KENYA MEDICAL TRAINING COLLEGE

A RESEARCH STUDY ON FACTORS INFLUENCING ADOPTION

OF TELEMEDICINE AMONGST CLINICIANS IN MIGORI
COUNTY REFERRAL HOSPITAL

BY

NAME: Brian Otieno Onyango

STUDENT NO: D/NURS/19036/5788
CLASS: MARCH 2019

A Project Report Submitted to the Kenya medical

training college for the partial fulfilment of diploma
studies in Kenya Registered Community Health Nursing

KENYA MEDICAL TRAINING COLLEGE

MIGORI CAMPUS
P.O BOX 58-40400
MIGORI
December, 2022
 STUDENT DECLARATION

I, the undersigned declare that this is my original work and has not been submitted to any
other college, institution or university other than Kenya Medical Training College in Migori
for academic fulfilment.

Signed: ______________________________ Date:__________________________

Brian Otieno(D/NURS/19036/5788)

This Project has been presented for examination with my approval as the appointed
supervisor

Signed:______________________________ Date:__________________________

Mr. Paul Collins Kwasi

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DEDICATION

This study is dedicated to myself, family and friends together with every other person that
put in work to the accomplishment of this research study.

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ACKNOWLEDGEMENT

All praise to the almighty God for health and strength provided during the period of this
study, I am very grateful to my principal Mr. Paul Musango and my deputy principal Mdm.
Elizabeth Misula and also my supervisor Mr. Paul Kwasi, the entire nursing and clinicians
staff at Migori County Referral Hospital. It is my great pleasure to express my deepest
regards to them for their time, commitment, inspiration, constant supervision and all the
valuable suggestions and guidance.

Finally, I express my gratitude to my friends who were also a precipitating factor towards
completion of this research study namely, Calvin Ochieng, David Onyango, Shadrack
Newton and Mark Vutambula. Moreover, I thank my parents for their full support and
commitment for me to achieve academic excellence.

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DEFINITION OF TERMS

Telemedicine; The remote diagnosis and treatment of patients by means of

telecommunication technology.

Clinicians; A physician, nurse, psychiatrist, who specializes in clinical work as opposed

to one.

Attitude; A way of thinking or feeling about something in a truculent or uncooperative

behavior.

Adoption; The action of choosing to take up or follow or use something.

Neuroticism; A broad personality trait dimension representing the degree to which a

person experiences things as distressing.

Extravasation; Leakage of content.

Trialability; Capable of being tested or verified by a means of trial.

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 ABSTRACT

The purpose of this research was to investigate factors that influence the adoption of
telemedicine amongst clinicians in Migori County Referral Hospital which was achieved
by answering the following research questions: To what extent does perceived ease of use
of technology affect adoption of telemedicine amongst clinicians in Migori county hospital;
to what magnitude does perceived usefulness determine adoption of telemedicine amongst
clinicians in Migori county hospital and to what degree does attitude determine adoption of
telemedicine amongst clinicians in Migori?

The descriptive research design was used in this research. The target population consisted
of 20 doctors and nurses at the Migori County Referral Hospital (MCRH). The sampling
frame was obtained from the hospital’s human resources office. The sample size constituted
of 9 nurses and 11 doctors who were selected from the two strata through systematic
random sampling. The research instrument that was used was a questionnaire consisting of
a 5-point Likert scale. Data was later analyzed using pie charts and graphs to come up with
generalized conclusions. The data collected on personal information and use of
telemedicine was analyzed using mean and cross tabs where applicable to better describe
the population characteristics from the respective strata, i.e.
nurses and doctors. Additionally, Pearson’s correlation coefficient was applied to determine
the relationship between the aspects of perceived ease of use and adoption of telemedicine
amongst clinicians in Migori; aspects of perceived usefulness and adoption amongst
clinicians in Migori & the aspects of attitude and adoption amongst clinicians in Kenya
respectively.

The majority of the respondents rated the frequency of use of most of telemedicine modules
as seldom. Most of the respondents agreed that perceived ease of use, perceived usefulness
and attitude influence the adoption of telemedicine amongst clinicians in Migori county
hospital. On the first objective, a significant correlation was found to exist between the
aspects of perceived ease of use (compatibility, trialability & complexity) and adoption of
telemedicine. On the second objective, a significant correlation was also found to exist
between the aspects of perceived usefulness (observability, compatibility & relative
advantage) and adoption of telemedicine. On the last objective, a significant correlation
was found to exist between the dimensions of attitude (conscientiousness, openness to
experience, agreeableness, neuroticism and extroversion) and adoption of telemedicine.
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The study concluded that, in general, the rate of adoption is low amongst clinicians in
Migori county referral hospital. On the first objective, the study concluded that the
dimensions of perceived ease of use (relative advantage, trialability, complexity and
compatibility) play an important role in explaining the telemedicine adoption rates amongst
clinicians in Migori county referral hospital. On the second objective, the study concluded
that the factors linked to perceived usefulness (compatibility, relative advantage and
observability) play an important role in explaining telemedicine adoption rates amongst
clinicians in Migori county referral hospital. On the last objective, the study concluded the
dimensions of attitude (conscientiousness, openness, agreeableness, neuroticism and
extroversion) play an important role in explaining the adoption of telemedicine amongst
clinicians Kenya.

On the first objective, the study recommended that telemedicine systems should be
designed to present advantages to clinicians, allow for trial usage periods during which time
clinicians can discover the features and capability of a system without making a formal
commitment, the systems should also be compatible with clinicians’ values and
professional standards. On the second objective, the study recommended that telemedicine
implementation teams should ensure that clinicians are involved in the process of acquiring
and rolling out telemedicine systems. Involving clinicians in the implementation of
telemedicine systems and acting on the issues they raise will lead to the development of a
system that fits into clinicians’ work process. In regards to the third objective, it was
recommended that the clinicians’ representative for a telemedicine project should be an
individual who is an extrovert, conscientious, open to experience and agreeable as they are
more likely to focus on achieving the telemedicine implementations’ goals unlike their
neurotic peers.

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 TABLE OF CONTENTS

STUDENT DECLARATION ........................................................................................... ii

ABSTRACT ...................................................................................................................... vi

LIST OF TABLES ............................................................................................................ xi

LIST OF FIGURES ........................................................................................................viii

CHAPTER ONE ................................................................................................................1

1.0 INTRODUCTION........................................................................................................1

1.1 Background of the Problem ...........................................................................................1

1.2 Statement of the Problem ...............................................................................................2

1.3 Purpose of the Study ......................................................................................................3

1.4 Broad Objectives ............................................................................................................3

1.5 Specific Objectives .........................................................................................................3

1.6 Research Question ..........................................................................................................4

1.7 Hypothesis.......................................................................................................................4

1.8 Scope of the Study.......................................................................................................... 4

1.9 Significance of the Study………………………………………………………………5

CHAPTER TWO

2.0 LITERATURE REVIE...........................................................................................6

2.1 Introduction ....................................................................................................................6

2.2 Adoption and Implementation of Telemedicine ............................................................ 6

2.3 Perceived Ease of Use and adoption of telemedicine .................................................. 8

2.4 Perceived Usefulness and Adoption of Telemedicine ................................................. 9

2.5 Personality and adoption of telemedicine .................................................................... 11

2.6 Chapter Summary .........................................................................................................11

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CHAPTER THREE ......................................................................................................... 12

3.0 RESEARCH METHODOLOGY .............................................................................12

3.1 Introduction ..................................................................................................................12

3.2 Research Design........................................................................................................... 12

3.3 Populations and Sampling Design ............................................................................... 12

3.4 Data Collection Methods ............................................................................................. 14

3.5 Research Procedures .................................................................................................... 14

3.6 Data Analysis Methods ................................................................................................ 14

CHAPTER FOUR

4.0 DATA ANALYSIS, INTERPRETATION AND PRESENTATION

4.1 Introduction .........................................................................................................15

4.1.1 Gender of the Respondents ...............................................................................15

4.1.2 Level of Education ........................................................................................... 15

4.1.3 Age Distribution……………………………… ................................................16

4.1.4 Designation Distribution…………………….....................................................17

4.1.5 Work Experience…………………………………………………....................17

4.1.6 Computer Literacy Level....................................................................................18

CHAPTER FIVE

5.0 DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS .................19

5.1 Introduction ............................................................................................................19

5.2 Summary ................................................................................................................19

5.3 Discussions .............................................................................................................21

5.4 Conclusions ............................................................................................................23

5.5Recommendations.....................................................................................................32

REFERENCES ..............................................................................................................33
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APPENDICES...........................................................................................................35

Appendix I: Letter to Respondents .............................................................................35

Appendix II: Questionnaire for Doctors and Nurses ................................................36

Appendix iii: Work plan………………………………………………………………42

Appendix iv: Budget…………………………………………………………………..43

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 LIST OF TABLES
Table 4.1: Education Level*Designation ........................................................................... 48

Table 4.2: Age in Years*Designation .................................................................................49

Table 4.3: Designation of the Respondents ........................................................................ 50

Table 4.4: Work Experience in Years * Designation ........................................................ 50

Table 4.5: Level of my computer literacy skills * Designation ..........................................52

LIST OF FIGURES
Figure 2.0: Telemedicine adoption model.........................................................12

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ABBREVIATIONS

AMREF: African Medical Research Foundation.

