PATIENT PERSPECTIVES ON TELEHEALTH ADOPTION IN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

Globally, sub-Saharan Africa is characterized by a recognized and significant scarcity of healthcare professionals, a high burden of disease, and inadequately funded healthcare services (Latif et al., 2020). To address these concerns and issues, it is advisable to employ innovative interventions such as Telehealth and eHealth/digital health. This includes the use of telemedicine, which refers to the provision of healthcare services by healthcare professionals using information and communications technologies, particularly in situations where distance is a significant factor. The year is 2023. It is advised that each country develops an eHealth / digital health plan (Alghamdi et al., 2017). Maina and Singh have recently asserted that telehealth solutions have gained widespread acceptance and serve as a guiding framework for intervention (Youssef, 2018). Nevertheless, the worldwide effort to establish telehealth has not yet produced the intended results. 

With the exception of technology leapfrogging, the progress and expansion of telehealth in developing countries closely resembles that of developed countries over a decade ago. This progress is typically slow, often improvised, and unplanned, with discussions about the importance of having a national strategy (Househ et al., 2022). Despite the presence of information and communication technology (ICT), health information systems, and telehealth strategies in many countries in sub-Saharan Africa, the adoption of telehealth has been sluggish (Tulenko, 2019). One possible reason for this contrast could be that if telehealth is not a central aspect of an established plan, it may not receive enough attention for its adoption and execution. On the other hand, several advanced nations have integrated telehealth into their eHealth strategies and enacted telehealth action plans, recognising telehealth as the essential component of future healthcare services. This has resulted in enhanced implementation of telehealth across their whole countries. 

Undoubtedly, effective telehealth requires a focus on clear communication, building rapport virtually, and conducting thorough examinations (when possible). Understanding patient perceptions of the quality of care delivered through telehealth helps identify areas for improvement and ensure patient satisfaction with this new model of care delivery. Patients frequently utilise mobile phones as the primary means to remotely receive, arrange, and transfer data (Ekanem, 2021). In recent times, numerous emerging economies have prioritised investing in mobile telecommunication infrastructure over road transport and electric power generation. This shift has the potential to greatly enhance telehealth services (Latif et al., 2020). Despite this investment, the rural poor in the developing world, who stand to gain the most from the implementation of telehealth, are not receiving adequate attention. 

According to Davis (2021), telehealth can empower patients to take a more active role in their health management. By understanding their perspectives, providers can develop telehealth programs that support self-monitoring, medication adherence, and communication between appointments, ultimately leading to better patient outcomes. Evaluating the viewpoints of patients can offer valuable understanding of their level of knowledge, opinions, and choices in relation to telehealth. Additionally, it has the capability to detect possible obstacles to the acceptance of a product or service and indicate areas that require enhancements in order to improve the overall user experience. Therefore, the necessity for this investigation arises.

1.2 Statement of the Problem

Telehealth has evolved as a revolutionary method of delivering healthcare, with the promise to address access issues and enhance patient outcomes (Okechuklwu et al., 2023). Telehealth is not yet widely used in Nigeria, even though it has been acknowledged as beneficial for solving the difficulties of the country's healthcare system. Gaining insight into the viewpoints of patients regarding telehealth is essential for effectively implementing and maintaining its long-term viability. 

Remilekun (2023) identifies patient acceptance, computer literacy, and language barrier as hindrances to the adoption of telehealth in Nigeria. Remilekun (2023) asserts that the efficacy of telehealth depends not only on the readiness of healthcare workers, but also on the willingness and technological aptitude of patients. A considerable portion of the Nigerian population may face limited access to digital technology, which poses a challenge to the implementation of telehealth. According to Remilekun (2023), the adoption of telehealth was hindered when patients lacked confidence in speaking in an unfamiliar language. According to Ekpenyong et al (2024), patients must possess literacy skills in two aspects to engage in telehealth services. Firstly, they should be proficient in traditional literacy, which includes the ability to read, write, and communicate in their native language. Secondly, they should have a broader literacy that encompasses understanding the technical requirements for effectively utilising a mobile device and comprehending their health conditions and treatment.

