A case study exploring elements within the use and possible future use of Internet and mobile technologies for health service delivery

1. Information and communication technologies in health care service delivery

2. An exploratory study

3. Acknowledging that technology as used in healthcare service delivery is a social-technical system

4. A case study exploring elements within the use and possible future use of Internet and mobile technologies for health service delivery

5. Service sector under scrutiny -midwifery service delivery

6. Midwifery health service sector was chosen: Why? Users of midwifery service are well women who receive relatively standardised care for a clearly defined period of time. Data collection does not interfere with service delivery as semi-structured interview data is collected after the healthcare service encounter. Women ~15 – 45 are likely to be active users of new technologies compared with other groups of people receiving healthcare.

7. Why (continued) Midwives practice in clinics and birthing centres/hospitals and women’s homes, therefore it is a mobile service setting and mobility presents a challenge. Different generational populations have different perceptions and expectations. Current service users are predominantly ‘generation Y’ (~18 – 32) but ‘generation Z’ (0 – 18) are now reaching childbearing age and are the first generation to be termed ‘digital natives’. Marketers of products and services are heeding these generational differences.

8. Time frame under scrutiny (~40 weeks, women care at ~6 weeks post conception )

9. Players

10. Guiding questions What are the current assets and actions (use) of technology of both groups? Current every-day assets and actions and also Within the defined setting What are the initial perceptions, attitudes and feelings of consumers (women) and health care professionals (midwives) regarding the value of using the Internet and mobile technology? What are the barriers (perceived or otherwise) and facilitators to acceptance of these technologies?

11. (continued) Are there time saving efficiencies? Are there perceived risks? Are there perceived benefits? Can current information and communication technologies enhance the service delivery process? If so, how?

12. Methodology Case study using semi structured interviews and grounded theory techniques

13. Case study Using one (of twenty one) District Health Boards (DHB) in New Zealand. One clearly defined geographical region (Hawke’s Bay). Using only independent midwives gives a tightly defined group. Using a population which includes a high percentage of Maori women, Pacific Island women, and rural women groups.

14. Data collection:Semi-structured interviews Midwives: who practice independently within the Hawke’s Bay region. Women: after they have been discharged from midwifery care.

15. Data collection

16. Mobile and Internet technologies

17. Explosion in growth There has been an explosion in the growth of information and communication technologies and particularly mobile technologies. There are around 45 million Internet users compared with <4 billion mobile phone subscribers (2008)* Cost is an inhibiter for mobile but many more now rely on mobile only and there is a clear shift in this direction.. *http://www.itu.int/newsroom/press_releases/2008/29.html

18. The rise and rise of mobile phone subscribers * http://www.itu.int/newsroom/press_releases/2008/29.html

19. Percentage increase in broadband subscription rates 2004 – 2006 (NZ) * * ttp://www.med.govt.nz/templates/MultipageDocumentPage____32729.aspx

20. Broadband New Zealand broadband subscription rates are 20th out of 24 OECD countries but the rate growth in uptake of broadband is second out of 14 countries.* *http://www.med.govt.nz/templates/MultipageDocumentPage____32729.aspx

21. Mobile phone subscribers per 100 inhabitants (2005) http://www.med.govt.nz/templates/MultipageDocumentPage____32729.aspx

22. New Zealand has more mobile phone subscriptions than people (6th out of 24 OECD countries.*)*http://www.med.govt.nz/templates/MultipageDocumentPage____32729.aspx

23. Mobile phones Mobile phones can be seen as disruptive technologies because they are changing the ‘traditional’ way of communicating and transferring information.

24. Mobile phones (continued) In New Zealand, there is greater use of mobile phones using 2G technology which enables voice and SMS. 3G networks enable high speed broadband but cost is an inhibiter.

25. New Zealand is stepping towards ubiquitous computing anytime always available anywhere

26. and there is a trend towards …

27. Internet-centred communication

28. and a shift towards….

29. Mobile communication By the end of 2008, there were over three times more mobile cellular subscriptions than fixed telephone lines globally. Two thirds of those are now in the developing world compared with less than half in 2002. International Telecommunication Union Report http://www.itu.int/newsroom/press_releases/2009/07.html

30. and convergence of technologies

31. Health consumers are seeking and are expecting appropriate (to the person) information to make better informed decisions.But they would do better with guidance.

32. Participatory health care results in care that is customised to the needs of each particular person. This may lead to greater ownership of decision outcomes.

33. Information and communicationtechnologies are now able to provide more and diverse ways for health care providers and patients to communicateand transfer information.

34. Midwife Woman

35. Information from midwiveshas been found to beimportant in trust development within midwifery service delivery. Bova, C., Fennie, K. P., Watrous, E., Dieckhaus, K. & Williams, A. B. (2006) The health care relationship(HCR) trust scale: Development and psychometric evaluation. Research in nursing & health, 29, 5, 477-488.

36. Communication enables the midwife – women’s relationshipRecent new and converging technologies haveprovided many diverse ways of communicating.

37. Consumer expectations Web 2.0 aware consumers will demand to have access to, and to control their data. Eysenbach: Consumer health informatics http://www.slideshare.net/eysen/eysenbach-consumer-health-informatics

39. Another definition of Consumer Health Informatics Eysenbach: Consumer health informatics http://www.slideshare.net/eysen/eysenbach-consumer-health-informatics

40. Opportunities and conditions for information and communication Technologies to increase consumer satisfaction

41. Acceptance of new technologies is affected by many conditions. Venkateshand Rogers are major contributors to understanding this topic.

42. Conditions affecting user acceptance of technology Venkatesh Venkatesh, V., Morris, M.G., Davis, F.D., and Davis, G.B. “User Acceptance of Information Technology: Toward a Unified View,” MIS Quarterly, 27, 2003, 425-478

43. Diffusion of innovations (Rogers 1995) Rogers, E. Diffusion of Innovations. 4th edition 1995

44. Some people take longer to accept inevitable change Rogers Diffusion of Innovation Curve (1995)

45. Dallas Knight April 2010