Professional Documents
Culture Documents
to Hospital IS in Nigeria/Benson 1
ISSN
2159-6743
(Online)
Assessing
Barriers
to
Adoption
of
Hospital
Information
Systems
in
Nigeria
Ayodele
Cole
Benson,
MB
BCH,
PhD
DHA
*
Abstract
This paper provides detailed information on the mixed method case study research using indepth interviews and a questionnaire-based survey to ascertain the barriers hindering
adoption of hospital information systems in Nigeria. The discussion in this paper provides
the problem that a robust health care policy on implementation of a hospital information
system is lacking in Nigeria and that caregivers in the country have yet to commence
noticeable implementation of hospital information technologies. The objective of the study
was to explore the reasons for the absence of hospital information systems (HIS)
implementation policy in Nigeria and the impact of the lack of adoption of HIS in the health
care delivery system of the nation. In this paper, an elaborate analysis on method is provided
with emphasis on design appropriateness, population, sampling, and data collection
procedure and rationale. Other essential elements of the paper include internal and external
validity approaches, data analysis, organization, and clarity. The analysis method involved
the integration of qualitative and quantitative data sets into two separate data sets of
coherent wholes, thereby presenting the entire research as a holistic, reflective, and
integrative process. Results obtained from the study are summarized in tables.
Keywords:
Global
health,
health
information
systems,
hospital
information
systems,
review
of
literature,
Nigeria
*Principal,
Echo-Scan
Services,
Ltd.
Correspondence:
Ayodele
Cole
Benson,
MB
BCH,
PhD,
DHA,
Email:
benson_ayodele
at
yahoo.com
www.jghcs.info
[ISSN 2159-6743 (Online)]
Assessing
Barriers
to
Adoption
of
Hospital
Information
Systems
in
Nigeria
Electronic Medical Record Systems (EMRs) in developing countries facilitate improved data collection
and information retrieval and generation of research reports (Williams & Boren, 2008). The problem is
that a robust health care policy on implementation of hospital information system is lacking in Nigeria.
Caregivers in the country have not yet commenced noticeable implementation of hospital information
technologies (Ouma & Herselman, 2008; William & Boren, 2008). Williams and Boren (2008) posited that a
poor technological base and lack of funding support by the developed countries may be responsible for
poor implementation of electronic medical record systems in the developing countries.
The consequences of non-adoption of hospital information technologies include: mix up with
laboratory results, misdiagnosis, medication order errors, and mismanagement of patients (Keenan et al.,
2006; Okeke, 2008). Williams and Boren believed that successful implementation of the Millennium
Development Goals (MDGs) will hinge on the assistance of the developed countries to poor nations in
Sub-Saharan Africa. Such assistance will be to develop human capital, increase funding aids, and
collaborate with local communities to facilitate implementation of hospital information systems adaptable
to their peculiar environment to improve delivery of care. This mixed method study examined the
perceptions of stakeholders by gathering information on the perceived reasons for the paucity of policy
on health information technology and causes of poor implementation of hospital information systems in
Nigeria.
STUDY PURPOSE
The purpose of this mixed method research was to identify the barriers hindering adoption of
hospital information systems in Nigeria. The study was designed to examine the perceptions of heads of
units at the federal Ministry of Health, members of the House Committee on Health, CEOs of health care
organizations, directors of State Ministry of Health, and COOs of information technology companies in
the six geo-political zones of Nigeria. Research instrument was structured to gather information on the
perceived paucity of health information technology policy in Nigeria and reasons for the poor
implementation of hospital information systems in the country.
Qualitative exploratory data was obtained through a purposive sampling of 18 members of the
sample population by selecting three persons in each geo-political zone. Sampling targeted a participant
each from health care policy makers, health care providers, and information technology experts in the six
geo-political zones of the country. However, interviews were eventually granted by 19 participants
because of additional interview granted by an Internet service provider in the North Central geo-political
zone. A questionnaire-based survey was conducted to gather quantitative descriptive data from 180
participants obtained by proportionate stratified random sampling methods to break the heterogeneous
population into its homogeneous components. Themes and theorems generated from the qualitative
aspect of the study was subjected to content data analysis and compared with SPSS statistical analysis of
the quantitative data. The mixed method approach helped to ascertain the relationship between health
www.jghcs.info
[ISSN 2159-6743 (Online)]
Z
n / 2
Where;
Hence,
Z / 2 = Z 0.025 = 1.96
= 0.22 (is the chosen error rate)
= 1.47 (the estimated population standard deviation)
Table 1 depicts the value of the sample standard deviation, which is an estimator for the population
standard deviation. A sample size of at least 172 is required to arrive at a sample with a sampling error of
at most 0.22. For convenience, a sample size of 180 was used so that the three strata could be included
adequately.