TPB: Theory of Planned Behavior.

WHO: World Health Organization

DIT: Diffusion of Innovation Theory.

TAM: Technology Adoption Model.

TRA: Theory of Reasoned Action.

IT: Information Technology.

MCRH: Migori County Referral Hospital.

xii
 CHAPTER ONE

1.0 INTRODUCTION

This chapter introduced the objectives of the study by discussing various definitions of
telemedicine and highlighting its advantages. The factors that influence adoption were also
introduced as well as the purpose of the study and the research questions. The researcher
also introduced the significance of the study and defined its scope.

1.1 Background of the Problem

Kenya is a developing nation in sub-Saharan Africa whose doctor patient ratio is 1 doctor
to 17000 patients Karongo(2012), This is way below the world health organization
recommendation of one doctor for every 1000 patients Karongo(2012), In November 201,
it was estimated that up to 80% of doctors and nurses would leave government by the third
year of service to give to the private sector, with Botswana and South Africa being the
biggest beneficiaries Okoth(2013), All these reveal that, generally health coverage is low
and to enforce the vision 2030 goals, one has to critically assess solutions toa achieving
better health care in the country. Telemedicine, if well implemented can provide a solution
to this predicament. Therefore, understanding the Factors that influence adoption of
telemedicine in Migori County Referral Hospital will be of value to stakeholders who are
involved in its implementation. Telemedicine can be described as the delivery of health
care services where human distance is a critical factor by healthcare professionals using
information and communication technologies for exchange of valid information for
diagnosis, treatment and prevention of disease and injuries, research and evaluation for the
continuing education of healthcare providers, all in the interest of advancing the health of
individuals and their community. It is not one specific technology but a means for providing
health services at a distance using telecommunication and medical computer science
Joseph(2011), Telemedicine is being propelled by the converging megatrends: advances in
enabling technologies and telecommunication as well as increasing demand for access to
high quality medical care irrespective of location.

Telemedicine has the potential to simultaneously improve healthcare quality and efficiency
by providing patients with virtual access to an organization’s healthcare process.
Telemedicine has the potential to change the way healthcare service providers deliver better
and coordinated healthcare to most countries and communities, Migori in particular

1
however, despite the benefits, there are several challenges to the successful deployment
telemedicine that must be addressed by healthcare organizations explore the potential
adoption of the technology. According to YK Chau, a professional user like a physician’s
technology acceptance prediction is different from the common Information Technology
(IT) user. Since telecommunication is the use of information, communication technology
to provide healthcare across a distance we will define adoption. IT adoption, in
organizations has been defined by prior literature as a decision to accept and use the
innovation, the full use of innovation as intended by the designer, the acceptance and
continued use of a product, service or idea and extent of usage. According to studies
undertaken in the developed world, factors that influence the successful implementation of
telemedicine include: Infrastructure, government policies, availability of finance, top
management support, external suppliers’ capability, and project teams understanding of the
user’s requirements, corporate culture and adoption. Most studies undertaken in Kenya
investigate factors such as, infrastructure, availability of finance and government policies.
This study focused on determining the factors that influence adoption of telemedicine
among clinicians with the goal of increasing understanding of user specific factors among
stakeholders involved in implementation of telemedicine. Therefore, the factors to be
investigated in this study are: Ease of use to clinicians, usefulness and attitude. Usefulness
can be described as the prospective adapters to subjective probability that applying new
technology from other sources will be beneficial to the adopting company. Attitude is a
disposition to evaluate certain objects, actions and situations in certain ways. The study
used the model to discuss the aspects, the Diffusion of Innovation model was applied to
discuss the adoption process. Technology adoption model (TAM) was used to expound on
perceived ease of use and perceived usefulness. Therefore, a combination of TAM and the
diffusion of innovation model was used in this study to determine the model was used in
this study to determine the extent to which ease of use, usefulness and attitude can influence
adoption of telemedicine.

1.2 Problem Statement

In developed countries, the success stories on IT adoption of telemedicine are noteworthy.

The benefits are reflected in this countries health system and coverage that are doing
expandingly well. There has been a clear reduction of healthcare costs as well as improving
their quality of healthcare. Maurice (2010), identified a number of factors that impede the

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adoption of telemedicine in Africa and Kenya at large to include: Poverty, shortage of human
resources, limited infrastructure, lack of connectivity and lack of capacity development and
policy and legislative issues. The low adoption of telemedicine in Migori, therefore, can be
attributed to issues such as, lack of commitment by hospital administration and county
government, poor infrastructure, poor connections and poverty. Clinicians attitude is also very
critical in determining continuity in the adoption of telemedicine as this characteristic have
been have cited as factors driving adoption, where this characteristic represents individual
level ability to adopt. Without the clinicians on board, the hospital and the country will not
enjoy full advantages of telemedicine. That being the case, it is imperative that we investigate
perceived ease of use, attitude and usefulness as factors that influence adoption of
telemedicine in Kenya.

1.3 Purpose of the Study

The purpose of the study was to investigate the factors that influence the adoption of
telemedicine amongst clinicians in Migori County Referral Hospital.

1.4 Broad Objective

To determine the factors influencing adoption of telemedicine amongst clinicians in Migori

County.

1.5 Specific Objective

• Assess the use of telemedicine services amongst clinicians.

• Evaluate the attitude of clinicians towards the use and implementation of
telemedicine in Migori County Referral hospital.
• Assess the usefulness of telemedicine in improving healthcare coverage and
quality of healthcare delivery.
• Evaluate the sociodemographic characteristics of people acquiring health
services in Migori.

1.6 Research Question

• The study was guided by the following research questions;

To what extent does perceived ease of use of technology affect adoption of Technology
affect adoption of telemedicine amongst clinicians in Migori.

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 To what magnitude does perceived usefulness determine adoption of telemedicine
amongst clinicians in Migori.

To what degree does attitude and personality determine adoption of telemedicine

amongst clinicians in Migori county.

1.7 Hypothesis

Telemedicine can improve health coverage to all areas of the county so as to improve
healthcare delivery, reduce cost and improve quality and efficiency of care. Telemedicine is
useful to reduce mortality, morbidity, and other medical complications.

1.8 Scope of the study

The study focused on healthcare providers in Migori County at large, specifically Migori
county referral hospital, to ensure adequate health delivery. The target populations consisted
of clinicians from MCRH who are the main users of telemedicine and selected people
visiting health facility as the consumers of telemedicine.

1.9 Significance of The Study

Practical Significance
This study will help clinicians who don’t know about telemedicine to know the
usefulness of it and learn on how to adopt to adopt to its effective use.

Theoretical Significance
This study will serve as a future reference material for whoever will be interested in
finding out about the impact of telemedicine to the countries and counties health system. It
will be a requirement for the partial fulfilment of Diploma in Kenya Registered Community
Health Nursing.

Limitation
Poor attitude and lack of cooperation from clinicians and top managers in the hospital and
county to integrate the use of telemedicine for suitable health provision and coverage.

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Delimitation
Challenge to telemedicine providers is it offer comprehensive and easily understandable way
to handle telemedicine equipment as well as the risk it imposes to clinicians who might
access rebellious areas.

