The Determinants of the Use of Telemedicine in Senegal
Creators: name: Ly, Birama Apho
Publisher: name: Université d'Ottawa / University of Ottawa
Year: 2016
Subjects: Physicians’ perception
Physicians' beliefs
Physicians' intention
Contextual factors
Telemedicine
Telehealth
Micro, meso, macro framework
Theory of planned behaviour
Senegal
Africa

description: Introduction In Senegal, as in many countries, physicians are unevenly distributed. This situation leads to health inequalities, but the solutions adopted to distribute physicians equitably do not give satisfactory results. This situation pushes decision-makers and researchers to look for other solutions such as telemedicine. This technology-based solution is considered to be a good means to improve physician recruitment and retention in underserved areas, thus improving access to healthcare in these areas, but it is still underused in Senegalese health facilities. Objective This study aimed to identify the determinants of the use of telemedicine in Senegal. More specifically, it aimed to identify the individual (micro) and contextual (meso and macro) factors that influence the use of telemedicine in Senegal. Method The study involved mixed methods: a descriptive qualitative study involving individual interviews and a cross-sectional quantitative study involving questionnaires. The first method was used to study the individual (micro) factors such as physicians’ beliefs on the use of telemedicine and physicians’ perception of the impact of telemedicine on their recruitment and retention in underserved areas. It was also used to study the contextual meso (technical, organizational and ethical) and macro (financial, political, legal and socioeconomic) factors that influence the use of telemedicine. The second method was used to study participants’ intention to use telemedicine in their professional activities, another individual (micro) factor. This study included physicians working in public hospitals, those working in district health, and telemedicine projects managers. Qualitative data was collected through individual interviews, transcribed and imported into NVivo 10 where they were coded thematically. Quantitative data was collected by administering questionnaires and analyzed using SPSS 23. Results The results showed that telemedicine could contribute to, but could not guarantee the recruitment and retention of Senegalese physicians in underserved areas. It was found that physicians in Senegal have both positive and negative behavioural, normative and control beliefs that can encourage or discourage them from using telemedicine in their professional practice. The most salient behavioural beliefs were that telemedicine makes experts’ opinions accessible across distances (positive behavioural belief), but could lead to medical errors (negative behavioural belief). The most common normative beliefs were that their patients would most probably approve the use of telemedicine (positive normative belief) while their colleagues working in the public sector might disapprove of it (negative normative belief). The most reported control beliefs were that the use of telemedicine is easy (positive control belief), but could be time-consuming (negative control belief). For physicians in Senegal, the findings also demonstrate that the probability that they will use telemedicine in their professional activities is moderate and influenced by their perceived behavioural control which, in turn, is influenced by their positive and negative control beliefs. Finally, the results demonstrate that many contextual meso (technical, organizational and ethical) and macro (financial, political, legal and socioeconomic) factors influence the use of telemedicine in Senegal. Conclusion The results of this study can inform the choice of telemedicine development strategies. These strategies can help to promote the use of telemedicine in Senegal, which in turn can help to increase physician recruitment and retention in underserved areas, resulting in better access to healthcare and, and as a result improved population health.