Table 1
Descriptive Statistics
Minimum
Maximum
Mean
Standard
Deviation
180
3.07
1.47
Z 1.96 1.47
n / 2 =
= 172
0.22
Research Questions
Presenting well-articulated research questions is an important step in any research process because
these questions convey the research objective and determine the research methodology. The specific
purpose of a research process is gleaned from research questions (Creswell, 2005; Onwuegbuzie & Leech,
2005). According to Onwuegbuzie and Leech (2005), research questions are evidently more important in
mixed methodology research because researchers employing the mixed methods approach combine
pragmatism with an elaborate system of philosophy. In mixed methods studies, the types of
www.jghcs.info
[ISSN 2159-6743 (Online)]
kr
1 + (k 1)r
Based on the formula of alpha, a rule of thumb that applies to most situations for the interpretation of
reliability is as shown in Tables 2-4.
www.jghcs.info
[ISSN 2159-6743 (Online)]
Table 2
Rules for Reliability Test
Cronbachs Alpha
Remark
Excellent
0.9
0.8 < 0.9
0.7 < 0.8
0.6 < 0.7
0.5 < 0.6
< 0.5
Good
Acceptable
Questionable
Poor
Unacceptable
Table 3
Case Processing Summary
Status of Participants
Policy makers
Items
Cases
Valid
Excluded*
Healthcare providers
Cases
Valid
Excluded*
Cases
Valid
Excluded*
Total
Percent
60
100.0
0.0
60
100.0
0.0
60
100.0
0.0
180
100.0
Cronbach's Alpha
Based on
Standardized Items
Number of Items
Policy makers
0.924
0.921
12
Healthcare providers
0.897
0.893
12
0.896
0.899
12
Status of Participants
Apart from the already discussed measures, other approaches were used to ensure instrument
reliability in the study was as encouraged by Creswell (2005) that included the following:
1. Designing a research instrument to ask the same question in different ways to increase the
validity of the responses.
2. Avoiding causal arguments during interviews to avoid making cause-and-effect statements
that compel participants to introduce biases in their responses.
3. Staying within the study scope to ensure interpretative validity.
Based on the results in Table 5, the Cronbachs alpha of 0.924 for the instrument used for the policy
makers implies that the policy makers instrument is reliable. The Cronbachs alpha of 0.897 for the
healthcare providers implies that the healthcare providers instrument is also reliable. Last, the
www.jghcs.info
[ISSN 2159-6743 (Online)]
Mean
Minimum
Maximum
Range
Variance
N of Items
2.967
1.383
4.467
3.083
0.880
12
Healthcare providers
2.744
1.300
4.467
3.167
0.974
12
Internet service
providers
3.104
1.867
4.567
2.700
0.743
12
Population
Population is defined as a larger pool of entities on which a generalization can be made at the end of
a research study (Creswell, 2005; Neuman, 2003). The target population involves the subset of the larger
pool of entities from which the sample is drawn (Creswell, 2005). The Nigerian population stands
currently at more than 140 million people (National Population Commission, 2007). Nigeria is the largest
country in Africa with a land area of 910,000 square kilometers. For ease of political administration, the
country is divided into six geo-political zones. The target population in the present study was drawn
from heads of units at the Federal Ministry of Health, members of the House Committee on Health, CEOs
of health care organizations, directors of state Ministry of Health, and COOs of information technology
companies in the six geo-political zones of Nigeria. The sample was restricted to persons who form part
of health care policy-making in Nigeria, health care providers, and information technology experts and
service providers.
Sampling
The sampling method and sample size vary significantly in mixed method research. Collins, et al.
