Development of an evidence-based e-health readiness assessment framework for Uganda

Abstract

Background:

While e-health readiness assessment is vital to the successful implementation of e-health innovations, there is little published guidance (i.e. e-health readiness assessment frameworks (eHRAFs)) for institutions and countries.

Objective:

To develop an evidence-based and locally relevant eHRAF for Uganda.

Method:

A list of possible e-health readiness domains and constructs was developed through a structured review of the e-health literature. This list was first refined using author experience, insight and reflection. Based on this refined list, an eHRAF questionnaire was developed, which was initially pilot tested for face and content validity. Thereafter, it was distributed to 13 purposively selected study participants who were Ugandan e-health experts from the fields of health, information and communications technology (ICT) and academia. The questionnaire was discussed in a focus group setting for consensus input, where study participants confirmed, rejected or revised proposed domains and constructs suitable to guide e-health readiness assessment at either the national or site-specific level within Uganda.

Results:

Of 148 identified literature resources, 13 met inclusion criteria. A subjective review highlighted 11 frequently used e-health domains. Further reflection reduced these to nine domains, which were shared with study participants by means of the questionnaire. Based upon prior use of, and familiarity with, a management tool (PESTEL), participants’ consensus on factors essential for readiness assessment in Uganda was aligned with PESTEL’s six domains: political, economic, sociocultural, technological, environmental, and legal and regulatory. The participants considered engagement, and core and societal readiness as optional domains. Based on this input, the authors developed a proposed eHRAF suitable for Uganda, comprised of domains, sub-domains and constructs.

Conclusion:

The eHRAF developed in this research is an evidence-based framework (literature and cross-sectoral expert opinion) and consists of primary domains, sub-domains and constructs suitable for assessing e-health readiness in Uganda, either nationally or locally, prior to implementation of any e-health system. The process and principles may have utility in other countries.

Implications:

A national, culturally relevant, context-specific Ugandan eHRAF could facilitate efficient and effective planning and implementation of new e-health programmes across the country and assist policymakers and legislators to develop consistent and reliable guidelines and regulations.

Keywords

e-health readiness readiness assessment framework Uganda

Introduction

E-health, “the use of information and communications technologies (ICTs) for health” (WHO and ITU, 2015), is now among the key pillars of healthcare systems of many countries. E-health has the potential to address many diverse problems affecting healthcare delivery by providing equitable, accessible and efficient healthcare services (Coleman et al., 2011; Shekelle et al., 2006).

The concept of “readiness” of a setting to successfully adopt and implement e-health arose around the turn of the century. The need for, and importance of, e-health readiness assessment (eHRA) prior to considering implementation of e-health solutions has been emphasised in the literature. Jennett et al. (2003) indicated that “readiness” needed to be systematically assessed and that it was important for long-term success. More recently, Li et al. (2013) argued that prior to an e-health implementation, it is necessary to plan for a smooth introduction and to assess organisational preparedness; while Whitten and Adams (2003: 127) described the rationale more holistically:

Telemedicine programs are positioned within larger health organizations and do not operate in a vacuum. It is crucial that the organization in which it is intended to launch telemedicine is examined carefully first. Each organization operates within a larger environment, which is often constrained by fiscal, geographical and personnel factors. All these will affect the introduction of telemedicine.

Despite agreement of the fundamental importance of eHRA, the literature shows little evidence of routine application of eHRA prior to most e-health implementations. Certainly within developing countries, e-health readiness assessment is not a common practice prior to e-health implementation (Li et al., 2013). E-health readiness, sometimes referred to as e-health preparedness, has been defined as “the degree to which users, healthcare institutions, and the healthcare system itself, are prepared to participate and succeed with e-health implementation” (Jennett et al., 2005b; Khoja et al., 2008).

