Assignment on FINDINGS OF EXPLORE HEALTHCARE PROFESSIONALS’ PERCEPTIONS AND EXPERIENCES ABOUT OPPORTUNITIES FOR LEVERAGING HEALTH INFORMATION TECHNOLOGY

In this chapter, the data collected is portrayed in a purposeful way to highlight the perception of healthcare professionals about the use of MHAs for diabetes care and management. The findings of the study as well as selected representative quotes from the participants are presented below.

4.1. Participant Demographics of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Overall, five physicians and five nurses took part in this case study with an age range from 35 to 50 years. Table 1 below summarises the participants’ demographic information.

Table 1: Summary of Participant Demographic Information

Notes: M = Male, F = Female, GP = General Physician

4.2. Healthcare Professionals’ Perceptions of MHAs

Overall, four main themes and nineteen subthemes emerged. The main themes included: Knowledge, MHA barriers and benefits, governance issues, privacy, and security. The subthemes leading to the main themes were: lack of knowledge, adherence to knowledge, patient/family knowledge, diabetes self-management, app regulation, app standardisation, app customisation, app reliability, app troubleshooting, app benefits, end-user feedback, self-management training, lack of trained workforce, legislation, patient access, technology adoption, healthcare professionals’ training, data security, and patient privacy. The themes and subthemes can be viewed in Figure 2 below.

4.2.1. Knowledge

4.2.1.1. Lack of knowledge of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

There were sixteen accounts from eight participants that discussed the issue with patients’ lack of knowledge about DSM. The study participants viewed the lack of health knowledge as one of the most significant barriers to DSM. The concerns highlighted by the participants included patients’ overall literacy, health literacy, perceived seriousness of their disease, social beliefs, not having access to reliable information, and the lack of self-confidence. The participants of this study highlighted the lack of knowledge as a hurdle for the use of MHAs. One of the participants noted:

“Maybe they are not acknowledged how to use the apps” (Nurse 2).

Regarding health literacy and social beliefs, one participant noted:

“Some people have their own beliefs like some patients do not consider honey and dates to be bad and do not follow the diet chart or advice from the dietician or some might not follow the instructions due to their literacy” (Doctor 1).

Regarding the patients’ literacy and perceived seriousness of their disease, one participant noted:

“There are many challenges, and the most challenging one might be ignorance of the patient about his disease, for example, most of the patients like a fixed dose of insulin and do not know how to adjust the dose according to their sugar levels” (Doctor 3).

4.2.1.2.   Adherence to knowledge of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Eight accounts from six participants expressed concerns that it is not always patients’ lack of knowledge of diabetes, but sometimes it is the lack of adherence to the knowledge delivered to them at the time of clinical visits or educational programs. Regarding this, one of the participants noted:

“Some, even if they are acknowledged, might lack adherence to the knowledge delivered. For example, when we ask the patients to exercise and diet, they normally do not abide by the recommendations. They might not follow the instructions properly or do not turn up to learning sessions” (Doctor 1).

One participant noted that the attitude of the patient with accepting or ignoring the advice given was an issue:

“But some, they take advice from their friends, family, and make their own decisions on starting a medication or stopping the medication or about diet, about herbal medication. All this has an impact on their diabetes management because some they stop all medication prescribed and start herbal medications to treat their diabetes” (Doctor 3).

Regarding the attitude and behaviour of the patients towards the DSME, one participant noted:

“Compliance is the most challenging thing. Sometimes they ignore the advice given to them” (Nurse 4).

Another issue highlighted by the participants was that patients do not keep all the information delivered to them or merely forget; one participant noted:

“Patients do not retain all the points from information given to them during a clinical visit or forget them” (Doctor 2).

4.2.1.3.   Patient/family education

Ten accounts from six participants reported that it is not only the patients who need educational programs; the family members should also be considered regarding patient DSM and how to manage conditions such as hypoglycaemia and whom to contact in an emergency. Regarding the patient’s education, one participant noted:

‘The patient should know the importance of regularly seeing his diabetic physician, dietitians, diabetes educators, ophthalmologist, and other related specialities. He should know the complication of diabetes and should know how to take care of them. The patient should think about how to take care of his foot’. (Nurse 1)

Regarding the family’s education in providing care to a family member with diabetes, one of the participants noted:

“Patients and it is the family’s education about the disease, lifestyle, exercise, insulin injection technique, insulin storage and side effects of the medications is very essential” (Doctor 3).

4.2.1.4.   Diabetes self-management

Regarding DSM, twenty-two counts from ten participants appeared from the interviews showing the importance of this theme. All the research participants highlighted the importance and benefits of DSM. The findings also showed that younger patients are more likely to self-manage their disease as compared to elderly patients.

