Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Dynamics Research & Development Institute, Gaborone, Botswana.
PLoS One. 2023 Feb 16;18(2):e0281754. doi: 10.1371/journal.pone.0281754. eCollection 2023.
In March 2020, the Botswana Ministry of Health and Wellness approved a National eHealth Strategy. Although a milestone, the strategy does not mention telemedicine. There is need to address this by developing an evidence-based adjunct strategy for telemedicine to facilitate its introduction and adoption. To do so, several stages of a published eHealth Strategy Development Framework were mimicked. This allowed situational awareness to be created through exploring behavioural factors and perceptions that might influence the adoption of telemedicine in Botswana. The study aim was to explore current issues, concerns, perceptions, attitudes, views, and knowledge of patients and healthcare professionals regarding health-related issues and telemedicine that might influence implementation of telemedicine in Botswana and thereby inform future development of a telemedicine strategy.
An exploratory survey study was conducted using different survey questionnaires for patients and healthcare professionals, each using a mix of open- and closed-ended questions. These questionnaires were administered to convenience samples of healthcare professionals and patients at 12 public healthcare facilities in Botswana; seven clinics (three rural; four urban), and five hospitals (two primary, two district, and one tertiary), selected to align with the country's decentralised healthcare structure.
Fifty-three healthcare professionals and 89 patients participated. Few healthcare professionals had actively used telemedicine for clinical consults and self-education using telephone calls, cell phone apps, or video conferencing (doctors 42%, nurses 10%). Only a few health facilities had telemedicine installations. Healthcare professional preference for future telemedicine uses were e-learning (98%), clinical services (92%), and health informatics (electronic records (87%). All healthcare professionals (100%) and most patients (94%) were willing to use and participate in telemedicine programmes. Open-ended responses showed additional perspective. Resource shortages (health human resources and infrastructure) were key to both groups. Convenience, cost effectiveness, and increased remote patient access to specialists were identified as enablers to telemedicine use. However inhibitors were cultural and traditional beliefs, although privacy, security and confidentiality were also identified. Results were consistent with findings from other developing countries.
Although use, knowledge, and awareness of telemedicine are low, general acceptance, willingness to use, and understanding of benefits are high. These findings bode well for development of a telemedicine-specific strategy for Botswana, complementary to the National eHealth Strategy, to guide more systematic adoption and application of telemedicine in the future.
2020 年 3 月，博茨瓦纳卫生和福利部批准了国家电子卫生战略。尽管这是一个里程碑，但该战略并未提及远程医疗。需要通过制定远程医疗的循证辅助战略来解决这个问题，以促进其引入和采用。为此，模仿了已发布的电子卫生战略制定框架的几个阶段。这使得通过探索可能影响博茨瓦纳远程医疗采用的行为因素和看法来创建情境意识。该研究的目的是探讨患者和医疗保健专业人员在与健康相关的问题和远程医疗方面的当前问题、关注点、看法、态度、观点和知识，这些问题可能会影响远程医疗在博茨瓦纳的实施，并为未来的远程医疗战略制定提供信息。
使用不同的调查问卷对患者和医疗保健专业人员进行了探索性调查研究，每个问卷都使用了开放式和封闭式问题的组合。这些问卷分发给博茨瓦纳 12 个公共医疗设施的便利样本，包括 7 个诊所（3 个农村，4 个城市）和 5 个医院（2 个初级，2 个地区，1 个三级），这些诊所和医院是根据该国的分散式医疗结构选择的。
53 名医疗保健专业人员和 89 名患者参加了调查。很少有医疗保健专业人员积极使用远程医疗进行临床咨询和自我教育，包括通过电话、手机应用程序或视频会议（医生 42%，护士 10%）。只有少数几家医疗机构安装了远程医疗设备。医疗保健专业人员对未来远程医疗的使用偏好是电子学习（98%）、临床服务（92%）和健康信息学（电子病历（87%）。所有医疗保健专业人员（100%）和大多数患者（94%）都愿意使用和参与远程医疗计划。开放式回答显示了更多的观点。资源短缺（卫生人力资源和基础设施）是两组人员的关键问题。便利性、成本效益以及增加远程患者与专家的接触被认为是远程医疗使用的促进因素。但是，文化和传统观念以及隐私、安全和保密性也被认为是抑制剂。结果与其他发展中国家的发现一致。
尽管远程医疗的使用、知识和意识水平较低，但普遍接受、愿意使用和理解其益处的程度较高。这些发现为博茨瓦纳制定专门的远程医疗战略提供了良好的基础，该战略将补充国家电子卫生战略，以指导未来更系统地采用和应用远程医疗。