Consideration of different eHRA domains is necessary to promote adequate awareness and assessment of readiness and to aid in the formulation of national strategies and subsequent action plans (Jennett et al., 2005; Khoja et al., 2008; Zaied, 2008). Readiness for change considers capacity for making change and the extent to which individuals perceive the change as needed. For example, Jennett et al. (2003) argued that it is important to ascertain a community’s ability to successfully implement e-health as this will save time, money and energy. This calls for performance of an eHRA prior to any telehealth implementation. Developing countries have now realised that if they fail to provide an adequate infrastructure and knowledge base, they risk falling behind both economically and socially in the emerging networked world (Al-Solbi and Mayhew, 2005).

Uganda’s Ministry of Health (MoH) recognises the use of ICT as an enabling tool in delivery of quality healthcare to the population (Health Sector Development Plan, 2015). With support from development partners (Centers for Disease Control and Prevention, United Nations Children’s Education Fund, the World Health Organization (WHO)), and the National Information Technology Authority, the MoH is in the process of validating its draft national e-health policy and strategy. Built on the foundation and methods of the ITU/WHO National E-health Strategy Toolkit (WHO and ITU, 2015), Uganda’s National E-health Strategy is intended to provide guidance on the use of ICT to facilitate information flow in the delivery of health services (MoH-Uganda, 2016). However, no e-health readiness assessment framework (eHRAF) for implementation of e-health innovations has been presented in Uganda, despite its paramount importance. Research on the issues that impact e-health readiness assessment and the steps needed for mitigation of these issues is required (Al-Solbi and Mayhew, 2005). The aims of this study were to conduct a literature review of existing eHRAFs, to identify domains and key constructs relevant for the Ugandan context and to validate these constructs through expert opinion, in order to create a Ugandan eHRAF.

Method

Research design

The study was conducted in four stages, which led to the development of the eHRAF for Uganda. The stages were; a structured search of the peer-reviewed literature, development of a questionnaire, arranging a focus group session with 13 e-health experts as study participants to provide a consensus response to the questionnaire and final eHRAF formulation. Although planned as a mixed methods study, study participants demanded consensus discussion during the focus group setting, reverting this to a qualitative study. Ethics approval was provided by the Humanities and Social Science Ethics Committee of the University of KwaZulu-Natal. Participants each gave informed consent.

Literature review

A structured search of the peer-reviewed literature was conducted in April 2016 and updated in September 2016. Several databases were searched: PubMed, Google Scholar, Scopus, CINAHL, Embase, EBSCO Health and Lilacs (Virtual Health Library).

Search terms identified literature on eHRAFs. In PubMed, the search string was: (e-Health [All Fields] OR (“telemedicine”[MeSH Terms] OR “telemedicine”[All Fields] OR “ehealth”[All Fields]) OR “telehealth”[All Fields]) AND ((Readiness [All Fields] OR Preparedness [All Fields]) AND (Framework [All Fields] OR Model [All Fields])). For Google Scholar, the search used: (e-Health OR eHealth OR Telehealth OR Telemedicine) AND ((Readiness OR Preparedness) AND (Framework OR Model)). Only the first 100 hits in Google Scholar were considered. The following keywords were used for other databases: e-Health, ehealth, telemedicine, telehealth, readiness, preparedness, framework and model, using Boolean logic. Results were combined and duplicates removed.

Inclusion criteria were: the resource addressed readiness or preparedness to adopt e-health, presented a model or framework, addressed developing country needs or was developed for a rural/remote setting in a developed country and was written in English. There was no date restriction. All three authors reviewed titles and abstracts to eliminate duplicates and mutually determine articles for inclusion.

Questionnaire development

A structured E-health Readiness Assessment questionnaire was developed, comprised of both closed- and open-ended questions, and based on the list of possible domains and constructs gained through analysis of the included literature resources. Thereafter, through personal insight and reflection of the authors, this list was refined by insertion, deletion or recasting of the descriptions to provide nine domains. The final questionnaire consisted of these nine domains with specific attributes presented (see Appendix 1, available online). Each item consisted of a brief description and definition of the domain, attributes associated with that domain and provision to answer the related closed- and open-ended questions about the relevance of the domain for an eHRAF in Uganda. The questionnaire was pilot tested for face and content validity.