Assumption
The study assumes that the information acquired will help to improve health coverage,
quality of health, cost of health and the efficiency and active utilization of healthcare
services across every part of Migori county in the coming years, in order to improve the
general populations health and avoid death from the conditions that can be reversed if health
care service is offered at the right time

Chapter Summary
This was an introductory chapter, which was to lay down a foundation for the research by
giving a background of telemedicine and highlight its advantage. After which the problem
statement where we argued out the need to investigate perceived ease of use, usefulness and
attitude as factors that influence adoption of telemedicine among clinicians in Migori county
referral hospital. This paved way for the purpose of the research which was identified to the
factors that influence adoption of telemedicine among clinicians in migori county. The
purpose of the study was broken down into research questions, in order to set boundaries by
pointing out that the research would investigate how perceived ease of use, usefulness, and
attitude and personality influence the adoption of telemedicine amongst clinicians in migori
county referral hospital. The chapter that will follow will introduce literature that is related
to and consistent with adoption of telemedicine.

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 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 Introduction

In this chapter, literature, which is related to and consistent with the objectives of the study,
was reviewed. Important theoretical and practical problems were brought out with
reference to relevant literature on the factors influencing adoption of telemedicine amongst
clinicians in Migori county referral hospital. In other research, technology adoption has
been discussed using a number of theories, which include the Theory of Reasoned Action
(TRA), Technology Acceptance Model (TAM), Diffusion of Innovation Theory (DIT) and
Theory of Planned Behavior (TPB). None of these theories is full proof as each has its
advantages and disadvantages. Therefore, for the purpose of this study this chapter lay out
a theoretical framework by discussing adoption as a part of the process of diffusion of
innovation. Each of the stages of the process was discussed at length after which the factors
that influence adoption were introduced. Literature on the perceived characteristics of
innovation was discussed exhaustively to lay out a framework to determine the extent to
which perceived ease of use and usefulness influence adoption of telemedicine amongst
clinicians in Migori county referral hospital. Literature on the personality variables was
also extensively discussed to lay a foundation that will be applied to measure the degree to
which attitude influences adoption of telemedicine amongst clinicians in Migori county.
Consequently, perceived ease of use, perceived usefulness and attitude were discussed as
factors that influence the adoption of telemedicine amongst clinicians in Migori county.

2.2 Adoption and Implementation of Telemedicine

There is no widely accepted definition of telemedicine. In this study, it was described as

the delivery of health care services, where distance is a critical factor, by health care
professionals. It involves using technologies for the exchange of valid information for
diagnosis, treatment and prevention of disease and injuries and research & evaluation all in
the interests of advancing the health of individuals and their community WHO(2014),
Health care providers can use telemedicine to remotely diagnose, treat, and manage the care
of their patients. Patients can be seen remotely by physicians in their homes, places of
work, or at a dedicated telehealth center, and physicians can treat patients remotely from a
hospital, medical facility, or other places of work including their own homes or even while
6
on vacation, as long as they have access to the internet Castro et al (2014), The ability to
connect clinicians and patients without regard to their respective locations is one of the
most compelling benefits of telemedicine services.

Telemedicine represents an opportunity to not only improve clinical encounters, but also
the entire patient experience. Using telemedicine services, patients who need to see a
provider can go online, perhaps to a website provided by their health care provider, and
quickly find physicians who can see them immediately. Once patients choose a provider,
they will make their electronic health records available to the physician. After the
encounter, physicians will send any prescriptions electronically to the patient and add
clinical notes to the patient’s electronic health record. Payment can be handled
automatically, via credit card or mobile transfer technology and patients will leave feedback
for other users (Castro et al, 2014).

The major players in Kenya’s health sector are in public and private hospitals which are
concentrated in the country’s metropolis (Shikuku, 2013).
Moreover, most of the specialist doctors are located only in the country’s major cities,
making them inaccessible to the common person. Therefore, adoption of telemedicine can
be instrumental in enabling healthcare providers reach more patients without incurring
transport or relocation costs (Shikuku, 2013).

With the advances in information technology infrastructure in Kenya, various organizations

such as AMREF Computer Aid International(2013), AAR healthcare services and
Safaricom Ltd Galgallo(2013), have embarked on telemedicine projects. However, most of
these projects stall for several reasons, such as human resources necessary to maintain the
projects not being trained and doctors rejecting the idea of seating in a call center to answer
to patient queries. This could be because physicians work in a different working
environment with higher requirements for their qualification, professionalism, ethical
behavior, autonomous practice and professional responsibilities. The result is they have
dissimilar technology acceptance decision making and readiness. However, most studies
that investigate factors that influence adoption of telemedicine in Kenya focus on the
infrastructure, government policies and funding overlooking the fact that for an innovation
to be successful the consumers, in this case, physicians and nurses, need to accept it and
continue using it fully.

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The decision to accept and continue using technology is a process which according to
Rogers (2010), involves several stages. Stage 1 is the awareness stage where the individual
is exposed to innovation but lacks complete information Kaminski(2011), Social economic
characteristics, personality variables and communication behavior greatly influence the
outcome of this stage. Stage 2 is the persuasion stage where the potential adopter anticipates
future use satisfaction and risk adoption. According to Kaminski (2011), some perceived
characteristics, namely relative advantage, compatibility, complexity, trialability and
observability influence an individual during this stage. Stage 3 is the decision stage which
according to Rogers (2010), is the stage during which the adopter starts to actively seek out
information about the innovation that assists the decision making. The perceived
characteristics of the innovation also play a major role in influencing the individual’s
decision. This is followed by the implementation step where an innovation is put into
practice Rogers(2010), The confirmation stage follows closely which is where the
individual looks for support for his or her decision to adopt an innovation. According to
Rogers (2010), the decision can be reversed at this stage if the individual is exposed to
conflicting messages about the innovation. Last but not least is the adoption stage which
Rogers (2010), defined as the acceptance and continued use of a product, service or idea.

Adoption is an individual’s decision to become a user of a product. A potential adopter

passes through certain stages before a decision is made on whether or not to adopt an
innovation.

Consumers go through “a process of knowledge, persuasion, decision, implementation and

confirmation” before they are ready to adopt a product or service.

2.3 Perceived Ease of Use and adoption of telemedicine

Perceived Ease of Use (PEOU) is the degree to which one believes that technology is easy
to use and understand. When one believes the technology will be free of effort, it will
increase their behavioral intention to adopt the technology Teo(2009), It can also be defined
as the degree to which a person believes that using a particular system would be free of
effort. It has also been defined as a user’s subjective perception of the ability of a computer
to increase job performance when completing a task. This follows from the definition of
the word ease: Freedom from difficulty or great effort. All else held constant, an application

8
perceived to be easier to use than another is more likely to be accepted by users. Perceived
ease of use explains the user’s perception of the amount of effort required to utilize the
system or the extent to which a user believes that using a particular technology will be
effortless (Davis).

Researchers argued that perceived ease of use is the extent to which a person accepts as
true that using an exacting method would be at no cost to them Extensive research over the
past decade provides evidence of the significant effect of perceived ease of use on usage
intention, either directly or indirectly; it was noted that understanding the technology leads
to adaptation of innovative service/product by customers is known as ease of use. Recently,
Chen and Barnes have empirically found that two technological aspects of the interface,
namely perceived ease of use and perceived usefulness significantly affect customer
adoption intentions. This led to our research question: To what extent does perceived ease
of use of affect adoption of telemedicine amongst clinicians in Kenya and Migori county?

The existing studies suggest that perceived ease of use is a major attribute in determining
the attitude of an individual towards system usage. Users would be concerned with the
effort required to use an application and the complexity of the process involved. Perceived
ease of use of identifying information and performing transactions should enable a
favorable and compelling individual experience. It is also hypothesized to have a significant
effect on adoption. Perceived ease of use consists of the following determinants: easy to
use, easy to read, using understandable terms, able to link to search for related information
and easy to return to previous page (Lederer et al, 2011).

