The individual and contextual determinants of the use of telemedicine: A descriptive study of the perceptions of Senegal's physicians and telemedicine projects managers

• Published in: PloS one Vol. 12; no. 7; p. e0181070
• Main Authors: Ly, Birama Apho, Labonté, Ronald, Bourgeault, Ivy Lynn, Niang, Mbayang Ndiaye
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.07.2017; Public Library of Science (PLoS)
• Subjects: Adult; Ambulatory care; Analysis of Variance; Attitude of Health Personnel; Computer and Information Sciences; Culture; Data processing; Decision making; Design factors; Engineering and Technology; Ethics; Female; Health care; Health care facilities; Hospitals; Hospitals, Public; Humans; Informatics; Interviews as Topic; Male; Management; Medical care; Medical ethics; Medical personnel; Medicine and Health Sciences; Middle Aged; People and Places; Physical Sciences; Physicians; Physicians - psychology; Politics; Population; Practice; Practice Patterns, Physicians; Qualitative analysis; Random sampling; Recruitment; Researchers; Retention; Rural areas; Sampling; Senegal; Social Sciences; Socioeconomic factors; Studies; Surveys and Questionnaires; Telemedicine; Telemedicine - economics; Telemedicine - legislation & jurisprudence; Workloads; Senegal
• DOI: 10.1371/journal.pone.0181070
• ISSN: 1932-6203

Telemedicine is considered to be an effective strategy to aid in the recruitment and retention of physicians in underserved areas and, in doing so, improve access to healthcare. Telemedicine's use, however, depends on individual and contextual factors. Using a mixed methods design, we studied these factors in Senegal based on a micro, meso and macro framework. A quantitative questionnaire administered to 165 physicians working in public hospitals and 151 physicians working in district health centres was used to identify individual (micro) factors. This was augmented with qualitative descriptive data involving individual interviews with 30 physicians working in public hospitals, 36 physicians working in district health centres and 10 telemedicine project managers to identify contextual (meso and macro) factors. Physicians were selected using purposeful random sampling; managers through snowball sampling. Quantitative data were analyzed descriptively using SPSS 23 and qualitative data thematically using NVivo 10. At the micro level, we found that 72.1% of the physicians working in public hospitals and 82.1% of the physicians working in district health centres were likely to use telemedicine in their professional activities. At the meso level, we identified several technical, organizational and ethical factors, while at the macro level the study revealed a number of financial, political, legal, socioeconomic and cultural factors. We conclude that better awareness of the interplay between factors can assist health authorities to develop telemedicine in ways that will attract use by physicians, thus improving physicians' recruitment and retention in underserved areas.