A concern arose about the differing interpretation of domains seen in the literature. There were differences found in the definition, description and intent of domains. To provide consistency of interpretation for this (and future) research, the authors described each of the nine preferred domains as follows:

Core readiness refers to a recognised need for the e-health service along with an expressed dissatisfaction with any existing service or circumstance.

Technology readiness refers to the ability of existing hardware, software, networks and internal ICT resources to support clinical innovations and ICT needs of healthcare providers.

Policy readiness refers to the availability of a set of statements, directives, regulations, laws and judicial interpretations that direct and manage the life cycle of e-health.

Societal readiness refers to the existence and use of communication links and collaboration amongst and between individual members (patients, providers, the public), and institutions (including healthcare organisations) of a society.

Engagement readiness refers to the active participation of people with the concept of e-health, including weighing of the advantages and disadvantages of e-health, assessing risk and questioning e-health as a solution.

Learning readiness refers to use of, and willingness to use, ICT in the training and education of stakeholders (patients, providers and the public) including their direct involvement in e-health projects (such use of technology is sometimes referred to as Technology Enabled/Enhanced Training or TEET).

Structural readiness refers to whether an organisation has available adequate resources (e.g. human capacity and capability, training, policies, funding and appropriate equipment) to provide reliable e-health services.

Cultural readiness refers to the recognition and consideration of cultural aspects in the design, implementation and ongoing use of e-health solutions. Culture is the complex and multifaceted setting created through the intergenerational sum of attitudes, customs and beliefs (often expressed in language, material objects, ritual, habits, tradition, institutions and art) that distinguish one group of people from another (or one organisation from another).

Non-readiness refers to the state of an individual or group when there is a lack of any expressed or perceived need for change (and thereby implementation of e-health).

Focus group

The 13 purposively selected study participants were all members of a national committee who had previously participated in the development of the e-health policy and strategy for Uganda. Given their expert knowledge (experts in the fields of e-health (3), ICT (5) and academia (5)), understanding of national context and recent experience, they were considered to represent the current knowledge base of the Ugandan setting. These participants were each initially contacted by phone and briefed on the study, and each item in the questionnaire was explained.

Each participant received the questionnaire in advance, allowing them to independently review and prepare responses to the questions. However, subsequently the national committee determined that they would be better served by a consensus response only and the individual questionnaires were not completed. Thereafter, in one of the regular committee meetings, considered a focus group setting and coordinated by the primary author, the committee used the questionnaire to guide discussion and develop consensus about the relevance of the nine themes and identified final themes, domains, sub-domains and constructs regarded as relevant for Uganda.

eHRAF formulation

The consensus responses formed the basis of the proposed eHRAF. The insights provided by participants (themes, domains, sub-domains and constructs) were then reviewed and reflected upon by the authors, before aligning them with the management tool PESTEL and formulating the eHRAF.

Results

Literature review results

The search identified a total of 148 articles, of which 135 were excluded as either duplicates, unrelated to the study or not meeting the inclusion criteria. A total of 13 articles met the inclusion criteria and were further reviewed. Of the 13 papers reviewed, 4 were from developing world countries (Khatun et al., 2015; Khoja et al., 2008; Ojo et al., 2007; Rezai-Rad et al., 2012). In addition, nine were from rural/remote areas in developed world countries (Campbell et al., 2001; Jennett et al., 2003; Jennett et al., 2005a; Jennett et al., 2005b; Kgasi and Kalema, 2014; Li et al., 2012; J. Li et al., 2013; Skinner et al., 2006; Van Dyk et al., 2012)

The study by Rezai-Rad et al. (2012) aimed to design an eHRAF for Iran. The framework identified components and indices that could determine strengths and weaknesses of health centres to access ICT services in Iran. The developed framework was also based on a literature review and experts’ opinions in ICT and health. Snowball sampling identified respondents with an academic specialty and/or executive background. A Delphi method was used to test the instruments, and the results were presented in three segments. The first presented the mean weight of the indices (attributes) of readiness in each of the dimensions (domains), segment two showed indices of the eHRAF that were statistically significant to Iran and segment three showed a final framework (4 domains, 11 components and 58 attributes). Domains included in the framework comprised technological readiness, engagement readiness, societal readiness and core readiness. Although the study developed an eHRAF for Iran, only views from experts in health and ICT were obtained, ignoring opinions from stakeholders like the public, practitioners and patients.