(2006) asserted that one rationale for the mixed method research is to optimize the sample size, which
includes increasing the number of research subjects. The sample was restricted to persons who form part
of health care policy-making in Nigeria, health care providers, and information technology experts and
service providers. Only CEOs of 100 bedded hospitals and above was included because such hospitals are
considered to have the financial capability and understands the need for adoption of hospital information
technology to service their large customer base. COOs of information technology companies included in
the research were those working in large corporations that have 500 or more workers in their
employment. These subjects are those professionals with requisite training and job experience that makes
them experts in their various fields of endeavor. Therefore, their opinions and judgments on the issue of
hospital information systems could be considered as expert opinion.
The purposive expert sampling approach was intended to examine the perceptions of persons with
demonstrable knowledge or experience in hospital information systems. In purposeful sampling, the
researcher intentionally selects participants who have experience with the central phenomenon or the
key concept being explored (Creswell & Plano Clark, 2007, p. 112). The qualitative part of the study ran
concurrently with the quantitative descriptive aspect of the study in which the sample was randomly
selected from the same population subset. Ten participants was drawn from each group made up of
health care policy makers, health care providers, and information technology experts in the six geopolitical zones of the country to make up the total of 180 participants for the quantitative aspect of the
mixed method study.
A letter explaining the study accompanied by a survey questionnaire was delivered by hand to the
180 potential participants inviting them to sign the consent form and return the form and the completed
www.jghcs.info
[ISSN 2159-6743 (Online)]
!! !!
!!
Where:
X2 = Chi-square
fo
= Frequency observed
fe
= Frequency expected
The Chi-square statistical test method has certain assumptions, which are as follows:
1. Where two or more than two samples are used, they are independent of one another;
2. The samples are randomly selected;
3. The data are classifiable and satisfy the nominal level of measurement requirement; and
4. The sample size is between 25 and 250.
For the purpose of hypothesis testing, the degree of freedom (df) was defined as:
df = (r -1) (c 1)
Where:
r = Number of rows
c = Number of columns
1 = Constant
The decision criteria was to reject
H0
if
Analysis of the qualitative data in the study was in two stages. Using the descriptive coding format in
appendix D to conduct thematic analysis, the responses were scored to convert the non-numeric
responses into quantified numeric data. The second stage involved conducting same quantitative analysis
as was done with the survey data as described above using the quantified data.
www.jghcs.info
[ISSN 2159-6743 (Online)]
Healthcare providers
Internet service
providers
Responses
Strongly agree
Percent
Cumulative
Percent
14
23.3
23.3
Agree
15
25.0
48.3
Undecided
5.0
53.3
Disagree
Strongly disagree
Total
22
6
60
36.7
10.0
100.0
90.0
100.0
--
Strongly agree
13
21.7
21.7
Agree
12
20.0
41.7
Undecided
6.7
48.3
Disagree
17
28.3
76.7
Strongly disagree
14
23.3
100.0
Total
60
100.0
--
14
23.3
23.3
Agree
18
30.0
53.3
Undecided
8.3
61.7
Disagree
11
18.3
80.0
12
20.0
100.0
60
100.0
--
Strongly agree
Strongly disagree
Total
Overall Responses
Frequency
Strongly agree
41
22.8
22.8
Agree
45
25.0
47.8
Undecided
12
6.6
54.4
Disagree
50
27.8
82.2
32
17.8
100.0
180
100.0
--
Strongly disagree
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
Table 7
Responses to Relevancy of Healthcare Policy on Nigerian HIS by Participant Status
Status of Participants
Policy makers
Healthcare providers
Internet service
providers
Overall Responses
Responses
Strongly agree
Frequency
Percent
Cumulative
Percent
3.3
3.3
Agree
8.3
11.7
Disagree
27
45.0
56.7
Strongly disagree
26
43.3
100.0
Total
60
100.0
--
Strongly agree
5.0
5.0
Agree
3.3
8.3
Undecided
1.7
10.0
Disagree
Strongly disagree
18
30.0
40.0
36
60.0
100.0
Total
60
100.0
--
15.0
15.0
Agree
6.7
21.7
Undecided
1.7
23.3
Disagree
19
31.7
55.0
Strongly disagree
27
45.0
100.0
Total
60
100.0
--
Strongly agree
Strongly agree
14
7.8
7.8
Agree
11
6.1
13.9
Undecided
1.1
15.0
Disagree
64
35.6
50.6
Strongly disagree
89
49.4
100.0
180
100.0
--
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
Table 8
Responses to Effect of HIS on Quality of Medical Outcome by Participant Status.
