Khatun Fatema, Heywood Anita E, Ray Pradeep K, Bhuiya Abbas, Liaw Siaw-Teng
School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW 2052, Australia; Asia-Pacific ubiquitous Healthcare Research Centre, School of Information Systems, Technology and Management. Australian School of Business, UNSW Australia, Sydney, NSW 2052, Australia; Health Systems and Population Studies Division. International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW 2052, Australia.
Int J Med Inform. 2016 Sep;93:49-56. doi: 10.1016/j.ijmedinf.2016.05.010. Epub 2016 Jun 1.
There are increasing numbers of mHealth initiatives in middle and low income countries aimed at improving health outcomes. Bangladesh is no exception with more than 20 mobile health (mHealth) initiatives in place. A recent study in Bangladesh examined community readiness for mHealth using a framework based on quantitative data. Given the importance of a framework and the complementary role of qualitative exploration, this paper presents data from a qualitative study which complements findings from the quantitative study.
The study was conducted in the Chakaria sub-district of Bangladesh. In total, 37 in-depth interviews were conducted between December 2012 and March 2013. Participants included the general public, students, community leaders, school teachers, and formal and informal healthcare providers. Thematic analysis was used to develop a logical and relevant framework to examine community readiness. As in the quantitative exploration, this study approached the investigation with four types of readiness in mind: core readiness, technological readiness, human resource readiness and motivational readiness.
Community members, community leaders and healthcare providers expressed their interest in the use of mHealth in rural Bangladesh. Awareness of mHealth and its advantages was low among uneducated people. Participants who have used mHealth were attracted to the speed of access to qualified healthcare providers, time savings and low cost. Some participants did not see the value of using mobile phones for healthcare compared to a face-to-face consultation. Illiteracy, lack of English language proficiency, lack of trust and technological incapability were identified as barriers to mHealth use. However, a sense of ownership, evidence of utility, a positive attitude to the use of mHealth, and intentions towards future use of mHealth were driving forces in the adoption of mHealth services.
This study re-affirmed the mHealth readiness conceptual framework with different dimensions of readiness and identified potential barriers and possible solutions for mHealth. Moving forward, emphasis should be placed on training users, providing low-cost services and improving trust of users.
中低收入国家旨在改善健康成果的移动医疗举措越来越多。孟加拉国也不例外，当地已有20多项移动医疗（mHealth）举措。孟加拉国最近的一项研究使用基于定量数据的框架，考察了社区对移动医疗的接受程度。鉴于一个框架的重要性以及定性探索的补充作用，本文呈现了一项定性研究的数据，该研究对定量研究的结果起到了补充作用。
该研究在孟加拉国的查卡里亚分区开展。2012年12月至2013年3月期间共进行了37次深度访谈。参与者包括普通公众、学生、社区领袖、学校教师以及正规和非正规医疗服务提供者。采用主题分析法来构建一个合理且相关的框架，以考察社区的接受程度。与定量探索一样，本研究在进行调查时考虑了四种接受程度类型：核心接受程度、技术接受程度、人力资源接受程度和动机接受程度。
社区成员、社区领袖和医疗服务提供者表达了他们对在孟加拉国农村地区使用移动医疗的兴趣。未受过教育的人群对移动医疗及其优势的认知较低。使用过移动医疗的参与者被其快速联系到合格医疗服务提供者、节省时间和低成本所吸引。一些参与者认为与面对面咨询相比，使用手机进行医疗服务没有价值。文盲、缺乏英语语言能力、缺乏信任和技术能力不足被确定为使用移动医疗的障碍。然而，主人翁意识、效用证据、对使用移动医疗的积极态度以及未来使用移动医疗的意愿是采用移动医疗服务的驱动力。
本研究通过不同维度的接受程度再次确认了移动医疗接受程度概念框架，并确定了移动医疗的潜在障碍和可能的解决方案。展望未来，应着重培训用户、提供低成本服务并增强用户信任。
