Healthcare workers’ perspectives on the barriers and facilitators to digital health technology use to support symptomatic cancer diagnosis in South Africa and Zimbabwe: a qualitative study (Preprint)
Authors: Arendse Kirsten Deanne , Day Sarah , Guzha Bothwell Takaingofa , Ras Tasleem , Sills Valerie Anne , Moodley Jennifer , Walter Fiona M , Scott Suzanne E 
Published: November 2024

BACKGROUND

Despite improvements in early cancer diagnosis globally, morbidity and mortality in Southern Africa continue to rise. Challenges with funding, sociocultural beliefs, and healthcare access underlie the evolving cancer burden in the region. The increasing global use of digital health has the potential to expand healthcare access, particularly to remote communities, and expand support for healthcare workers (HCWs). However, there is limited research exploring the readiness to use digital health to support symptomatic cancer diagnosis in Southern Africa.

OBJECTIVE

This study explored the barriers and facilitators of digital health use by HCWs to support the management of people presenting with symptoms of possible breast, cervical or colorectal cancer in South Africa (SA) and Zimbabwe.

METHODS

We conducted semi-structured in-depth interviews (IDIs) with HCWs (n=56) across all levels of healthcare in SA and Zimbabwe who managed patients with symptoms of possible cancer. Conducted in English or local languages, interviews were audio-recorded, translated into English, and transcribed. Data were analyzed using framework analysis. To check the credibility of results, early findings were shared at four clinical advisory group workshops with 26 participants.

RESULTS

Median age of IDI participants was 44 years, 38 (68%) were female, and most were nurses (n=34, 61%) or doctors (n=18, 32%). Four themes were developed: 1) the lack of reliable infrastructure (e.g., access to electronic devices, internet, and electricity) hindered technology use among HCWs; 2) the use of personal mobile devices increased digital health access at the expense of patient privacy and personal cost; 3) Information, workflow integration, and access: while digital health improved access to information, many tools were already in use, were poorly integrated into workflow, and use disrupted consultations; 4) Digital health is expanding whether we like it or not, describes a spectrum of attitudes toward digital health, ranging from enthusiasm to resistance but willingness to adapt to those completely against its use. Themes from the workshops were concordant with the IDI findings.

CONCLUSIONS

To capitalize on the potential benefits of digital health use among HCWs to improve early cancer diagnosis, infrastructural challenges must be addressed, tools designed to meet user needs and be integrated into clinical workflow. For the value of digital health to be realized in Southern Africa, as in many other resource-constrained settings, significant improvements in development are required. In addition, where resources such as electricity are limited, its use for eHealth needs to be weighed against its use for other priorities such as operating ventilators. Furthermore, energy production in these regions is largely reliant on burning fossil fuels and use of eHealth tools risks contributing negatively to climate change. The findings of this study can be used to guide future digital health design or implementation strategies that are more contextually suitable.

CLINICALTRIAL

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