Status of Participants
Policy makers
Responses
Strongly agree
68.3
13
21.7
90.0
Undecided
1.7
91.7
Disagree
5.0
96.7
Strongly disagree
3.3
100.0
Total
60
100.0
--
Strongly agree
38
63.3
63.3
Agree
16
26.7
90.0
Undecided
5.0
95.0
Disagree
3.3
98.3
Strongly disagree
1.7
100.0
60
100.0
--
39
65.0
65.0
18
30.0
95.0
1.7
96.7
3.3
100.0
60
100.0
--
118
65.6
65.6
Strongly agree
Agree
Undecided
Disagree
Total
Overall Responses
Cumulative
Percent
68.3
Total
Internet service
providers
Percent
41
Agree
Healthcare providers
Frequency
Strongly agree
Agree
47
26.1
91.7
Undecided
2.8
94.4
Disagree
3.9
98.3
Strongly disagree
1.7
100.0
180
100.0
--
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
Table 9
Responses to Effect of Implementation of HIS on Health Care Outcomes by Participant Status.
Status of Participants
Policy makers
Healthcare providers
Responses
Strongly agree
Overall Responses
Percent
Cumulative
Percent
3.3
Agree
15
3.3
25.0
Undecided
43
71.7
100.0
Total
Strongly agree
60
100.0
--
28.3
1.7
1.7
1.7
3.3
Disagree
12
20.0
23.3
Strongly disagree
46
76.7
100.0
Total
60
100.0
--
10.0
10.0
Agree
3.3
13.3
Undecided
3.3
16.7
Disagree
18
30.0
46.7
Strongly disagree
32
53.3
100.0
Total
60
100.0
--
Strongly agree
5.0
5.0
Agree
1.1
1.1
Undecided
1.7
1.7
45
25.0
25.0
Strongly disagree
121
67.2
67.2
Total
180
100.0
--
Undecided
Internet service
providers
Frequency
Strongly agree
Disagree
www.jghcs.info
[ISSN 2159-6743 (Online)]
Healthcare providers
Responses
Strongly agree
Cumulative
Percent
10.0
10.0
17
28.3
38.3
Undecided
14
23.3
61.7
Disagree
13
21.7
83.3
Strongly disagree
10
16.7
100.0
Total
60
100.0
--
Strongly agree
3.3
3.3
Agree
10
16.7
20.0
Undecided
13
21.7
41.7
Disagree
18
30.0
71.7
Strongly disagree
17
28.3
100.0
Total
60
100.0
--
Strongly agree
8.3
8.3
Agree
11
18.3
26.7
Undecided
11
18.3
45.0
15.0
60.0
Strongly disagree
24
40.0
100.0
Total
60
100.0
--
Strongly agree
13
7.2
7.2
Agree
38
21.1
28.3
Undecided
38
21.1
49.4
Disagree
40
22.2
71.7
Strongly disagree
51
28.3
100.0
180
100.0
--
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
Percent
Agree
Disagree
Overall Responses
Frequency
Healthcare providers
Responses
Strongly agree
Cumulative
Percent
10.0
10.0
21
35.0
45.0
Undecided
17
28.3
73.3
Disagree
10
16.7
90.0
Strongly disagree
10.0
100.0
Total
60
100.0
--
Strongly agree
11.7
11.7
Agree
17
28.3
40.0
Undecided
16
26.7
66.7
Disagree
11
18.3
85.0
Strongly disagree
15.0
100.0
Total
60
100.0
--
Strongly agree
13
21.7
21.7
Agree
15
25.0
46.7
Undecided
11
18.3
65.0
Disagree
12
20.0
85.0
100.0
15.0
Total
60
100.0
Strongly agree
26
14.4
14.4
Agree
53
29.4
43.9
Undecided
44
24.4
68.3
Disagree
33
18.3
86.7
Strongly disagree
24
13.3
100.0
180
100.0
--
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
Percent
Agree
Strongly disagree
Overall Responses
Frequency
--
Healthcare
Providers
Internet service
Providers
Overall
Responses
Responses
Frequency
Cumulative
Percent
Percent