Another study by Khatun et al. (2015) examined rural communities in Bangladesh and described the influence of community readiness for m-health. A survey was conducted based on a conceptual framework with three domain categories: technology, motivation and resources. This framework was tested within rural communities in Bangladesh and the results showed the tools have potential to inform planning and implementation of m-health interventions. Campbell et al. (2001) investigated perceptions of rural health providers to develop a framework to guide implementation and assess readiness to adopt telemedicine. Health workers (physicians, nurses and administrative staff) were selected from 10 healthcare practices within four communities in rural Missouri counties in the United States. The framework was based on qualitative data collected from semi-structured interviews with six open-ended questions. Study results showed that for a rural area to adopt telemedicine, it must take into account factors such as economic ramifications, efficacy, social pressure and apprehension. This framework was used to assess technology readiness before adoption and identified six themes related to readiness: turf, efficacy, practice context, apprehension, time to learn and ownership.

Early studies by Jennett and colleagues in Canada examined readiness of rural communities for telehealth implementation (Jennett et al., 2003; Jennett et al., 2005a; Jennett et al., 2005b). Through participatory research, the authors examined organisational readiness for telemedicine as a factor to explain why telemedicine initiatives succeed or fail. Qualitative semi-structured interviews of 16 key informants, two community awareness sessions, five focus groups and in-depth interviews were conducted. Different groups (patients, organisations, public, practitioners) across settings (rural outpatient practices, hospice programmes, rural communities), as well as government agencies, national associations and organisations participated. Four types of readiness were identified: core, engagement, structural and concerns for non-readiness. However, a limitation was the tool’s reliability, which was not assessed and that the tool was only pilot tested in a single community.

The eHRA tools developed by Khoja et al. (2008) were suitable for healthcare institutions in developing countries when introducing e-health solutions. Their methodology involved a literature review with a participatory approach to obtain expert opinions on the composition and format of the developed tools. The tools were subjected to face and content validity testing, and Cronbach’s α was calculated for internal consistency. Domain categories included core, technology, learning, policy and societal readiness. These tools also have limitations, as they were only developed for managers and healthcare providers who had prior experience at planning or implementation of e-health systems. The categories for managers and healthcare providers included 54 and 50 items, respectively.

In addition, Ojo et al. (2007) pilot tested a model to determine the critical factors for eHRA in the developing world. The study determined status of healthcare practitioners, the public and patients from communities associated with two healthcare facilities in South Africa. The e-health readiness factors assessed included need-change readiness, engagement readiness, structural readiness, and acceptance and use readiness. Results showed that “acceptance and use” was an important factor, while the attitude of healthcare practitioners could be determined as a function of their preference for technology usefulness versus ease of use.

Furthermore, Li et al. (2013) aimed to develop an e-health readiness framework for an influenza pandemic and focused on organisational and provider perspectives. A literature review led to the development of an interview questionnaire about aspects of the framework. Twelve interviews were conducted to gather information about motivational forces for change, healthcare providers’ exposure to potential e-health applications, and technological, resource and societal preparedness. The dimensions for the e-health readiness pandemic tool were motivational readiness, engagement readiness, technological readiness, resource readiness and societal readiness. A similar study conducted by Li et al. (2013) in China assessed e-health preparedness for an influenza pandemic. The study examined five areas of preparedness: technology, societal, engagement, human resource and organisational motivation.