Regarding the benefits, the participants mentioned that DSM improves HbA1c levels and delays diabetes-related complications. In support, the few quotes of the participants are worth considering. One of the participants noted:

“DSM of patients. We want to work more, um, again, but really to do something very much because that is what we are using. Like this is our field. However, I think if you, if others, apply it and there are clinics teaching patients to self-manage then; you can see a substantial difference. Eh, we will make the patient master himself, not, we are the one who is mastering him means we must make the patient take the decision” (Nurse 4).

DSM has many benefits including lowering HbA1c and delaying complications. Regarding the benefits of DSM, one participant noted:

“Yes, DSM for sure will improve the patient’s HbA1c level and delay the diabetes-related complications” (Doctor 1).

Regarding the long-term effects of DSM, like improving the quality of health, one participant noted:

“Yes. If they manage their diabetes, they will not have complications and lead a normal life. You know, a foot ulcer will not be incapacitating them, or they will not lose their sight by having retinopathy or, you know, other complications like kidney complications” (Nurse 1).

Additionally, some of the participants related to DSM compliance were associated with age; the younger patients are sometimes better in DSM. One participant noted:

“They do self-manage themselves at home, as they must check their sugar levels and titrate the insulin dose. Some young patients are particularly good at doing this, especially with Carb calculations” (Doctor 1).

4.2.2. MHA Barriers and Benefits of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

4.2.2.1.   App regulation of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

When asked about the uses of MHAs and the obstacles presented, four counts from four participants saying that the apps used by their patients were not regulated. Participants confirmed that their patients use the apps from the app store, which mostly consist of health fitness apps, apps that calculate calorie intake, and calendar apps that serve as their appointment reminder. However, they raised concerns about the regulations of such apps. One participant noted the following hurdle that these apps can present:

“But patients use apps from the app store like fitness apps or apps to see the calories of the food they take. Apps for reminders like calendars. These apps are not regulated, and the data provided is not verified. I do not think there is one comprehensive app that I might recommend to my patients” (Doctor 1).

Regarding regulated apps that patients can rely on and trust, one of the participants noted:

“You know, some apps they have the approval or are from some valid institute also they have this approval for example from the American Heart Association or American Diabetic Association approves it so they can use it” (Nurse 2).

4.2.2.2.   App standardisation

Three accounts from three participating healthcare professionals said that apps are not standardized. Participants in this research showed concerns about the lack of standards associated with MHAs available to patients. Participants showed that app standardisation is low and one of the primary reasons for this is the lack of agreed-upon standards for the development of MHAs. The participants also agreed that if there were official apps with legal and ethical considerations that were blended with evidence-based knowledge, they would recommend it to their patients. Regarding this, one of the participants noted:

“Many things are involved. I think these apps are not standardised many ethical and legal issues have to be seen” (Doctor 1).

Participants further showed that patients would be more eager to use MHAs if they were based on official standards. One participant noted:

“As I told you earlier that there should be an official app, and if I talk about my patients, it should be patiently customised. Patients are using apps, as I mentioned earlier, but the MoH has no app for patients. Many things have to be addressed” (Doctor 5).

4.2.2.3.   App customisation

Three accounts from three participating healthcare professionals showed that the apps should be customised to the patient's needs. Participants of this research highlighted that in medicine, one size does not fit all. Considering the MHAs for medical use, healthcare professionals are looking for apps that can be customised to fit the problem at hand. Furthermore, it was added that MHAs which are customisable and more flexible, will be easily incorporated in practice and readily accepted by patients. One participant noted:

“I think these apps are not standardised and not customised to my patient's needs” (Doctor 1).

Regarding ease of use, clinicians would appreciate apps that can be customised to their patients' needs. In this regard, another participant noted:

“If there is an app that is flexible and customisable to my patient’s needs. I want to use it” (Nurse 5).

4.2.2.4.    App reliability

Four accounts from three participating healthcare professionals highlighted concerns about app reliability. Participants emphasized that MHAs qualifying for medical use should be evidence-based and should be based on extensive research. Such apps can calculate the outcomes. Regarding this issue, one participant noted:

“It depends on the App and the issues I highlighted before. Are the policymakers willing to invest in such apps and standardise them? So, how trustworthy are these apps, and if the patients will use them?” (Doctor 1).

4.2.2.5.   App troubleshooting

Additionally, four accounts highlighted the need for customer-care such as troubleshooting. Participants noted that, regardless of the design of the MHAs, if they were difficult to use and did not have a useful troubleshooting feature, they were ineffective. Regarding this, one of the participants noted:

“Customer service. Available information for the patient on the App. We can only benefit from apps if they are easy to use, and the patient can troubleshoot it if any issue arrives” (Doctor 1).