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
Total
Strongly agree
8
13
7
19
13
60
7
13.3
21.7
11.7
31.7
21.7
100.0
11.7
13.3
35.0
46.7
78.3
100.0
-11.7
Agree
Undecided
Disagree
Strongly Disagree
Total
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
Total
16
4
19
14
60
11
19
6
14
10
60
26.7
6.7
31.7
23.3
100.0
18.3
31.7
10.0
23.3
16.7
100.0
38.3
45.0
76.7
100.0
-18.3
50.0
60.0
83.3
100.0
--
Strongly agree
26
14.4
Agree
48
26.7
41.1
Undecided
17
9.4
50.6
Disagree
52
28.9
79.4
Strongly disagree
37
20.6
100.0
180
100.0
--
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
Table continued
14.4
Responses
Strongly agree
Internet service
providers
Cumulative
Percent
10.0
10.0
16
26.7
36.7
Undecided
14
23.3
60.0
Disagree
18
30.0
90.0
10.0
100.0
Total
60
100.0
--
Agree
11
18.3
18.3
Undecided
10
16.7
35.0
Disagree
26
43.3
78.3
Strongly disagree
13
21.7
100.0
Total
60
100.0
--
10
16.7
16.7
Agree
18
30.0
46.7
Undecided
17
28.3
75.0
Disagree
10
16.7
91.7
8.3
100.0
60
100.0
--
Strongly agree
Strongly disagree
Total
Overall Responses
Percent
Agree
Strongly disagree
Healthcare providers
Frequency
Strongly agree
16
8.9
8.9
Agree
45
25.0
33.9
Undecided
41
22.8
56.7
Disagree
54
30.0
86.7
Strongly disagree
24
13.3
100.0
180
100.0
--
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
Responses
Strongly agree
Frequency
50.0
50.0
24
40.0
90.0
Undecided
1.7
91.7
Disagree
1.7
93.3
Strongly disagree
6.7
100.0
Total
60
100.0
--
Strongly agree
31
51.7
24
40.0
51.7
91.7
Disagree
3.3
95.0
Strongly disagree
5.0
100.0
Total
60
100.0
--
Strongly agree
33
55.0
55.0
Agree
22
36.7
91.7
Undecided
1.7
93.3
Disagree
3.3
96.7
Strongly disagree
3.3
100.0
60
100.0
--
Agree
Internet service
providers
Total
Overall Responses
Cumulative Percent
30
Agree
Healthcare providers
Percent
Strongly agree
94
52.2
52.2
Agree
70
38.9
91.1
Undecided
1.1
92.2
Disagree
2.8
95.0
Strongly disagree
5.0
100.0
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
180
100.0
--
Responses
Strongly agree
Agree
Undecided
Healthcare providers
Internet service
providers
Status of Participants
Overall Responses
Frequency
Percent
Cumulative Percent
3.3
3.3
12
20.0
23.3
10.0
33.3
Disagree
18
30.0
63.3
Strongly disagree
22
36.7
100.0
Total
60
100.0
--
Strongly agree
6.7
6.7
Agree
6.7
13.3
Undecided
13.3
26.7
Disagree
14
23.3
50.0
Strongly disagree
30
50.0
100.0
Total
60
100.0
--
10.0
10.0
Agree
10
16.7
26.7
Undecided
13
21.7
48.3
Disagree
15
25.0
73.3
Strongly disagree
16
26.7
100.0
Total
60
100.0
Strongly agree
Responses
Strongly agree
Frequency
12
Percent
6.7
-Table continued
Cumulative
Percent
6.7
Agree
26
14.4
21.1
Undecided
27
15.0
36.1
Disagree
47
26.1
62.2
Strongly disagree
68
37.8
100.0
180
100.0
--
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
Responses
Strongly agree
Frequency
Cumulative Percent
29
48.3
48.3
Agree
16
26.7
75.0
Undecided
10.0
85.0
Disagree
6.7
91.7
Strongly disagree
8.3
100.0
60
19
100.0
31.7
22
6
4
9
60