When constructing an eHRAF, a literature search by Kgasi and Kalema (2014) on e-health readiness identified the following readiness domains: core, engagement, structural, societal, and acceptance and use. Using principal component analysis to rank indices for each domain, the study concluded that the framework would minimise problems encountered during implementation of e-health projects. The spiral technology action research (STAR) model, developed by Skinner et al. (2006), guided the design, evaluation and ongoing improvement of the e-health promotion activities. STAR comprises five cycles: listen, plan, do, study and act. While developing an e-health architectural framework, these authors assessed patient healthcare records systems, processes and procedures in consultation with healthcare professionals, as well as prescription of medication, referral of patients and training of healthcare professions in ICT usage. However, the assessment only focused on e-health readiness assessment of need, technological, engagement and social acceptance.

In a similar context, Van Dyk et al. (2012) proposed a telemedicine maturity model to measure, manage and optimise components of a telemedicine system. Because other frameworks have not been validated, the authors based this model on Khoja’s study of e-health readiness assessment tools and initially used the five dimensions of technology, policy, learning, core and societal readiness in developing their model (Khoja et al., 2008).

A summary of e-health readiness domains identified from the literature is shown in Table 1. Kgasi and Kalema (2014) used the greatest number of primary domains (eight), while most used four or five. Those domains that were used most commonly addressed technology, engagement, societal and core readiness.

Table 1.

A summary of e-health readiness domains identified from the literature.

E-health readiness domains
References	Policy	Technology	Core	Structural	Learning	Societal	Engagement	Performance expectance	Effort experience	Non- readiness	Acceptance and use	Human resource	Need- change	Practitioners	Organisation	Public	Government	Organisational motivation	System	Patient	Provider/staff	Number of domains
Campbell et al. (2001)	–	–	–	–	–	–	–	–	–	–	–	–	–	–	X	–	–	–	–	–	X	2
Jennett et al. (2003)	–	–	–	–	–	–	–	–	–	–	–	–	–	–	X	X	–	–		X	X	4
Jennett et al. (2005a)	–	–	X	X	–	–	X	–	–	X	–	–	–	–	–	–	–	–	X	–	–	5
Jennett et al. (2005b)	–	–	–	–	–	–	–	–	–	–	–	–	–	X	X	X	–	–	–	X	–	4
Kgasi and Kalema (2014)	–	–	X	X	–	X	X	X	X	–	X	–	–	–	–	–	X	–	–	–	–	8
Khatun et al. (2015)	–	X	–	–	–	–	–	–	–	–	–	X	X	–	–	–	–	–	–	–	–	3
Khoja et al. (2008)	X	X	X	–	X	X	–	–	–	–	–	–	–	–	–	–	–	–	–	–	–	5
Li et al. (2012)	–	X	–	–	–	X	X	–	–	–	X	X	–	–	–	–	–	X	–	–	–	6
Li et al. (2013)	–	X	–	–	–	X	X	–	–	–	–	X	–	–	–	–	–	X	–	–	–	5
Ojo et al. (2007)	–	–	–	X	–	–	X	–	–	–	X	–	X	–	–	–		–				4
Rezai-Rad et al. (2012)	–	X	X	–	–	X	X	–	–	–	–	–	–	–	–	–		–	–	–	–	4
Skinner et al. (2006)	–	X	–	–	–	–	X	–	–	–	X	–	X	–	–	–	–	–	–	–	–	4
Van Dyk et al. (2012)	X	X	X	–	X	X	–	–	–	–	–	–	–	–	–	–	–	–	–	–	–	5
Total for each domain	3	8	6	3	3	7	7	1	1	1	4	3	3	1	3	2	1	2	1	1	2

Questionnaire development – resulting domains

Of the 21 domains identified from the literature (Table 1), the 11 domains most commonly described (frequency of 3 to 8; bottom row, Table 1) were further reviewed, refined and adjusted based upon author reflection, experience and discussion. This resulted in nine domains being formulated to develop the eHRA questionnaire that explored participant opinion.