Easy to use refers to how easy it is for the user to maneuver their way through the system
to achieve their work goals. Easy to read and understandable terms refer to how closely the
terms used in the system relate to the clinicians’ profession. That is, if clinicians can relate
to the language used on the telemedicine system, they would find it easier to use. For
example, ensuring that online forms have the same name as the manual forms would make
a telemedicine system easier to use. The system should also enable the clinician make
reference to related information by linking to medical journals or the internet. For example,
telemedicine systems should include a button that loads the National Formulary when
clicked. This provides up-to-date, practical guidance on prescribing, dispensing, and
administering medicines. This essential reference reflects current best practice as well as
legal and professional guidelines relating to the uses of medicines. Systems that are able to
9
link to it make online prescriptions easier as clinicians do not have to retrieve the BNF hard
cover book for every prescription (Vreis & Henning, 2011).

According to Lee et al(2011), the effects of compatibility, trialability, and complexity on

the perceived ease of use are significant to determine attitude towards the ease of adoption
of telemedicine service.

2.4 Perceived Usefulness and Adoption of Telemedicine

Perceived Usefulness (PU) is the subjective probability that using a technology would
improve the way a user could complete a task (Ndubuisi, 2016).

The use of PU to determine the behavioral intention has been in the limelight for most of
the IT studies. It is defined as one’s belief that the use of technology will increase his or
her job productivity Pai & Huang(2011), Therefore, a system high in perceived usefulness,
in turn, is one for which a user believes in the existence of a positive user-performance
relationship.

To expound on the issue of telemedicine being more easily adopted if its application is
perceived as a benefit, people tend to use or not to use a system application to the extent
they believe it will help them perform their job better. Usefulness can also be defined as
the prospective adopter’s belief that applying the new technology from foreign sources will
be beneficial to his personal and/or the adopting company’s wellbeing for example, if
clinicians were able to attend to more patients without being physically present, they could
generate more consultation revenue for themselves and the hospital. Perceived usefulness
explains the user’s perception on the extent that the technology will improve the user’s
workplace performance. This means that the user has a perception of how useful the
technology is in performing his job tasks. This includes decreasing the time it takes to do
the job, increased efficiency and accuracy. In the case of clinicians, a good telemedicine
system would be one that makes it easier to make referrals even across countries, undertake
research, and provide patient consultation within the same duration of time or less and
access patient clinical details in less time than it takes when they have to wait for a file to
be delivered.

Additionally, if clinicians viewed telemedicine as a solution to political and medical legal

issues, they would be more receptive because it allows them to reach across borders which
gives them an opportunity to treat more people and make more revenue. However, the legal

10
environment could be a limitation to the adoption of telemedicine. It compounds multiple
aspects including the lack of an international legal framework to enable clinicians deliver
services in different jurisdictions and countries; lack of policies that govern patient privacy
and confidentiality vis- a-vis data transfer, storage and sharing between clinicians and the
judicial systems; and the risk of medical liabilities of clinicians offering telemedicine
services. Lack of support of telemedicine implementations could be affected by the fear
that the integration of new technology may alter work practices, challenge referral methods
or interrupt the workflow.

It is believed that perceived usefulness was affected by the level of an individual’s trust, In
terms of perceived privacy, it has been found to be a significant variable to shared value,
both patient physical safety and patient information security are crucial to support the trust
relationship between health care providers and patients and for acceptance of telemedicine
implementations. Savastano noted that lack of patient trust means that patients would not
reveal accurate and complete information, which lowers the quality of care. This is a critical
consideration because a big part of the treatment of diabetes patients is in the accurate self-
reporting of blood glucose levels. Poor quality of care would further reduce the confidence
of both providers and consumers of telemedicine services. Lack of confidence would make
it less likely for telemedicine services to be deployed widely. Earlier research suggests that
security is not the primary focus of the telemedicine research community

Determinants of perceived usefulness are closely related to those of perceived ease of use
as they are also perceived characteristics of innovation. The effects of the relative
advantage, compatibility and observability on the perceived usefulness are significant (Lee
et al ,2011).

2.5 Personality and adoption of telemedicine

Personality is described as the individual’s responses to particular situations (Oxford

languages).
The studies of personality have been an important measure for human behavior Chen
(2011), The relationship between big five personality traits and user’s intention to adopt of
a collaborative technology in a university campus in United States. The study proved that
personality dimensions can be useful predictors of user’s attitudes and beliefs. (Devaraj et
al., 2010). Found that personality traits such as conscientiousness, extraversion, and
11
agreeableness are positively associated with adoption and these variables influence the
intention to use a new technology. Study also revealed that neuroticism is negatively
associated with adoption of technology.

It was also suggested that the introduction of Big Five personality factors into models of
technology acceptance and adoption as an avenue for research. Following
The above, we will explore personality’s direct effect on clinicians’ adoption of
telemedicine. We will not cast personality as a precursor to perceived ease of use and
perceived usefulness like in the Technology Acceptance Model (TAM). Within the context
of the existing TAM, we consider the personality traits’ potential to explain variance in IT
system adoption. To achieve this, we will apply the five-factor model (FFM) which is a
personality model that organizes personality traits hierarchically in terms of five basic
dimensions: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness
to Experience.

Perceived
Ease of Use

Perceived
Adoption
Usefulness

Personality

Figure 2.0: Telemedicine Adoption Model

2.6 Chapter Summary

In this chapter, the researcher defined telemedicine and listed the advantages it presents to
healthcare. The researcher went further to pinpoint that amongst clinicians the rate of
adoption of telemedicine is very low. Most research that has been undertaken in this field
in the Kenyan context focusses on infrastructure, funding and government policies. Little
research has been undertaken in regards to the user specific factors that influence the
adoption of telemedicine amongst clinicians in Migori County Referral Hospital.
12
Telemedicine was viewed as an innovation for the purpose of this study which led the
researcher to define adoption in the context of the diffusion of innovation theory. Each of
the stages of diffusion discussed at length giving special attention to the personality
variables which greatly influence adoption and the characteristics of innovation which
influence perceived ease of use, perceived usefulness.

An extensive literature review led to the conclusion that there is limited literature on the
specific factors that influence the adoption of telemedicine amongst clinicians in Africa and
Migori county to be specific., Therefore, this research will determine the influence of
perceived ease of use on adoption of telemedicine amongst clinicians in Kenya by
determining the effect of compatibility, trialability, and complexity on perceived ease of
use. Secondly, the research will investigate the influence of perceived usefulness on
adoption of telemedicine amongst clinicians in Migori county referral hospital by
determining the effect of the trialability, compatibility and observability on the perceived
usefulness. Last but not least the research will investigate the influence of personality on
adoption of telemedicine amongst clinicians in Migori by determining the effects of
extraversion, agreeableness, conscientiousness, neuroticism, and openness to Experience
on adoption of telemedicine.

The model that would be applied to this research was borrowed from the perceived
characteristics of innovations as postulated in the diffusion of innovation theory together
with the personality variables as advanced in the five-factor model and the relationships
between adoption and perceived ease of use, perceived usefulness respectively as defined
in the technology acceptance model. The following chapter discusses the method of study
to be applied, the target population and proposed the tools and techniques employed in the
research.

13
 CHAPTER THREE

3.0 RESEARCH METHODOLOGY

3.1 Introduction

This chapter provides the line of approach of the study. It does so by discussing the research
design, population and sample of the study. It will discuss the tools and techniques that will
be employed in the research. The chapter will also discuss the procedure of study, data
organization and presentation.

3.2 Research Design

Research design refers to the plan, structure and strategy of research; it provides a roadmap
for the project. Research design provides the glue that holds the research project together.
Descriptive research design was suitable for this research because the objective was to
determine and explain certain characteristics that influence the adoption of telemedicine.
Descriptive research was applied to attempt to describe, explain and interpret conditions of
the present i.e., “what is”

3.3 Populations and Sampling Design

3.3.1 Population

The population includes elements that meet certain criteria for inclusion in a study Burns
& Grove(2003), In this study, the population was drawn from Migori county referral
Hospital clinicians that are about 20 in number. The target population comprised of 9 nurses
and 11 doctors. Each of these specializations has varied system requirements, which means
that they provide good sources of data. For a telemedicine implementation to be considered
as successful, doctors and nurses need to stop using the manual prescriptions and written
notes for diagnosis and patient care. However, in instances where telemedicine has been
implemented in Kenya, these users do not embrace the use of online tools, hence the need
to investigate the factors that influence the adoption of telemedicine amongst doctors and
nurses in Migori County.

