EVALUATION OF THE IMPACT OF WIRELESS COMMUNICATION TECHNOLOGIES; A CASE STUDY IN HEALTHCARE SERVICE

By BULE STEPHEN Reg.No:2005/HD18/637U BSc Rad(UJ), PgDip US(USA), DMR (Mak) buleasteve@yahoo.com/sbule@cit.mak.ac.ug/+256-772-441304 A Project Report Submitted to the School of Graduate Studies in Partial Fullment of the Requirements for the Award of a Master of Information Technology of Makerere University Option: Information Technology Management

October, 2007

Declaration
I, Stephen Bule do hereby declare that this Project Report is original and has not been published and/or submitted for any other degree award to any other University before. Signed....................................................... Date..................................................... Bule Stephen, MSc. Department of Information Technology Faculty of Computing and Information Technology Makerere University

Approval
This Project Report has been submitted for Examination with the approval of the following supervisor(s). Signed:....................................................... Date:.................................................... Dr.Patrick Ogao, PhD Department of Information Systems Faculty of Computing and Information Technology Makerere University Signed:........................................................ Date:.................................................... Mr.Drake Mirembe, MSc. Department of Networks Faculty of Computing and Information Technology Makerere University

Dedication
I dedicate this work to my family espcially my wife Susan ,and sons Nicholas and Philip who have been patient and supportive during this period. Lastly, I also dedicate my work to my Dad Stephen who has always given me call when I least expect.

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Acknowledgement
I would like to acknowledge the following people without whose help and contribution to this work would never have come this far. These are Dr.Patrick Ogao, my committed supervisor from the faculty who has indeed been very helpful and kept me stay on track all along and particularly so for his valuable time. Associate Professor.Micheal Kawooya my mentor and co-supervisor who has willingly encouraged me to pursue this course and supported me in the radiology department where I work. Not-with-standing I do acknowlodge the tireless contribution of Mr.Drake Mirembe my Assistant superior to this work at the Faculty who assimilated and introduced me to the health informatics group/ club at the faculty of computing and Information Technology. In the same breadth I would wish to thank Prof.Janet Aisbett of Newcastle University, Australia for her vital and timely contribution in critiquing this work. Special commendations go to my memebers of radiology department in Mulago Hospital especially the acting head of department, Dr.Rosemary Byanyima, Mr.Mpiima Patrick, Principle Imaging Technologist assessment centre radiology suite and Dr.Faith Ameda, Radiology Postgraduate student for their encouragement, contribution and moral support. My thanks also goes to the staff of the faculty of Computing and IT that created a conducive environment that made it possible for me to complete this study in time. Lastly I wish to thank the staff at Mulago Hospital at various departments of Radiology, Medicine, Surgery, Pathology, Obstretrics and Gynaecology, Physiotherpy, Nursing and medical school for the support given to this study survey Finally, I thank myself for my personal efforts and also to the Almight God for his superb wisdom.

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Contents
Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i ii iii xi

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii

INTRODUCTION 1.1 1.2 1.3 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Statement of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Main objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.3.1 1.4 1.5 Specic Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 1 2 3 3 3 4

Scope of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signicance of the study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LITERATURE REVIEW 2.1 Wireless technologies and Healthcare . . . . . . . . . . . . . . . . . . . . . . . .

5 5

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2.2 2.3 2.4

Application of wireless technology in healthcare . . . . . . . . . . . . . . . . . . . Measuring attitudes to technology and quality of service . . . . . . . . . . . . . . UTAUT and SERVQUAL Models. . . . . . . . . . . . . . . . . . . . . . . . . . .

8 9 9

METHODOLOGY 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8

11

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Research Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Study Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Study Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Validity and Reliability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Procedure of Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Ethical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

PRESENTATION AND FINDINGS. 4.1 4.2 4.3

14

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Developing questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Findings and characteristics of healthcare professionals. . . . . . . . . . . . . . . . 21 4.3.1 4.3.2 4.3.3 Analysis of the questionnaire by relationship . . . . . . . . . . . . . . . . 21 Validity and reliability . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Characterictics of Healthcare professionals. . . . . . . . . . . . . . . . . . 23

4.3.4 4.3.5 4.3.6 4.4

Available wireless communication technologies . . . . . . . . . . . . . . . 25 Ownership of the wireless information communication technologies . . . . 26 Current state of use or expected time of use . . . . . . . . . . . . . . . . . 27

Deployment environment of the wireless communication technologies . . . . . . . 29 4.4.1 4.4.2 4.4.3 4.4.4 4.4.5 Regulatory policies in healthcare centres . . . . . . . . . . . . . . . . . . 29 National laws covering use of wireless technologies . . . . . . . . . . . . . 29 Lack of funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Changing technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Availability of support personal . . . . . . . . . . . . . . . . . . . . . . . 30

4.5 4.6

Limitations of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 The attitudes of the respondents in determining the level of technology acceptance by the healthcare professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 4.6.1 4.6.2 4.6.3 4.6.4 4.6.5 Usefulness to job . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Enables quick accomplishment . . . . . . . . . . . . . . . . . . . . . . . . 33 Productivity increase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Skilled to perform job . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Work more interesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