Focus group outcomes

From analysis of notes taken during the focus group/consensus meeting, the study participants identified some domains used in the questionnaire as either not relevant or of secondary concern to the Ugandan context. Thus, the non-readiness domain was not considered relevant for the Ugandan context given the current countrywide e-health activity, and the three domains (core, societal and engagement readiness) were considered of secondary importance to the Ugandan context. Conversely, four alternate domains emerged: political, sociocultural, environmental, and legal and regulatory readiness. Whereas policy readiness has always been a primary e-health domain when developing frameworks in other developing countries, for the Ugandan context, this has been embedded within the legal and regulatory readiness domain. Although technology and economic readiness were considered relevant, new sub-domains and constructs were proposed for each, relevant for Uganda.

eHRAF formulation from collective results

The final themes, domains, sub-domains and constructs described by the participants and adapted by the authors are reflected in Figure 1. The primary domains (major themes) identified by the participants were aligned with the business analysis tool PESTEL (political, economic, sociocultural, technological, environmental, and legal and regulatory (or Legislative)). This use of PESTEL was not planned but emerged based upon prior experience of the participants, who had collectively been exposed to this management tool. Alignment of the study findings with this already accepted management tool, as seen in Figure 1, was considered sensible and practicable and likely to facilitate adoption of the study findings.

Figure 1.

An evidence-based e-health readiness assessment framework (eHRAF) for the Ugandan setting.

Based upon the opinion and collective insight of country study participants, insight from the literature and the knowledge of the authors, a proposed eHRAF relevant for Uganda was then developed (Figure 1). Some of the major domains had sub-domains identified, and within those sub-domains specific constructs were described.

Discussion

To adequately assess e-health readiness, an assessment tool must address key factors relevant to the setting. Once such factors have been put into context, the planning and implementing process for any e-health system should be simplified. Thus the eHRAF developed in this study was based on review of the available literature, professional insight and reflection, and local expert opinion. Review of existing eHRAFs provided a basis for the design of a preliminary eHRA questionnaire, which underwent face and content validation by study participants, leading to the development of an eHRAF for Uganda.

Limitations of the study include the concept of e-health readiness still being new in Uganda, and uptake may be limited. Further, the response to the eHRA questionnaire relied on consensus response of just the few purposively selected participants and did not consider individual opinion or opinion from other stakeholders, for example, the public, practitioners and patients. However, all of the participants were part of the national team that had participated in the development of e-health policy and strategy for Uganda, which may have compensated for this shortcoming. These participants provided adequate collective feedback to aid in the formulation of an evidence-based eHRAF with domains and constructs relevant for Uganda.

A further, but unavoidable, limitation relates to the consensus opinion provided by the participants. This study was designed as a mixed methods qualitative study consisting of a structured literature review informing the development of a questionnaire on Uganda’s e-health readiness. Thus, the questionnaire was based on a list of possible domains and constructs gained directly from the e-health literature, and enhanced through personal insight and reflection of the authors. The survey, using the questionnaire, was to be administered to the 13 purposively selected people involved in the development of Uganda’s e-health strategy, followed by individual interviews which were to be transcribed and analysed by themes using NVivo software.

As described, the questionnaire was indeed distributed to these individuals, and each was contacted individually to explain the study, review the questions and obtain consent. However, the 13 participants then decided (as a group) not to complete the surveys as individuals or to be interviewed individually but rather to request a face-to-face group meeting. This was treated as a focus group opportunity, but the end result was that despite planned intentions a consensus position emerged from the group, not individual opinion.

Alignment of the framework with the management tool PESTEL was opportunistic. PESTEL is an extension of the “Economic, Technological, Political, Social (ETPS)” model first conceived by Aguilar in 1967 (Aguilar, 1967). PESTEL highlights areas of concern in modern business strategy and situational analysis. In particular, it is a useful model for assessing the influence of factors in the external environment that impact an organisation (PHAST, 2017). This tool has found prior use in the health sector (Iles and Sutherland, 2001; Visconti, 2016).

The study findings contribute to the body of knowledge on eHRAF development for Uganda and may inform – but are not generalisable to – other settings. The study also contributes to addressing the deficiency in the e-health readiness literature, highlighting the need for (but seldom performed) eHRA prior to implementation. Further research should now be conducted to develop tools that measure and ascertain the impact that each of the identified domains and constructs may have on e-health readiness assessment. These tools may also need to be sector specific (i.e. directed towards management, technologists, practitioners or the public) as appropriate.