In addition, telehealth in Nigeria has numerous obstacles despite its potential benefits (Akin et al., 2023). Current knowledge regarding patients' perceptions of telehealth services, including their level of awareness, attitudes, and experiences, is insufficient (Okechukwu et al., 2023). Without possessing this knowledge, it becomes challenging to overcome the obstacles to adoption and create telehealth services that effectively cater to the needs and expectations of patients. The Nigerian healthcare system faces challenges in effectively integrating telehealth due to the limited availability of complete patient perspective data (Aba et al., 2023). Therefore, the necessity for this investigation arises.

AObjectives of the study

The primary objective of this study is to critically assess patients perspectives on telehealth adoption in Nigeria. Specific objectives of this study are to:

To evaluate the level of awareness and understanding of telehealth services among patients in Nigeria.

To explore patient attitudes and perception towards telehealth.

To identify the challenges patients, face in adopting telehealth services in Nigeria.

To suggest strategies for improving telehealth adoption and user experience based on patient feedback.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the level of awareness and understanding of telehealth services among patients in Nigeria?

What are the attitudes and perceptions of patients towards telehealth?

What are the challenges patients face in adopting telehealth services in Nigeria?

What are the strategies for improving telehealth adoption and user experience based on patient feedback?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The level of awareness and understanding of telehealth services among patients in Nigeria is low

Ha: The level of awareness and understanding of telehealth services among patients in Nigeria is high.

1.6 Significance of the study

It is essential to investigate the viewpoints of patients in Nigeria regarding the use of telehealth. This research will provide valuable insights into the potential advantages, difficulties, and consequences of telehealth for healthcare provision, fairness, cost-effectiveness, policy formulation, public health readiness, and research progress. This project has the potential to ultimately improve healthcare access, quality, and results for people throughout Nigeria. Analysing the viewpoints of patients can provide valuable insights for developing strategies that promote fair and equal access to healthcare services among various socioeconomic groups in Nigeria. 

Moreover, the implementation of telehealth is greatly dependent on the willingness and acceptability of patients to utilise remote healthcare services. An examination of patient views can offer valuable insights into their preferences, worries, and expectations surrounding telehealth. This, in turn, can aid in the creation of patient-centered telehealth programmes that effectively cater to their needs. Studying the viewpoints of patients regarding the use of telehealth can aid in evaluating its influence on health outcomes. Evaluating patients' perception of telehealth consultations in terms of effectiveness, reliability, and satisfaction can provide valuable insights to healthcare professionals and policymakers regarding the advantages and obstacles of incorporating telehealth into the Nigerian healthcare system.

Additionally, the study's findings can provide valuable insights for the formulation of rules and laws that facilitate the incorporation of telehealth into the Nigerian healthcare system. This include factors such as the prerequisites for obtaining licenses as telehealth providers, the laws governing the funding of telehealth services, and the guidelines for safeguarding patient privacy and data security. Furthermore, examining the viewpoints of patients about the adoption of telehealth adds to the expanding corpus of research on telehealth in developing nations such as Nigeria. The study offers tangible data and valuable insights that might inform future research efforts, innovations, and enhancements in telehealth technologies and services.

1.7 Scope of the study

Broadly, this study focuses to critically assess patient’s perspectives on telehealth adoption in Nigeria. Specifically, this study seeks to evaluate the level of awareness and understanding of telehealth services among patients in Nigeria and explore patient attitudes and perception towards telehealth. 

Further, this study will focus on identifying the challenges patients face in adopting telehealth services in Nigeria and it also seeks to suggest strategies for improving telehealth adoption and user experience based on patient feedback.

1.8 Limitations of the study

As is typical in any human endeavour, the researchers faced minor limitations during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data for assessment of patient’s perspectives on telehealth adoption in Nigeria. Hence, a significant investment of time and effort was necessary to locate appropriate materials, publications, or information and gather data.

 Moreover, this study is constrained by its small sample size and narrow geographic scope, namely focusing solely on Nigeria. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation. 

Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities.

1.9 Definition of terms

Telehealth: Telehealth involves the delivery of healthcare services using digital technologies and telecommunications.

Telemedicine: Telemedicine encompasses a range of electronic communication methods, such as video calls, phone conversations, and online messaging, that enable the diagnosis, treatment, and management of patients without the requirement of face-to-face appointments 

Perception: Perception is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information or environment. 

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