3.3.2 Sampling Frame

The sampling frame is a list of elements in the population from which the sample is actually
drawn Cooper & Schindler(2010), The sampling frame for this research was a list of nurses

14
and doctors that was obtained from the human resources departments at Migori county referral
Hospital, Migori by putting in a written letter for formal request.

3.3.3 Sampling Technique

A sample is part of the target (or accessible) population that has been procedurally selected
to represent it and whose properties are studied to gain information. According to Trochim
(2015), sampling is the process of selecting units (people, organizations) from a population
of interest so that studying the sample we fairly generalize our results back to the population
from which they are chosen. In this study it referred to the procedure the researcher used to
select the final sample to study.

To achieve the purpose of this research, the researcher used proportionate stratified random
sampling technique. The population was divided into two strata which consisted of nurses
and doctors respectively. The stratification applied was proportionate as the population
sizes were almost the same. Therefore, part of the sample was selected from the doctors’
stratum which consists of 11 members and the other half were selected from the nurses’
stratum which has a population size of an estimated 9 members.

Systematic random sampling was applied to each stratum to select the respondents who
answered the questionnaire. In systematic random sampling, the researcher first randomly
picks the first item or subject from the population. Then, the researcher will select each nth
subject from the list (Tromp). According to (Tromp,) the formula below can be used to
calculate the nth subject.

Nth subject= N/n

Where N= Population and n= sample size

The doctors’ stratum=11/4=3 and the nurses’ stratum=9/2=4.5

3.3.4 Sample Size

According to (Stat Trek, 2014) the formula below can be used to calculate the sample
size for known population proportions.

n = [ (z2 * p * q) + ME2] / [ ME2 + z2 * p * q / N] (Stat Trek, 2014)

Where n= sample population

15
 z=1.96 as the z value for 95% confidence level

p=sample proportion of successes= 0.1

q= (1-p)

e=0.05 margin of error for confidence level 95%

p=0.1 q=0.9 N=20

n= [(1.962*0.1*0.9) +0.052/ [0.052+1.962*0.1*0.9/20]x

100 n= 36 – 16=20

n= 20

The same formula was applied to the respective stratum in order to determine sample size per
stratum
Doctors Nurses

p=0.1 q=0.9 N=11 n= p=0.1 q=0.9 N=9

[(1.962*0.1*0.9) + n= [(1.962*0.1*0.9) +

0.052/ [0.052+1.962*0.1*0.9/311] 0.052/ [0.052

n=0.17658/0.052+0.021 +1.962*0.1*0.9/9]

n=2.42 n=0.17658

+0.052/0.0254

n=0.176+2.047

n=2.22

3.4 Data Collection Methods

The researcher used both secondary and primary data sources. Secondary data was collected
through reviewing written records and reports on the subject matter. On the other hand, the
data collected from Migori County Referral Hospital was primary data collected using

16
questionnaires. A structured questionnaire was used to collect quantitative and qualitative
data.

After undertaking an extensive literature review, items selected from the constructs of the
diffusion of innovation model, technology acceptance model and the five-factor model
were used to develop the questionnaire to facilitate the investigation of factors that
influence the adoption of telemedicine amongst clinicians in Migori county referral
hospital. The items were modified to make them relevant to the context of telemedicine.
The questionnaire was applied as it was expected to consume less time than focus groups
and interviews. It also enabled the researcher generate data in a systematic and orderly
fashion.

The questionnaire consisted of two parts. The first part was divided into two sections. Part
I asked questions related to demographic data such as gender, age, level of education,
designation and clinical experience. It excluded the subject’s name in order to provide
anonymity and increase chances of getting more genuine answers. Part II consisted of
questions pertaining to different aspects of adoption. It was subdivided into several
sections. That is, section A which contained questions relating to adoption of telemedicine.
They included self-rating questions on computer literacy, registration status on the
telemedicine system and training on how to use the system and usage of the telemedicine
system on patient care. This section was followed by section B which was used to collect
data on compatibility, complexity and trialability in order to better understand perceived
usefulness. This was closely followed by section C which contained questions on relative
advantage, compatibility which were asked in order to better understand perceived
usefulness and finally section D which collects data on extraversion, neuroticism,
conscientiousness, openness to experience and agreeableness which are factors that
influence individual attitude towards telemedicine. A 5-point Likert scale with anchors
ranging from “strongly disagree” to “strongly agree” was used for questions. The scale was
simple to construct, likely to produce a highly reliable scale and easy to read and complete
for participants.

3.5 Research Procedures

Pre- testing of the identified measures was conducted in order to identify and correct any
potential problems by administering the questionnaire to randomly selected 5 nurses and 5
doctors. They were asked to critique the questions and identify any vague questions.
17
The data collection stage paved way for they the analysis and reporting stage of the research
which took 4 months.

3.6 Data Analysis Methods

The data collected by use of the research instrument was edited to get the relevant data for
the study. The edited data was then coded for easy classification in order to facilitate input
in (Statistical Analysis Software) used to generate a description of the population and to
make generalized conclusions in regards to adoption of telemedicine amongst clinicians in
Migori. The data collected on personal information and use of telemedicine was analyzed
using mean and cross tabs where applicable to better describe the population characteristics
from the respective strata, i.e., nurses and doctors.

18
 CHAPTER FOUR

4.0 DATA ANALYSIS, INTERPRETATION AND PRESENTATION

4.1 Introduction

This chapter presents the results of the data collected according to the research objectives.
The data collection instrument used was a questionnaire. Out of (20) questionnaires
distributed, (15) were returned. (5) out of the expected (9) nurses responded to the
questionnaire and (7) out of the expected (11) doctors responded to the questionnaire. The
data was analyzed based on the research questions as defined in chapter 2 and the results
presented.

4.1.1 Gender of the Respondents

Gender distribution was very essential as it presents the gender distribution of the
respondents of the study. It was also expected that gender could influence the adoption of
telemedicine amongst clinicians in Migori county referral hospital. The gender distribution
of the participants of the study is as follows: (65.4%) male where (35%) were nurses and
(31.2%) were doctors and (35%) female where (12.1%) were nurses and (15%) were
doctors.

4.1.2 Level of Education

It was necessary to describe the respondents’ level of education as it represents the

respondents’ level of education. Cross-tabulation was used to present the findings because
it can accommodate two, or more, variables. Its purpose was to examine the shared
distributions of the variables. Cross tabulation enabled the researcher to represent the
respondents’ level of education based on their designation. The education level with the
highest number of respondents was Bachelor’s Degree with (75%) of the respondents where
(29%) were nurses and (46%) were doctors. It was revealed that (20%) of the respondents
indicated that their highest level of education was Master/Post Graduate level. Table 4.1:

19
Education Level*Designation
Designation

Nurse Doctor Total

Education Level Masters/Post Graduate 2 2 4
Diploma
10% 10% 20%

Bachelor Degree 6 9 15

45% 30% 75%

Diploma 0 0 01

0.01% 0.01% 0.01%

Total 20

95%

4.1.3 Age distribution

Age distribution was sought in order to describe the respondents’ age distribution. A Cross-
tabulation was used to present the findings because it can accommodate two, or more,
variables.

20
Table 4.2: Age in Years*Designation
Designation

Nurse Doctor Total

Age in Years 50 and above 2 1 3

45-50 1 0 1

41-44 1 0 1

36-40 4 6 10

26-35 2 3 5

Total = 20
Count=20

4.1.4 Designation Distribution

It was necessary to describe the respondents’ designation which was used to define the
strata that were applied in the study. It was expected that respondents from different
designations behave differently when it comes to adoption of telemedicine.

21
Table 4.3: Designation of the Respondents
Frequency Percent
Nurse 09 45%
Doctor 11 55%

Total 20 100%

4.1.5 Work Experience

Work experience was sought in order to describe the respondents’ work experience in years.
A cross-tabulation was used to present the findings because it can accommodate two, or
more, variables. Its purpose was to examine the shared distributions of the variables. The
cross tabulation enabled the researcher to present the respondents’ work experience based
on their designation.