Regarding troubleshooting the MHAs, participants expressed concerns about the lack of responsive customer service and troubleshooting instructions if a problem occurs, which was described this way, by one participant:

“Who will be the back of me if in case if I had any problem, any question, any troubleshooting with the APP, how who will be my back up, how I can, if I lost the data, how I can then retrieve the data. These are the challenges I think with the new applications” (Nurse 2).

4.2.2.6.    End-user feedback

Ten accounts from four participating healthcare professionals noted a need for obtaining feedback from the patients in developing apps. They emphasized that one of the reasons for MHAs not being wildly used is the lack of opportunity to incorporate patient feedback. It was noted that the patients should be involved in developing an app so that it would genuinely reflect their needs. In this respect, one of the participants noted:

“So, it is more likely to be suitable for the patient. So, involving the patient from an early stage in both content and layout” (Nurse 3).

4.2.2.7.   Apps’ benefits

Twenty accounts from ten participants reported benefits of the apps, making this subtheme one of the most discussed and reported benefits of MHAs. The most highlighted benefits were communication capabilities, source of information, source of DSM, source of delivering DSME, patient monitoring, clinical decision-making, and time management. As one participant noted:

“We have so many clinical trials that confirm the effectiveness and importance of using the technology” (Doctor 3).

In terms of the usability of the MHAs, one participant pointed out specific examples:

“A reminder to check their sugar. So, depending on their regimen, if they are on insulin or oral, it will be different, their timing of checking blood sugar and a reminder to take their medication. If it can monitor their physical activity, that will be good. Yeah, things like that. I think it will help” (Nurse 1).

Another participant concluded:

“This will be good for patients. Phone apps will be good for patients who have a smartphone. A spoken lecture is good for patients that cannot read” (Nurse 3).

MHAs were also perceived as a source of communication. As one participant explained:

“So whenever you are you checking your blood glucose, then monthly, weekly or for every frequently you can connect to the, uh, to the, uh, to the computer and all your data automatically will be transferred to this app, this app doing multiple jobs for you, making different kinds of reports and the graph report charts showing to you the maximum, minimum. Moreover, you can share it easily with others, like your doctor or with the educator or keep the history for yourself. Also, this is some examples of the useful application that I saw” (Doctor 4).

4.2.3. Governance Issues

4.2.3.1.   Self-management training

Healthcare professionals discussed patients training on several occasions. The researcher found four accounts from four participants highlighting the need for DSM training for patients. It was emphasised that the patient should be trained in the management of diabetes through a healthy lifestyle, carb calculations for better blood sugar control and better regulation of medicine dosage, techniques, sites for insulin injection, and what to do in case of hypoglycaemia. However, due to overcrowding at diabetes clinics, the caregivers are unable to spare time to provide DSME. The following quotes might highlight the views of the participants. One participant noted

“In Kuwait, we have the para-clinic [inaudible] government para clinic is very crowded. They are very crowded and the doctor, the time that the doctors are spending with the patients is very less and minimal. So, they do not have enough time to educate people” (Nurse 2).

Talking about DSME, one of the participants noted:

“Evidence-based guidelines in mind. Moreover, hopefully, if I do all of that, the patients will get the right advice, their DSM will improve, and the long-term complications will be reduced” (Nurse 3).

4.2.3.2.   Lack of trained workforce of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Ten accounts from six participants reported that there is an insufficiently trained workforce in Kuwait regarding DSME. As discussed previously under the theme of knowledge, lack of knowledge is one of the most significant barriers in the way of DSM and is linked to the insufficiently trained workforce as highlighted by quotes from research participants. One of the participants noted:

“Number of healthcare providers should be increased, especially diabetic educators” (Doctor 1).

When asked about solutions to this problem, the participants responded that the number of caregivers must be increased. One of the participants noted:

“To have enough dietitians and diabetes educators who can teach the patients, to have podiatrists because I think this is a big gap in ministry. They do not have podiatrists to check the patients' feet and to educate them on how to prevent foot complications” (Nurse 1).

Another solution might be the use of MHAs to educate the patients about DSM through DSME, keeping in mind the theoretical building blocks for DSM. About this, one of the participants noted:

“Another way of doing it might be through apps, giving patients the evidence-based information.  There are many studies to support that, especially when these apps target changing human behaviours” (Doctor 4).

4.2.3.3.   Legislation of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Twelve reports from four participants highlighted the need for policymakers to engage in and encourage the practitioners to use technology to improve patient care. About this, one participant noted:

“It depends on the App and the issues I highlighted before. Are the policymakers willing to invest in such apps and standardise them?” (Doctor 1).