28
36.7
10.0
6.7
15.0
100.0
46.7
68.3
78.3
85.0
100.0
-46.7
19
5
2
6
60
76
31.7
8.3
3.3
10.0
100.0
42.2
78.3
86.7
90.0
100.0
-42.2
57
31.7
73.9
Undecided
17
9.4
83.3
Disagree
10
5.6
88.9
Strongly disagree
20
11.1
100.0
Total
Healthcare
providers
Percent
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
Total
Internet Service Strongly agree
Providers
Agree
Undecided
Disagree
Strongly disagree
Total
Overall
Strongly agree
Responses
Agree
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
180
100.0
-31.7
--
Responses
Strongly agree
Agree
Healthcare
providers
12
20.0
20.0
10
16.7
36.7
3.3
40.0
Disagree
10.0
50.0
Strongly disagree
30
50.0
100.0
Total
60
100.0
--
Strongly agree
Undecided
Disagree
Strongly disagree
Total
10
16.7
16.7
10
16.7
33.3
5.0
38.3
5.0
43.3
34
56.7
100.0
60
00.0
11
18.3
18.3
12
20.0
38.3
Undecided
5.0
43.3
Disagree
8.3
51.7
29
48.3
100.0
60
100.0
33
18.3
18.3
32
17.8
17.8
Strongly agree
Agree
Strongly disagree
Total
Overall
Responses
Cumulative
Percent
Undecided
Agree
Internet service
providers
Percent
Frequency
Strongly agree
Agree
Undecided
--
--
4.4
4.4
Disagree
14
7.8
7.8
Strongly disagree
93
51.7
51.7
180
100.0
Total
--
2 = k (n 1)W
where
W=
n
12
k (n + 1)
Ri
2
2
2
k n(n 1) i =1
H0
if
p < 0.05
Computations. The computations obtained using the SPSS in the following tables:
Conclusion for Kendalls Test. The descriptive statistics for the three categories of participants are
displayed in Table 18, while the inferential statistics are in Table 19. From Table 19, since
p = 0.026 < 0.05 the null hypothesis is rejected, with the conclusion that there is a weak agreement
between the responses from the policy makers, healthcare providers, and Internet service providers. As
shown in Table 19, the value of the Kendalls coefficient of concordance of 0.215 signified a weak
agreement between the assessment and evaluation of the barriers to adoption of hospital information
systems in Nigeria. The numbers imply that the stratification into the three subpopulations of
participants is vital to acquiring more research information. Stratification has contributed to the accuracy
and precision of the results.
Table 18
Descriptive Statistics for Kendalls Test
Status of Participants
Policy makers
Mean
Mean Ranks
Std. Deviation
60
4.28
1.94
1.106
60
4.47
2.00
0.873
60
4.57
2.06
0.698
Table 19
Kendalls Test Statistic
Test statistic
N
Test values
60
0.215
Chi-Square
7.316
Degrees of freedom
Asymptotic Sig.
www.jghcs.info
[ISSN 2159-6743 (Online)]
2
0.026
Mean
Std.
Error
Std.
Deviation
Remark
180
3.07
0.109
1.469
Agree
180
1.87
0.089
1.201
Disagree
180
4.50
0.064
0.862
Strongly
Agree
180
1.52
0.073
0.977
Disagree
180
2.57
0.097
1.295
Undecided
180
3.13
0.094
1.257
Agree
Mean
Std.
Error
180
2.86
0.104
1.395
Undecided
180
2.86
0.089
1.195
Undecided
180
4.31
0.075
1.003
Agree
180
2.26
0.096
1.283
Disagree
180
3.88
0.098
1.317
Agree
180
2.43
0.124
1.658
Disagree
Table continued
Std.