Table 4.4: Work Experience in Years * Designation

Designation

Nurse Doctor Total

Experience in Years 9 and above %Total

05 07
6-8 Years 41.67 58.3%

3-5 Years 42.86 57.14% 03 04

1-2 Years 1
01 00

Total =20
Count=85.53%

22
4.1.6Computer Literacy Level

Information was sought on the respondents’ computer literacy level because it was expected
that the higher the computer literacy level, the higher the rate of adoption of telemedicine
amongst clinicians. Cross-tabulation was used to present the findings because it can
accommodate two, or more, variables. A Cross tabulation enabled the researcher to present
the respondents’ computer literacy level based on their designation. Its purpose is to
examine the shared distributions of the variables. A cross-tabulation enabled presentation
of the respondent’s computer literacy level based on their designation, with the purpose of
examining shared distribution of variables

Table 4.5: Level of my computer literacy (Designation)

Designation

Nurse Doctor Total

Level of my computer literacy Count

Very high 4 5 09

High 2 3 05

1 0 01
Medium

Low 2 03
1
0 2 02
Very Low

Total =20

23
 CHAPTER FIVE

5.0 DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS

5.1 Introduction

This chapter summarized the important elements of the study, including the purpose of the
study, the research questions, the research methodology used and also major findings for each
research question or specific objectives. It also draws conclusions and makes
recommendations.

5.2 Summary

The purpose of the study was to investigate the factors that influence the adoption of
telemedicine amongst clinicians in Migori county referral hospital by answering the following
questions: to what extent does perceived ease of use of technology affect adoption of
telemedicine amongst clinicians in Migori, to what magnitude does perceived usefulness
determines adoption of telemedicine amongst clinicians in Migori and to what degree does
personality determine adoption of telemedicine amongst clinicians in Migori?

Descriptive research was applied to describe, explain and interpret conditions of the target
population. The demographic factors were described using percentages and frequencies after
which the relationship between each of the factors and adoption of telemedicine amongst
clinicians was analyzed using the Pearson’s correlation coefficient and the t-test of
independence.

From the research findings the majority of the respondents were aged 36-40 followed by 4144.
The study findings further established that most of the respondents were male. The designation
with the highest number of respondents was nurse. The study findings further established that
the highest level of education of majority of the respondent’s Bachelor’s degree and followed
by Masters/Post Graduate. Last but not least, most of the respondents had a work experience
of 3-5 years followed by 6-8 years.

With regard to the extent of adoption of telemedicine, the study found that telemedicine
applications are used to provide patient care quite a bit which could be translated to mean not
regularly but often. The study found that the extent of adoption amongst doctors and nurses
24
did not differ. This could be as a result of doctors and nurses working closely together. The
study established that there existed a positive correlation between perceived ease of use and
adoption of telemedicine amongst clinicians in Migori county referral hospital. Trialability,
compatibility and complexity which are factors linked to perceive ease of use in this study were
found to play an important role in explaining the perceived ease of use of telemedicine amongst
clinicians in Kenya. The study found that the significance of trialability, compatibility and
complexity amongst doctors and nurses did not differ. This could be as a result of doctors and
nurses working closely together.

The study found that there was a weak positive correlation between perceived usefulness and
adoption of telemedicine amongst clinicians in Migori. Relative advantage, compatibility and
observability which are factors linked to perceive usefulness in this study were found to play
a significant role in explaining the perceived usefulness of telemedicine amongst clinicians in
Migori county referral hospital. The study found that the significance of relative advantage,
compatibility and observability amongst doctors and nurses did not differ. This could be as a
result of doctors and nurses working closely together.

The study established that there is a significant correlation between the clinician’s personality
and adoption of telemedicine amongst clinicians in Migori county referral hospital. The big
five personality traits which were the dimensions used to investigate personality were found to
play an important role in determining adoption of telemedicine amongst clinicians in Migori
county referral hospital. The study found that the adoption of telemedicine was moderated by
the personality traits that were investigated. The study found that the significance of
extroversion, conscientiousness openness to experience, agreeableness and neuroticism
amongst doctors and nurses did not differ.

5.3 Discussions

5.3.1 Adoption of Telemedicine amongst Clinicians in Migori county referral hospital

The rate of adoption of telemedicine amongst clinicians in Migori county referral hospital was
generally very low level in most of the areas where clinicians operate except laboratory and
radiology. This is consistent with the study undertaken by Shikuku(2013), which concluded
that the extent of adoption of telemedicine systems amongst hospitals in Kenya is very low and
25
the study by Maurice(2010), which established that the adoption of telemedicine in sub-
Saharan Africa is low.

5.3.2 Perceived ease of use and adoption of telemedicine amongst clinicians in Migori county
referral hospital

The study found that the aspects of perceived ease of use that were investigated, trialability,
compatibility and complexity influence the adoption of telemedicine amongst clinicians in
Migori county hospital. This is in line with a study by Davis(2010), which explained that the
user’s perception of the amount of effort required to utilize a technology has an influence on
their behavioral intention to adopt it. The t-test of independence that was applied found that
the doctors’ and nurses’ responses in regard to the extent to which the respective aspects of
perceived ease influence the adoption did not differ.

5.3.3 Perceived Usefulness and Adoption of Telemedicine amongst Clinicians in Migori County
Referral Hospital

The research found that the aspects of perceived usefulness that were investigated,
compatibility, relative advantage and observability influence the adoption of telemedicine
amongst clinicians in Migori county hospital. The effects of the relative advantage,
compatibility and search of telemedicine literature revealed that telemedicine is successful and
therefore adopted into routine practice, when it is perceived as a benefit and as a solution to
political and medical issues (Lee et al, 2011).

5.3.4 Personality and adoption of telemedicine amongst clinicians in Migori County Referral
Hospital

Personality as a factor that influences adoption of telemedicine was investigated by

determining the relationship between the Big Five personality traits and adoption of
telemedicine amongst clinicians in Migori county hospital. It was found that personality traits
individually influenced adoption of telemedicine amongst doctors and nurses in varying ways.
McElroy et .al (2011), suggested the introduction of Big Five personality factors into models
of technology acceptance and adoption as an avenue for research. Devaraj(2010), found that
personality traits such as conscientiousness, extraversion, and agreeableness are positively
associated with adoption and these variables influence the intention to use a new technology.

26
The t-test of independence that was applied found that the doctors’ and nurses’ responses in
regard to the extent to which the respective aspects of attitude influence the adoption.

27
5.4 CONCLUSIONS

5.4.1 Adoption of Telemedicine amongst clinicians in Migori County Referral Hospital

The dependent variable for this particular study was the adoption of telemedicine. For the
purpose of this study, it was defined as the acceptance and continued use of telemedicine by
clinicians. This section discusses the level of adoption amongst clinicians in Migori county
hospital and the conclusions made in regards to the reasons for not adopting telemedicine.

5.4.1.1 The level of adoption of generally low amongst clinicians in Migori County Referral
Hospital

Nurses and doctors were found to seldom use telemedicine in most of their areas of work that
is patient consultation, prescribing drugs, major surgery and minor surgery. They were found
to mostly use telemedicine in laboratory and radiology only. It is therefore concluded that the
level of adoption of generally low amongst clinicians.

5.4.1.2 Lack of telemedicine equipment is a reason for not using telemedicine

Lack of access to computers was rated as one of the reasons for not using telemedicine along
with lack of time and insufficient incentives were also cited as some of the reasons for low
levels of use of telemedicine amongst clinicians in migori county hospital. It is therefore
concluded that lack of access to computers, lack of time and insufficient incentives are reasons
for not using telemedicine.

5.4.1.3 Lack of training is a reason for not using telemedicine

Clinicians’ inadequate training was cited as a reason for not using telemedicine amongst
clinicians in Migori county hospital. Majority of the study respondents were found to have low
levels of computer literacy. It is therefore concluded that lack of training and lack access to
telemedicine is important but it could only be supported by a system that is not only perceived
to be easy to use but also perceived to be useful to clinicians.

5.4.2 Perceived ease of use and adoption of telemedicine amongst clinicians in Migori County
Referral Hospital

This study expected that for the respondents to adopt telemedicine they will go through the
adoption stage which is part of the diffusion of the innovation process during which time they

28
would have an opportunity to determine the perceived ease of use of telemedicine. For the
purpose of this research, perceived ease of use was defined as a sum of complexity,
compatibility and trialability. Therefore, this section will discuss the conclusions made on
complexity, compatibility and trialability as aspects of perceived ease of use.