Another participant highlighted:

“Managers in MoH, policymakers in MoH and I would recommend them because if they are not encouraging practitioners to use this technology to improve their patient care, then that is an obstacle” (Nurse 3).

4.2.3.4. Patient access of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Three accounts from three participants showed concerns that in Kuwait, patients do not have access to evidence-based information and then the available information is not reliable. Regarding the MHAs as a source of information, the participants replied with positivity and wished if they can have something to empower the patients for DSM. One of the participants noted:

“Um, uh, where patients can find information. You know, as if I think about, the National Health Service (NHS) for example, there is a web page on for the NHS, which covers all kinds of conditions and gives many advises. In addition, this is evidence-based and associated with national guidelines. Is this; is there the same thing for Kuwait? I do not think there is” (Nurse 3).

About communication and access to reliable data on of the participants noted:

“MHAs might be one of the latest trends in communication and is increasing at a fast rate. We can utilize this to educate our patients and provide them with reliable information” (Doctor 5).

The financial burden of MHAs was highlighted by only one of the participants in this research saying:

“Who will pay for the subscription of these MHAs? Will it be sponsored by MoH? This is an important point for us physician while prescribing such apps to our patients as all will not be able to pay” (Doctor 4).

4.2.3.5.   Technology adoption of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Four accounts from three participants highlighted that the adoption of technology is slow in Kuwait. The participants of the study commented on the adoption of the MHAs is slow. The reasons for this have been discussed in the findings of this study under various themes. Here the researcher-highlighted one of the reasons to it is the confidence of the healthcare giver in MHAs. Although they were of the view that this can transform the healthcare system but, unfortunately, healthcare has not harvested the real benefits of it. One participant noted:

“Well, People these days do use technology. These days’ smartphones are a must-have thing life without one is unimaginable. People like apps and do use them often to do their everyday activities. I think technology has revolutionised the world, but unfortunately, the healthcare is lacking behind in harvesting the true benefits of it” (Doctor 1).

Healthcare professionals showed hesitance in recommending MHAs to their patients. When asked what the reasons behind this, one participant responded with the following:

“I think that these apps are lacking in studies that clearly show the beneficial outcomes” (Doctor 2).

4.2.3.6.   Healthcare professionals’ training of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

In emphasising the need for training of healthcare professionals, four accounts from four participants were noted. It is highlighted by the participants that it is essential to have well-trained staff to provide DSME to patients. Regarding this, one participant noted:

“We have to develop the education department in all the diabetic clinics around Kuwait with the self-trained and certified diabetic educator besides the doctors” (Nurse 2).

Another participant noted:

“We need to have the doctors and the nurses in ministry clinics properly educated about diabetes management and what are the latest guidelines on all diabetes management, starting from insulin storage to injection techniques to medications. There are so many new medications that are coming up, and they need to know of them” (Nurse 5).

4.2.4. Privacy and Security

4.2.4.1.   Data security of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Six accounts from four participants reported security issues with using the apps. This topic was important as some of the participants considered this a hurdle to the use of MHAs. The participants were of the view that there are many MHAs available, but they are not confident of privacy and security. One of the participants noted:

“Like data security, patient privacy, standardisation, ease of use, patient customised like for the patient with disabilities, data backup, quality control” (Doctor 1).

MHAs collect patients’ health-related details and these patient details by nature and law are sensitive. Therefore, the security of data held by MHAs is of immense importance and in this regard one of the participants noted:

“Yeah. Like their data like medical history and all to be, you know, hacked or leaked to...you know, in unwanted hands” (Nurse 1).

When asked about the barriers of recommending MHAs to patients, one of the participants noted:

“Maybe adoption of the technology, security of the applications, its integration with the system” (Doctor 2).

4.2.4.2.   Patient privacy of explore healthcare professionals’ perceptions and experiences about opportunities for leveraging health information technology

Four accounts from four participants had a specific concern about the patient's privacy. The participants showed concerns as the MHAs are increasing at a fast rate, particular care should be taken about the privacy of the patients. If the patients are not confident of their privacy being considered, they might not use the apps as these apps to operate need access to the data stored on the device of the user and which can be sensitive data. This does put the user under serious threat. About this one of the participants noted:

“Sometimes maybe they think if they store there sometime their confidentiality of the apps also important. They think if they a store or they share with uh, it, they are afraid of about the confidentiality because these also can be a challenge” (Nurse 2).

Linking statement here – I don’t expect you to summarise these all again as it would be long / repetitive but something that leads into your discussions below