Remark
Deviation
Major barriers
Percent of Cases
Percent
13.9%
83.3%
11.1%
66.7%
2.8%
16.7%
6
5
16.7%
13.9%
100.0%
83.3%
16.7%
100.0%
16.7%
100.0%
2.8%
16.7%
0.0%
0.0%
End-users' resistance
5.6%
33.3%
Total
36
100.0%
600.0%
Table 22
Healthcare Providers Responses on the Barriers Hindering the Adoption of HIS
Responses
Major barriers
Percent of Cases
Percent
11.1%
66.7%
13.9%
83.3%
11.1%
66.7%
6
3
16.7%
8.3%
100.0%
50.0%
11.1%
66.7%
11.1%
66.7%
8.3%
50.0%
5.6%
33.3%
End-users' resistance
2.8%
16.7%
Total
36
100.0%
600.0%
www.jghcs.info
[ISSN 2159-6743 (Online)]
Major barriers
Percent of Cases
Percent
12.5%
85.7%
12.5%
85.7%
10.4%
71.4%
7
5
14.6%
10.4%
100.0%
71.4%
14.6%
100.0%
10.4%
71.4%
10.4%
71.4%
0.0%
0.0%
End-users' resistance
4.2%
28.6%
Total
48
100.0%
685.7%
Table 24
Cumulative Responses on the Barriers Hindering the Adoption of HIS
Responses
Major barriers
Percent of Cases
Percent
15
12.5%
78.9%
15
12.5%
78.9%
10
8.3%
52.6%
19
13
15.8%
10.8%
100.0%
68.4%
17
14.2%
89.5%
15
12.5%
78.9%
7.5%
47.4%
1.7%
10.5%
End-users' resistance
4.2%
26.3%
120
100.0%
631.6%
Total
www.jghcs.info
[ISSN 2159-6743 (Online)]
References
Adetokunbo, O. L. (2005). Human resources for health in Africa. British Medical Journal, 331(7524), 10371038. Retrieved from http://www.bmj.com/
Akinyemi, K. (2008). Nigeria: Poor primary health care cause of maternal mortality. Retrieved from
http://allafrica.com/stories/200809150693.html
Alquraini, H., Alhashem, A. M., Shah, A., & Chowdhury, R. I. (2007). Factors influencing nurses attitudes
towards the use of computerized health information systems in Kuwaiti hospitals. Journal of
Advanced Nursing, 57(4), 375381. doi:10.1111/j.1365-2648.2007.04113.x
Amaghionyeodiwe, L. A. (2009). Government health care spending and the poor: Evidence from Nigeria.
International Journal of Social Economics, 36(3), 220- 236. doi:10.1108/03068290910932729
Anderson, H. J. (2005). Tackling the challenge of systems integration. Health Data Management, 13(4), 8.
Retrieved from http://www.healthdatamanagement. com/issues/
Angst, C. M., & Agarwal, R. (2009). Adoption of electronic health record in the presence of privacy
concerns: The elaboration likelihood model and individual persuasion. MIS Quarterly, 33(2), 339370. Retrieved from http://www.misq.org/
Apter, A. (2007). A culture of corruption: Everyday deception and popular discontent in Nigeria. African
Studies Review, 50(3), 153-155. Retrieved from http://www.africanstudies.org/p/cm/ld/fid=134
Arikpo, A., Etor, R., & Usang, E. (2007). Development imperatives for the twenty-first century in Nigeria.
Convergence, 40(1/2), 55-66. Retrieved from
http://www.uk.sagepub.com/journals/Journal201774
Arrow, K., et al. (2009). Toward a 21st-century health care system: Recommendations for health care
reform. Annals of Internal Medicine, 150(7). Retrieved from http://www.annals.org
Ash, J. S., & Bates, D. W. (2005). Factors and forces affecting EHR system adoption: Report of a 2004
ACMI discussion. Journal of the American Medical Informatics Association, 12(1), 8-12.
doi:10.1197/jamia.M1684
Ashley, R. C. (2002). Telemedicine: Legal, ethical, and liability considerations. American Dietetic
Association. Journal of the American Dietetic Association, 102(2), 267-269. doi: 10.1016/S00028223(02)90063-5
Atkinson, P. (2005). Managing resistance to change. Management Services, 49(1), 1419. Retrieved from http://www.ims-productivity.com/page.cfm /content/ManagementServices-Journal/
www.jghcs.info
[ISSN 2159-6743 (Online)]
www.jghcs.info
[ISSN 2159-6743 (Online)]