5.4.2.1 The more compatible telemedicine is with clinicians’ professional values and practical
values the more likely it is for clinicians to adopt it.

Clinicians would adopt telemedicine more easily if does not distort the diagnosis process.
The more compatible telemedicine is with a clinician’s practical values the more likely they
are to adopt it. Clinicians would adopt telemedicine if they feel in control when they use
telemedicine in their diagnostic endeavors. In addition to that clinicians would adopt
telemedicine if it did not cause them to change anything they do when they currently use
telemedicine.

Adoption of telemedicine amongst doctors and nurses is determined by how much it is

compatible with their professional values. Clinicians would adopt telemedicine if it does not
breach patient confidentiality. In addition to that, clinicians would also adopt telemedicine
more easily if the law was clear on the jurisdiction of telemedicine.

5.4.2.2 The more trialable telemedicine is the more likely it is for clinicians to adopt it

Adoption of telemedicine amongst doctors and nurses is determined by how trialable it is. The
respondents said they more likely to adopt telemedicine if they were allowed exposed to the
system prior to its deployment without full commitment. The study found that the doctors and
nurses would adopt telemedicine if they were involved in the implementation process by being
allowed to participate in demos from different suppliers, being involved in the selection process
and being involved in the pilot test.

The respondents indicated that they would adopt telemedicine more easily if implementers
allowed them to use telemedicine on a trial basis and acted on the feedback that they share with
them.

29
5.4.2.3 Clinicians find interacting with telemedicine complex.

The study respondents agreed that telemedicine systems have too many errors that clinicians
cannot resolve for themselves, learning how to use telemedicine applications being tedious
clinicians have to acquire technical assistance and that finding information in telemedicine
applications is tedious. This could be as a result of the low level of computer literacy amongst
the respondents as well as the little training provided to clinicians on how to use telemedicine

5.4.3 Perceived usefulness and adoption of telemedicine amongst clinicians in Migori County
Referral Hospital

This study expected that for the respondents to adopt telemedicine they will go through the
adoption stage which is part of the diffusion of the innovation process during which time they
would have an opportunity to determine the perceived usefulness of telemedicine. For the
purpose of this research, perceived ease of use was defined as a sum of relative advantage,
observability and compatibility. Therefore, this section will discuss the conclusions made on
relative advantage, observability and compatibility as aspects of perceived usefulness.

5.4.3.1 The more relative advantage telemedicine presents to clinicians the more likely they
are to adopt it

This was supported by the doctors and nurses agreeing that telemedicine will improve their
diagnostic endeavors. The respondents were found to agree that they would adopt telemedicine
more easily because it would translate to less travel to attend to patients. In particular,
physicians treating home health patients have especially benefited from the ability to deliver
higher quality care. It was further revealed that the nurses and doctors agree that telemedicine
makes information dissemination more efficient and that telemedicine presents more
advantages than disadvantages over the manually written notes.

5.4.3.2 The more observable telemedicine is to clinicians the more likely they are to adopt it

The respondents were preferred not to use telemedicine because their colleagues are
highlighting its weaknesses. They indicated that they would adopt telemedicine more easily, if
one of the members of the implementation team was their colleague. The respondents generally
agree that it would be easier to use telemedicine if they heard that doctors in other hospitals
are using similar applications, they learn new ways of using telemedicine from their colleagues.
30
Telemedicine implementers should be aware that respondents do not have issues informing
their colleagues of how their experience using telemedicine.

5.4.4 Personality and adoption of telemedicine amongst clinicians in Migori County Referral
Hospital

The third and final objective of the study was to examine the extent to which personality
influences the adoption of telemedicine amongst clinicians in Kenya. This information was
sought because it was expected the more a clinician was an extravert the more likely they would
adopt telemedicine. In addition, neuroticism was investigated because it was expected that the
more neurotic a clinician was, the less likely they would adopt telemedicine.

Conscientiousness was also investigated because it was expected that the more conscientious
a clinician was the more likely they would be to adopt telemedicine. Openness to experience
on the other hand was investigated because it was expected that the more a clinician was open
to experience the more likely they would be to adopt telemedicine. Agreeableness was
investigated because the more agreeable a clinician was the more, they were likely to adopt
telemedicine.

5.4.4.1 Clinicians who are extroverts will learn how to use telemedicine faster.

The researcher concluded that the more extraverted clinicians are the more likely they are to
adopt telemedicine technology as they have thoughts such as: telemedicine will enhance their
ability to make referrals because patient records are online and that it will enable them see
more patients. They will also be more inclined to discover system shortcuts that make the
patient care using the telemedicine technology more easily. Extroverts will also be more likely
to share their sentiments on telemedicine technology with their peers. Therefore, involving
extrovert clinicians in telemedicine deployment could enhance the system’s observability.

5.4.4.2 Clinicians who are neurotic are less likely to adopt telemedicine.

The researcher concluded that the more neurotic clinicians are the less likely they are to adopt
telemedicine technology as they have thoughts such as: telemedicine will increase their
workload, lead to the loss of jobs in future, vendors exaggerate on the advantages of
telemedicine.

31
5.4.4.3 Clinicians who are conscientious are more likely to adopt telemedicine

The researcher concluded that the more conscientious clinicians are the more likely they are to
adopt telemedicine technology as they have thoughts such as: use of telemedicine will increase
my efficiency and patient record management is enhanced when clinicians use telemedicine to
provide patient care. Contentious clinicians are also more likely to strongly support the use of
telemedicine technology at their work place.

5.4.4.4 Clinicians who are open to experience are more likely to adopt telemedicine

Further, the researcher concluded that the more open to experience clinicians are the more
likely they are to adopt telemedicine technology as they have thoughts such as: looking forward
to the extent to which telemedicine will enhance the patient experience, they will learn the
shortcuts to make use of telemedicine faster than their peers and learning to use telemedicine
will be an exciting learning experience. Therefore, clinicians who will be happy to learn how
to use telemedicine in order to contribute to organizational goals and will find not find learning
telemedicine very stressful are more likely to adopt telemedicine technology.

5.4.4.5 Clinicians who are agreeable e are more likely to adopt telemedicine

The researcher also concluded that the more agreeable clinicians are the more likely they are
to adopt telemedicine technology as they have thoughts such as: they will be happy to learn
how to use telemedicine in order to contribute to organizational goals and that learning how to
use telemedicine will not be a stressful process for them.

32
5.5 RECOMMENDATIONS

The goal of this study was to investigate factors that influence adoption of telemedicine
amongst clinicians in Kenya. This section will discuss the recommendations that were drawn
from the findings on perceived ease of use, perceived usefulness and personality as aspects of
adoption of telemedicine amongst clinicians in Migori County Referral Hospital.

5.5.1 Adoption of Telemedicine amongst clinicians in Migori County Referral Hospital

The Migori County Referral Hospital administration should include basic ICT training in the
continued medical education. This will make learning how to use telemedicine easier.

5.5.2 Perceived ease of use and adoption telemedicine amongst clinicians in Migori County
Referral Hospital

In order to enhance practical and professional compatibility, system developers should

endeavor to design systems that ensure patient confidentiality and do not deviate from the
clinicians’ traditional work process. Healthcare legislators should develop laws that govern the
use of telemedicine in order to resolve the issue of the jurisdiction within which clinicians can
operate.

5.5.3 Perceived usefulness and adoption of telemedicine amongst clinicians in Migori County
Referral Hospital

Clinicians are aware of the advantages that telemedicine presents; hence hospital
administration should enhance its observability by including telemedicine demonstrations in
the clinicians continued medical education sessions. It would be more efficient for telemedicine
implementers to train identified clinicians who will in turn train their colleagues because it was
found that clinicians are more likely to adopt telemedicine if they find that it makes their
colleagues more efficient and effective.

5.5.4 Personality and adoption of telemedicine amongst clinicians in Migori County Referral
Hospital

In regard to personality as a factor that influences the adoption of telemedicine amongst

clinicians in Migori county hospital, the researcher recommends that when the clinicians’
representative for the telemedicine project is being selected, individuals with strong traits of

33
extroversion, agreeableness, conscientiousness and openness to experience should be given
first priority.