This eHRAF developed for Uganda calls for a continuous relationship between government through its MoH and development/implementation partners for purposes of e-health application. Governance structure is critical and should involve creation of management and technical teams. Technology readiness in terms of ICT infrastructure is a foundation for electronic communication and information sharing across geographical and health sector boundaries. Areas such as computing infrastructure, databases, directory services, network connectivity and storage underpin a national e-health setting and should not be underestimated. Despite initiatives by the Ugandan Government to establish ICT infrastructure, the health sector is still constrained in this particular area, which remains an obstacle to deployment of e-health services; hence, the need to assess and establish “technologically appropriate” (Scott and Mars, 2013), cost-effective, and affordable ICT infrastructure and e-health services that support communication and sharing of information across the continuum of the healthcare system.

In addition, for the successful development, implementation and support of e-health, sufficient numbers of skilled e-health and health IT resources are needed. Given the increasing reliance on ICT for continuity and delivery of health and healthcare, this is another critical barrier to implementation of e-health. Again, building Uganda’s human resources and their skills, capacity and capability must not be underestimated.

Conclusion

An evidence-based eHRAF relevant for the Ugandan setting has been developed, based on review of peer-reviewed literature together with opinions from study participants who were expert in health, ICT and academia knowledgeable about e-health. This framework consists of primary domains, sub-domains and constructs suitable for assessing e-health readiness in Uganda, either nationally or locally, prior to implementation of any e-health system. However, we recommend a follow-up study to evaluate the impact of the identified domains on e-health readiness assessment but also to provide guidance on “how” and “what” constructs should be achieved and operationalised to make the framework more useful.

Supplemental material

Supplemental Material, HIMJ_18-57.R4_Kiberu_et_al._Appendix - Development of an evidence-based e-health readiness assessment framework for Uganda

Supplemental Material, HIMJ_18-57.R4_Kiberu_et_al._Appendix for Development of an evidence-based e-health readiness assessment framework for Uganda by Vincent M Kiberu, Maurice Mars and Richard E Scott in Health Information Management Journal

Footnotes

Authors’ note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.

Author contributions

VMK, MM and RES conceptualised the need to undertake the study. VMK searched for all the literature and also collected the data from the respondents. VMK, MM and RES all agreed on the literature that met the inclusion criteria. VMK wrote the first draft of the article; MM and RES reviewed it, providing substantial input. All the authors read the article thoroughly and approved the article for final submission.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) declared receipt of the following financial support for the research, authorship and/or publication of this article: This study was financially supported by the Fogarty International Center of the National Institute of Health under award number D43TW007004.

ORCID iD

Vincent M Kiberu

Supplemental material

Supplemental material for this article is available online.

References

Aguilar

(1967) Scanning the Business Environment. New York: Macmillan.

Al-Solbi

Mayhew

(2005) Measuring e-readiness assessment in Saudi organisations: preliminary results from a survey study. From e-government to m-government. Available at: http://www.mgov.cn/lab/Archives/EuromGov2005/PDF/48_131AA.pdf (accessed 4 February 2017).

Campbell

Harris

Hodge

(2001) Introducing telemedicine technology to rural physicians and settings. Journal of Family Practice 50(5): 419–424.

Coleman

Herselman

Potass

(2011) e-Health readiness assessment for e-health framework for Africa: a case study of hospitals in South Africa. In: International conference on electronic healthcare (eds. Kostkova

Patty

Szomszor

Martin

Fowler

David

), Malaga, Spain, 21–23 November 2011, pp.162–169. Berlin Heidelberg: Springer.

Health Sector Development Plan (2015) Health Sector Development Plan (2015/16 - 2019/20), Ministry of Health, Kampala, Uganda. Available at: http://library.health.go.ug/publications/health-workforce-human-resource-management/performance-management/health-sector (accessed 5 February 2017).

Iles

Sutherland

(2001) Managing change in the NHS: organisational change. Available at: http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1001-001_V01.pdf (accessed 21 July 2017).

