WILLINGNESS TO RECEIVE M-HEALTH SERVICES AND ASSOCIATED FACTORS AMONG DIABETIC PATIENTS ON CHRONIC FOLLOW UP IN PUBLIC HOSPITALS, EASTERN ETHIOPIA: MULTICENTER MIXED METHOD STUDY

Abstract

Background: Untreated or poorly managed diabetes may leads to life-threatening complications. Appropriate management of diabetes needs a long-term care plan, including advice and support for adherence to a healthy lifestyle and treatment for improvement. Mainly mHealth has been used in controlling outcome of disease such as hypertension, maternal health, and psychological disorders. Assessing willingness to receive mHealth services among diabetic patients and identifying factors influencing it would help to benefit policy makers in designing appropriate mHealth services. Existing studies are either inconclusive or have not qualitatively explore barriers to receive mHealth services which significantly influences its implementation. Objective: This study aimed to determine willingness to receive mHealth services and associated factors among diabetic patients on chronic follow up in public hospitals, eastern Ethiopia from September 1- October 10. Methods: Multicenter institution based sequential explanatory mixed method study was conducted. The quantitative cross-sectional study was sequentially triangulated with qualitative phenomenological study. For the quantitative study, a total of 365 diabetic patients who were on chronic follow up at three selected public hospitals were enrolled by a systematic random sampling method. Data were collected using structured interviewer-administered questionnaires and entered to Epi-data version 4.6 and analyzed using Stata version 17. Multiple logistic regression model was fitted to identify the factors associated with willingness to receive mHealth services at 5% level of significance. For qualitative study, seven in-depth interviews with diabetic patients on chronic follow up and eight key informant interviews with healthcare providers who provide chronic follow-up services were conducted. Data were analyzed thematically using ATLAS.ti V. 7.5 after translation and verbatim transcription. Results: Overall, from the total of 365 people on chronic diabetes follow up in this study, 282 (77.3%) had access to mobile phone and among these about three quarters 210(74.5%) were willing to receive mHealth services. Higher odds of willingness to receive mHealth services were associated with younger age group (age<35 years; AOR = 4. 11(1.15-14.71)), having higher educational status (educated: AOR = 2.63(1.19-5.77)), having no comorbidity (AOR = 3.6(1.54-8.41)), time takes to reach health facility (Less than 1 hr.; AOR = 3.57(1.03-12.36)), not xiii answering unknown calls (AOR = 2.3(1.04-5.13)), and being satisfied with health care providers (AOR = 2.44(1.04-5.72)). In the qualitative study, participants and key informants pointed out; infrastructure, health facility, socioeconomic and patients‘ behavioural factors as major barriers to receive mHealth services. Conclusion: This study revealed that willingness to receive mHealth services was high. Age, educational status, time takes to reach health facility, presence of comorbidity, how often patients answer unknown calls and satisfaction with health care providers were significantly associated with willingness. Given the high proportion of mobile phone access and willingness to receive mHealth services, mHealth interventions could be helpful for diabetic patients to reduce complications and promote their health. Additionally the study highlighted the common barriers to receive mHealth services and its implementation that should be addressed by program planners before implementing the service.