As a result of their outgoing and self-motivated nature they will learn the system quickly,
discover system shortcuts more easily and enhance its observability amongst peers.

5.5.5 Recommendations for Further Study

This study focused on the extent to which perceived ease of use, perceived usefulness and
attitude influence adoption of telemedicine amongst doctors and nurses. To enhance the
understanding of the adoption amongst clinicians, studies could be undertaken on the perceived
ease of use, perceived usefulness and attitudes of physiotherapists, dentists and nursing
assistants. Studies could also be undertaken on the attitudes of patients and the community as
factors that influence adoption of telemedicine in Migori county hospital. A study on how the
hospital administration’s attitude towards telemedicine influences its implementation would
add value because they are at the core of resource allocation. Further studies could also be
carried out on the challenges faced in the implementation of telemedicine.

34
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Telehealth Services. The Information Technology & Innovation Foundation.

Computer Aid International. (2013). Telemedicine: Improving Healthcare in East Africa.

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Devaraj, S., Easley, R. F., & Crant, J. M. (2010). How does personality matter? Relating the
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Sheba, G., & Hamilton, A. (2012). How Do Low-Income Urban African Americans and
Latinos Feel about Telemedicine? A Diffusion of Innovation Analysis. International
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Shikuku, S. (2013). Adoption of Telemedicine in Hospitals in Nairobi County.

Smith, A. (2014, April 3). Adoption is increasing, but many seniors remain isolated from
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36
 APPENDICES

Appendix I: Letter to Respondents

BRIAN OTIENO,

P.O.BOX 59865-00200,

MIGORI, KENYA.

MIGORI COUNTY REFERRAL HOSPITAL,

P.O.BOX 2002, SUNA, MIGORI

MIGORI, KENYA

Dear Sir/Madam

RE: QUESTIONNAIRE FOR A SURVEY ON FACTORS THAT INFLUENCE THE

IMPLEMENTATION OF TELEMEDICINE

I am currently pursuing a course in Diploma in Community Health Nursing at Kenya Medical Training
College, Migori campus. In partial fulfillment of the course, I am undertaking a study to investigate
more about the factors that influence adoption of telemedicine amongst clinicians in Migori County
Referral Hospital. I believe the results will not only be of value to individual clinicians but will also
help healthcare industry stakeholders better identify the wind of information, incentives, and assistance
essential to successful implementation of telemedicine in Migori county hospital You are part of a
representative sample of 20 clinicians, your opinions on perceived ease of use, perceived usefulness
and attitude as influencers of telemedicine adoption are critical to the success of my study, I recognize
the value of your time and sincerely appreciate your efforts. Individual responses are anonymous and
data will be held discreetly.

Regards,

Brian Otieno

Brianotieno793@gmail.com

37
Appendix II: Questionnaire for Doctors and Nurses

Section A: Personal Information

Please answer the questions by either ticking one of the options or writing the answer in the
space that is provided as applicable.

1. Gender

[ ] Male [ ] Female

2. Age in years

[ ] Between 26-35 [ ] Between 36-40 [ ] Between 41-44

[ ] Between 45-50 [ ] 50 and above

3. Education

[ ] High School [ ] Diploma [ ] Bachelor

[ ] Masters [ ] PHD [ ] Other......................................

4. Designation

[ ] Nurse [ ] Nursing Manager [ ] Clinical Medical Educator

[ ] Resident Doctor [ ] Consultant [ ] Other……………………

5. How long have you been working as a clinician....................................?

[ ] 1-2 Years [ ] 3-5 Years [ ] 6-8 Years [ ] 9 and above Years

38
SECTION A: Adoption of Telemedicine amongst Clinicians in Kenya 6. My computer
literacy rate is [ ] High =1 [ ] Low=0
7. On a scale of 1-5, where 1=Low and 5= high rate your computer skills in each of the below
applications

1 2 3 4 5

CL1 Word Processer

CL2 Spreadsheets or excel

CL3 Databases

CL4 Statistics package

CL5 Presentation software

CL6 Copy and transferring files

CL7 Scanning and creating PDF

CL8 Telemedicine applications

8. Are you registered as a user on the Aga Khan University telemedicine system? [ ] Yes=2

[ ] No=1

9. Have you ever been invited/been required to attend telemedicine training?

[ ] Yes=2 [ ] No=1

10. How many times do you use telemedicine systems to provide patient care?

(a) Not Applicable= 0 (b) Never=1 (c) Seldom= 2 (d) Quite a bit=3 (e) Mostly=4 (f)
Always=5

39
Section B: Perceived ease of Use as a Factor Influencing the Adoption of Telemedicine
amongst Doctors and Nurses in Migori County Referral Hospital
For the purpose of this study, perceived ease of use (PEOU) is the degree to which a
clinician believes that telemedicine is easy to use and understand.

11. Please tick the option that expresses the extent to

which you agree or disagree with the below statements.

PEOU1 I believe that telemedicine is likely to

breach patient confidentiality.
Compatibility

PEOU2 The diagnosis process is distorted by

the lack of physical presence.
Compatibility

PEOU3 I am more likely to use telemedicine

because of being part of a pilot test
Trialability

PEOU4 I like the idea of trying out telemedicine

technology on trial basis before
Trialability deciding whether they like it or not

PEOU5 Learning how to use telemedicine

applications is difficult
Complexity

PEOU6 I think that finding information in

Complexity telemedicine applications is tedious

40
Section C: Perceived ease of Use as a Factor Influencing the Adoption of Telemedicine
amongst Doctors and Nurses in Migori County Referral Hospital
For the purpose of this study, perceived usefulness (PU) is the probability that using the
telemedicine would improve the way a clinician provides patient care.
12. Please tick the option that expresses the extent to
which you agree or disagree with the below
statements.

I believe that telemedicine has the

PEU1
potential to improve the clinician’s
Relative diagnostic endeavors.
advantage
Telemedicine makes the
PEU2
prescribing process easier.
Relative
advantage
Telemedicine technology makes it
PEU3 more difficult to adhere to hospital
policies such as patient care
Compatibility
documentation.
Telemedicine equipment will work
PEU4 better if it was installed on mobile
devices.
Compatibility

I learn new ways of using

PEU5 telemedicine from my colleagues
Observability

PEU6
Observability Other clinicians using telemedicine
like using it.

41
Section D: Personality as a Factor Influencing the Adoption of Telemedicine amongst Doctors
and Nurses in Migori County Referral Hospital
Personality is described as the individual’s responses to particular situations.

13.Please tick the option that expresses the extent to

which you agree or disagree with the below statements

ATT1 Telemedicine will enable me

provide care to more patients.
Extraversion
ATT2 Telemedicine will degrade the
quality of care due to reduced
Extraversion
patient doctor contact
ATT3
Telemedicine could lead to
Neuroticism loss of jobs in the future.
ATT4 Telemedicine vendors
Neuroticism exaggerated on the
advantages of telemedicine
ATT5 Telemedicine vendors should
educate users on the
Conscientiousness
disadvantages as well
ATT6 Use of telemedicine will
Conscientiousness increase my efficiency

ATT7
Learning how to use
Openness to telemedicine will be an
experience exciting learning experience
ATT8 I look forward to discovering
Openness to the extent to which
experience telemedicine will enhance
patient experience
Openness to
experience
ATT9 I am worried telemedicine
will lead to loss of jobs
Agreeableness
ATT10
Learning telemedicine will be
Agreeableness
very stressful to me

42
 APPENDIX III: WORK PLAN.

OBJECTIVE JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER

2022 2022 2022 2022 2022 2022

Title and
Introduction

Literature Review

Methodology and
Writing

Proposal Typing and

Printing

43
 APPENDIX IV: BUDGET

NAME QUANTITY PER ONE ITEM TOTAL COST

PENS 5 30 150

FULLSCAPS 450 450 450

PENCILS 3 20 60

RUBBER 2 50 100

SHARPENER 2 30 60

RULER 1 50 50

FILE 1 250 250

NOTEBOOK 2 150 300

REAM PAPERS 1 700 700

TYPING AND 2 copies 1000 1000

BINDING

LUNCH X15 1500 1500

AIRTIME 500 500 500

MISCELLENIOUS 10/100x6000 600 600

GRAND TOTAL 5,380

44