Jennett

Jackson

Healy

. (2003) A study of a rural community’s readiness for telehealth. Journal of Telemedicine and Telecare 9(5): 259–263.

Jennett

Jackson

. (2005a) The essence of telehealth readiness in rural communities: an organizational perspective. Telemedicine Journal and E-Health 11(2): 137–145.

Jennett

Gagnon

Brandstadt

(2005b) Preparing for success: readiness models for rural telehealth. Journal of Postgraduate Medicine 51(4): 279–285.

10.

Kgasi

Kalema

(2014) Assessment e-health readiness for rural South African areas. Journal of Industrial and Intelligent Information 2(2): 131–135.

11.

Khatun

Heywood

Ray

. (2015) Determinants of readiness to adopt mHealth in a rural community of Bangladesh. International Journal of Medical Informatics 84(10): 847–856.

12.

Khoja

Scott

Gilani

(2008) E-health readiness assessment: promoting “hope” in the health-care institutions of Pakistan. World Hospitals and Health Services Journal 44(1): 36–38.

13.

Seale

Ray

. (2013) e-Health preparedness assessment in the context of an influenza pandemic: a qualitative study in China. BMJ Open 3(3): e002293.

14.

Ray

Seale

. (2012) An e-health readiness assessment framework for public health services--pandemic perspective. In: 45th Hawaii international conference on system sciences, Maui, Hawaii, USA, 4–7 January 20012. Washington: IEEE Computer Society.

15.

Ministry of Health (MoH) (2016) eHealth policy and strategy validation workshop, Colline Hotel, Mukono, Uganda. Available at: http://www.afro.who.int/en/uganda/press-materials/item/8761-ministry-of-health-and-partners-validate-ehealth-policy-and-strategy.html (accessed 19th July 2016).

16.

Ojo

Olugbara

Ditsa

(2007) Formal model for e-healthcare readiness assessment in developing country context. Innovations in information technology. In: 4th international conference: innovations in information technology, Dubai, United Arab Emirates, 18–20 November 2007, pp. 41–45. Washington: IEEE Computer Society.

17.

Public Health Action Support Team (PHAST) (2017) Health knowledge. The impact of political, economic, socio-cultural, environmental and other external influences. Available at: https://www.healthknowledge.org.uk/public-health-textbook/organisation-management/5b-understanding-ofs/assessing-impact-external-influences (accessed 21 July 2017).

18.

Rezai-Rad

Vaezi

Nattagh

(2012) E-health readiness assessment framework in Iran. Iranian Journal of Public Health 41(10): 43–51.

19.

Scott

Mars

(2013) Principles and framework for eHealth strategy development. Journal of Medical Internet Research 15(7): e155.

20.

Shekelle

Morton

Keeler

(2006) Costs and benefits of health information technology. Evidence Report/Technology Assessment 132: 1–71.

21.

Skinner

Maley

Norman

(2006) Developing internet-based eHealth promotion programs: the Spiral Technology Action Research (STAR) model. Health Promotion Practice 7(4): 406–417.

22.

Van Dyk

Fortuin

Schutte

(2012) A maturity model for telemedicine implementation. The Fourth International Conference on eHealth. Telemedicine, and Social Medicine 10: 56116.

23.

Visconti

(2016) Healthcare public-private partnerships in Italy: assessing risk sharing and governance issues with PESTLE and SWOT analysis. Corporate Ownership and Control 13(4): 122–131.

24.

Whitten

Adams

(2003) Success and failure: a case study of two rural telemedicine projects. Journal of Telemedicine and Telecare 9(3): 125–129.

25.

World Health Organization and the International Telecommunication Union (WHO and ITU) (2015) National eHealth Strategy Toolkit. Available at: http://apps.who.int/iris/bitstream/10665/75211/1/9789241548465_eng.pdf?ua=1 (accessed 11 May 2017).

26.

Zaied

(2008) Strategic planning for e-development in developing countries. Available at: http://ccis2k.org/iajit/PDF/vol.5,no.2/1-85.pdf (accessed 11 May 2017).

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