.1186/s12936-016-1546-5

    Article  Google Scholar 

  52. Boatin, A., Ngonzi, J., Bradford, L., Wylie, B., Hospital, M.G., Medical, H.: Education across two continents. Open J. Obstet. Gynecol. 5(13), 754–761 (2015). https://doi.org/10.4236/ojog.2015.513106.Teaching

    Article  Google Scholar 

  53. Kiberu, V.M., Scott, R.E., Mars, M.: Assessing core, e-learning, clinical and technology readiness to integrate telemedicine at public health facilities in Uganda: a health facility–based survey. BMC Health Serv. Res. 19, 1–11 (2019)

    Article  Google Scholar 

  54. Chang, L.W., Njie-Carr, V., Kalenge, S., Kelly, J.F., Bollinger, R.C., Alamo-Talisuna, S.: Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 25(7), 874–880 (2013). https://doi.org/10.1080/09540121.2013.774315.Perceptions

  55. Okunade, K., et al.: Understanding data and information needs for palliative cancer care to inform digital health intervention development in Nigeria, Uganda and Zimbabwe: protocol for a multicountry qualitative study. BMJ Open 9(10), 1–9 (2019). https://doi.org/10.1136/bmjopen-2019-032166

    Article  Google Scholar 

  56. US State Department: PEPFAR Uganda Country Operational Plan (COP) 2019 Strategic Direction Summary (2019)

    Google Scholar 

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Acknowledgement

I would like to extend sincere gratification to the Government of Uganda, through the Makerere University, Research and Innovations Fund for funding this research. In addition, gratitude goes out to the research assistants who helped in the literature search and synthesis.

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This research received funding from the Government of Uganda through the Makerere University Research and Innovations Fund.

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Correspondence to Hasifah Kasujja Namatovu .

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Namatovu, H.K., Magumba, M.A. (2023). Deciphering Barriers and Facilitators of eHealth Adoption in Uganda Using the Systems Thinking Approach - A Systematic Review. In: Saeed, R.A., Bakari, A.D., Sheikh, Y.H. (eds) Towards new e-Infrastructure and e-Services for Developing Countries. AFRICOMM 2022. Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, vol 499. Springer, Cham. https://doi.org/10.1007/978-3-031-34896-9_14

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