Barriers, Facilitators and Expectations of Telemedicine Healthcare Services Adoption in Rural Public Hospital Settings in Bangladesh

Abstract

Sustainability in healthcare provision has become a complex challenge in public administration, generating considerable interest in adopting innovative technologies such as telemedicine (Celdran, Perez, Clemente & Perez, 2018). Despite the expectation that telemedicine will address the problems of remote care delivery, adoption-related problems have meant that predicted benefits are largely unrealised (Bain, 2006). There is a growing consensus that telemedicine is now an essential health support system facilitating remotely based healthcare assistance to medically underprivileged rural populations with poor access to health services. Despite growing demand for telemedicine, the adoption rate is slow, and stakeholders remain sceptical and resistant (Bain, 2006). The low adoption rate (Kim, Gellis, Bradway & Kenaley, 2018) means that best practices are not captured and replicated (Van Dyk, 2013). This study deepens the understanding of the determinants of barriers, facilitators (i.e., determinants of health seekers’ acceptance and adoption) and antecedents to health seekers’ expectations of telemedicine adoption in rural public hospital settings in Bangladesh. The findings are based on the quantitative analysis of a dataset of 500 telemedicine patients collected using personally administered one to one interviews from rural areas in Bangladesh. The findings are based on the opinions of patients who experienced telemedicine services. The survey excluded non-users because patients in Bangladesh cannot access telemedicine services without a physician’s referral. Three conceptual predictive models were developed and a set of hypotheses was proposed and empirically evaluated by employing partial least squares structural equation modeling. The barriers, facilitators and antecedents to expectations were adapted from previous robust telemedicine (i.e., e-Health, telehealth and m-Health) studies and regarded as mutually exclusive and exhaustive when considered from a model parsimony perspective. All Adopting Telemedicine in Bangladeshi Rural Public Hospital Settings iii conceptual models demonstrated an optimal fit, including the path analysis postulated relationships, confirming that the proposed latent constructs had significant effects (p < .01) on barriers, facilitators and expectations of telemedicine adoption. This study confirms the applicability of all conceptual models in the context of Bangladesh. From the first phase of the study, four specific barriers to telemedicine adoption were identified and confirmed—lack of organisational effectiveness, health staff motivation, patient satisfaction and trustworthiness (together accounting for 62% of the variance [R2] in barriers)—providing empirical support for previous studies. These barriers offer considerable obstacles to the adoption and maintenance of current telemedicine projects in rural Bangladesh. The second phase makes use of an extended technology acceptance model to investigate determinants (i.e., facilitators) that influence patients’ acceptance and adoption of telemedicine in centres hosted by rural public hospitals in Bangladesh. Four significant determinants emerged from the analysis—perceived usefulness, service quality, privacy and data security, and social influence (together accounting for 64% of the variance [R2] in patients’ behavioural intention to accept and adopt telemedicine)—providing empirical support for previous studies. The third phase analyses the antecedent factors that influence patients’ expectations of telemedicine adoption. It validates four antecedents of health seekers’ expectations of telemedicine adoption—self-efficacy, telemedicine experience, enjoyment and prior satisfaction (together explaining 66% of the variance [R2] in expectations). These antecedents significantly contribute to health seeker’ expectations of telemedicine adoption in rural Bangladesh. The findings fulfilled the research objectives, answering the research question. A significant contribution to the literature within the context of developing countries (such as Bangladesh) was made. These empirical findings have the potential to elevate telemedicine into an institutionalised health infrastructure for providing better-quality Adopting Telemedicine in Bangladeshi Rural Public Hospital Settings patient care with greater flexibility through modernised, specialised healthcare support for medically underprivileged rural communities in Bangladesh. This thesis concludes with important implications for theories, research and specific policy interventions and recommendations, including a discussion of current research limitations and possible directions for future research.