Effects of Adopting Patient-Centred Healthcare Information Systems on Management of Personal Health and Wellbeing among the Elderly and Patients Living With Chronic Diseases in Homa Bay County, Kenya

AbstractHealth care delivery systems across the world have undergone major transformations in the last two decades. Researchers have associated these changes with three key drivers of change in the health sectors: advances in modern medicines and medical technologies; care shifts from acute, episodic care to chronic disease management; and adoption of information and communications technologies (ICTs) by the health sectors. These transformations have resulted in both positive and negative health outcomes. The number of patients suffering from acute diseases has significantly reduced leading to improvements in life expectancy and quality of life in general. The health sectors have also experienced sharp increases in cases of chronic diseases and other health conditions resulting from old age and lifestyle diseases. On the overall, these transformations have triggered a major paradigm shift in the care delivery model. Traditionally, diagnosis, treatment and care for a patient suffering from acute disease would happen in a hospital setting. Today, the hospital is for dealing with acute, life-threatening diseases, and once the patients have stabled, they are handed over to home- and community-based care centres where the focus is on active participation and involvement of patients and families in the management of personal health and well-being. The shift in care model has created a transition gap in which there are no linkages between hospitals and community-based care centres, i.e. there are no structured means by which health information can reach the patients and families. Therefore, in this new dispensation, health information will be needed to leverage the engagement of patients and families in the management of personal health and care. Access to and delivery of health services in Kenya is varied from county to county. In a county like Homa Bay County, for example, the number of people under home- and community-based care, and therefore, in need of health care information is on the rise, owing to the county’s past health demographics. The Ministry of Health has given Homa Bay’s current health situations as follows: number of people living with HIV virus (53,962), mother-to-child transmission of HIV virus (9.0%), malaria test positive rate (46.0%), malaria cases per 100, 000 people (58, 820), and Tuberculosis prevalence and incidence per 100, 000 people (433) and (85) respectively. This means that the number of care dependent and people who will have to consume health care information either in their homes or community-based care centres will always continue to grow. This happens against a general backdrop, across the country, of the inadequate number of trained health personnel, and high costs of medications and acute shortages of medical supplies. Given the current state of Kenya’s national health care delivery system, there is an urgent need for more research efforts to be directed towards finding new and better ways of improving access to health care information. One area that has attracted the interests of both practitioners and academics alike, is the recent innovation in which ICT-based solutions are employed for the delivery of health care services. Nonetheless, despite the prevalent belief that the use of ICTs by health sectors could revolutionise the country’s health care delivery systems, the extant literature reveal that little or no major research activity has been carried out on these critical topics in recent past, in Kenya, both at the national and county levels. Therefore understanding the roles which ICTs can play in enhancing active participation and involvement of patients and their families in health care management would be of great interest. The purpose of this research will be to investigate the effects of using ICT-based solutions on the management of personal health and well-being among the elderly and patients living with chronic illnesses in Homa Bay County. This purpose will be guided by a set of specific objectives: assess the current health information needs of the elderly and patients living with chronic diseases which could be addressed using ICT-based solutions; describe the effects of using ICT-based solutions on active participation and involvement of patients and families in management of personal health and wellbeing; and identify the positive health outcomes that could be derived from using ICT-based solutions in management of personal health and well-being among the elderly and patients living with chronic diseases. Both the purpose and research specific objectives will be anchored on four key assumptions held by the researcher about patient engagement in health care, and which will be analysed in an attempt to solve the current health challenges facing the elderly and patients living with chronic diseases in Homa Bay County. These assumptions are: 1.) patients are ill-equipped to effectively use ICTs to participate in management of their health because of prevalent low health care literacy levels among them; 2.) health information is something that only doctors can give since doctors/medical personnel know what is best suited for patients, and that use of ICTs will compromise this role; 3.) using ICTs to provide patients and families with disease information would enhance their health care literacy levels and abilities to participate in the management of personal health and well-being; and 4.) information and communications technologies (ICT) can be used to improve access and delivery of health care information to patients and their families. The analysis of the assumptions above will add nuance to our understanding of how ICTs could be deployed by health sectors to enhance access to health care information by patients and their families for use in decision-making. The researcher will adopt three theories which will provide the theoretical grounding and framing of the research process. These will be the Information Theory, System Thinking Theory and Social Cognitive Theory. The researcher will employ content analysis technique which involves an intensive review of relevant, current sources of information as a form literature review. The literature review will be detailed and broad; covering primary, secondary and tertiary sources. Specifically, the researcher will consult journals, dissertations, theses, white papers, reports, conference proceedings, official government publications, textbooks, newspapers, newsletters, contents from websites and grey material on relevant topics and subtopics to identify current knowledge gaps within the research topic. This research will be conducted in Homa Bay County. The research design will be qualitative. This is because the qualitative research design will allow the researcher to be closer to the research locations and gain a clear understanding of the phenomena under investigation through observation, semi-structured interviews and document analysis. Purposive sampling technique will be used to select participants and decide on the number best suited to help the researcher understand the problem and research questions. The research participants will be drawn from three main stakeholder groups: the elderly, patients living with chronic diseases and their relatives; medical professionals (doctors, clinical officers, nurses and social workers), and home- and community-based caregivers. Data collection will be carried out at the participant’s natural settings (hospitals, health centres and home- and community-based care centres). The interviewing will be conducted through face-to-face, telephone and focus group interviews. Participant observations and recordings of participant responses will be done alongside the interviews. New participants will be included as interviewing progress up to saturation point. The recordings of participant responses and notes on participant behaviour and activities will be used for the purposes of data analysis. The data collected from the interviews will be analysed and interpreted using both descriptive and qualitative techniques to provide study findings which will be used by the researcher to draw conclusions and derive recommendations. The data and information generated from this research will be used by the researcher to inform the design and development of a web-based health care information system prototype which can be upscaled for use by residents of Homa Bay County to improve access to health care information. This research will generate new insights and knowledge that will assist in developing evidence-based frameworks and methodologies for measuring the impact of use ICT-based solutions to provide health-related information services on active participation and involvement of patients and families in the management of care. The findings of the research will have scientific relevance with respect to our understanding how the integration of patients and families in the management of personal health can help improve health outcomes of the elderly and patients living with chronic diseases. The findings will also increase our scholarly understanding of the interrelations between different forms of ICT-based solutions for in delivery of health care services—how the use of ICT could influence patient behaviours with respect to their active participation and involvement in the management of personal health and well-being. Further, the research will provide useful insights into the adoption of ICT-based solutions in the delivery of health services. This will likely have direct implications for practitioners and policy makers in planning and improving the national health care delivery system. Lastly, the research will stimulate further research and open up academic discourses in similar and related topics on the applications of ICT-based solutions to health care delivery.

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