4.7

The perception of respondents to determine the service quality when using wireless information communication technologies. . . . . . . . . . . . . . . . . . . . . . . 34 4.7.1 4.7.2 Same level of healthcare services . . . . . . . . . . . . . . . . . . . . . . 35 Respond faster to x problem . . . . . . . . . . . . . . . . . . . . . . . . 35 vi

4.7.3 4.7.4 4.7.5 4.8

More care and consideration to patients . . . . . . . . . . . . . . . . . . . 36 Easier communication to healthcare professionals . . . . . . . . . . . . . . 36 Patient information more secure . . . . . . . . . . . . . . . . . . . . . . . 36

Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

CONCLUSION AND RECOMMENDATIONS. 5.1 5.2 5.3

41

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 APPENDIX 1 QUESTIONNAIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 APPENDIX 2 CHI-SQUARE VALUES . . . . . . . . . . . . . . . . . . . . . . . . . . 56

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List of Tables
4.1 4.2 4.3 Shows the Technology acceptance model using UTAUT technique . . . . . . . 15 Shows the SERVQUAL 10 dimensions used in healthcare service . . . . . . . . 19 Percentage distribution of the respondents according to background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 4.4 4.5 Brief background of the respondents . . . . . . . . . . . . . . . . . . . . . . . . 25 Shows the percentage distribution of the wireless technologies whether currently in use or expected to be used . . . . . . . . . . . . . . . . . . . . . . . . 28 4.6 Shows the Percentage distribution of the respondents according to the deployment environment of the wireless technologies . . . . . . . . . . . . . . . . 39 4.7 Shows the percentage distribution of the respondents according to the perception of the healthcare professionals to the delivery of quality healthcare services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

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List of Figures
4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Shows the Relationships and Chi-Square value . . . . . . . . . . . . . . . . . . 22 Shows the gender of respondents. . . . . . . . . . . . . . . . . . . . . . . . . . 24 Shows Available wireless communication technologies . . . . . . . . . . . . . . 26 Shows Ownership of the wireless information communication technologies . . 27 Shows Percentage of usage of the wireless technologies . . . . . . . . . . . . . . 28 Shows responses on deployment environment of the wireless technologies . . . 31 Shows dimensions of technology acceptance by healthcare professionals . . . . 33 Shows Components of service Quality in healthcare service by using wireless technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

5.1

Shows Resource necessary to use vs new technology making health centre look modern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

5.2 5.3 5.4 5.5

Shows Time to complete all tasks vs same level of healthcare

. . . . . . . . . . . 57

Shows Being able complete task alone vs Faster response to s problem . . . . . . 58 Shows Patient treated with care and consideration vs management supportive . . . 59 Shows Competence of healthcare provided vs technology acceptance . . . . . . . . 60

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5.6 5.7 5.8 5.9

Shows the valuing of patients by healthcare professionals vs the technology . . . . 61 Shows skilledness to use technology vs competence in providing healthcare . . . . 62 Shows the reputation of healthcare centre vs quick accomplishment of the work . . 63 Shows the reliability of patient information source vs quick accomplishment of the job . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

5.10 Shows the reliability of patient information source vs helpfulness of management . 65 5.11 Shows ease of patient communication vs technology acceptance . . . . . . . . . . 66 5.12 Shows the cost of healthcare vs quick accomplishment of the work . . . . . . . . . 67 5.13 Shows the cost of healthcare vs helpfulness of senior management . . . . . . . . . 68

LIST OF SYNONYMS/ABBREVIATIONS
WICT - Wireless Information and Communication Technology HIMSS - Healthcare Information and Management Systems society Wi-Fi - Wireless Fidelity ICT - Information and Communications Technology IS - Information System IT - Information Technology PDA - Personal Digital Assistant NHS - National Health Service LAN - Local Area Network SAN - Storage Area Network WAN - Wide Area Network WISP - Wireless Internet Service Provider PAN - Personal Area Network WLAN - Wireless Local Area Network WWAN - Wireless Wide Area Network SERVQUAL - Service Quality TAM Technology Acceptance Model UTAUT - Unied Theory in Acceptance and Use of Technilogy

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Abstract
Healthcare industry is ever increasing the use of new information and communication technology. The use of wireless information communication technology offers a successful adoption in healthcare for developing countries with relatively poor communication infrastructure. In Uganda some healthcare centres have deliberately deployed wireless information communication technologies like PDAs, Mobile phones, and teleradiology to improve healthcare. About 50 percent of new capital investments in organisations are on IT, yet they have to be accepted and used by employees to improve productivity. This is a concern to IT managers. The main aim of this study is to evaluate the perceived effectiveness of wireless information communication technologies on healthcare delivery by healthcare professionals. The following are the objectives: to investigate the deployment environment of wireless information technologies in healthcare service, to evaluate the attitudes of the health professionals to the deployment of wireless information communication technologies, to evaluate the perception of health professionals on the effect of the deployment of wireless communications technologies on quality healthcare service and to develop a research instrument for use in evaluating the effect of wireless technology in healthcare service provision. A qualitative and quantitative survey by questionnaire was adopted,combined, modied and used from two different research tools of a unied technology acceptance and service quality models. We developed a research instrument called UTAUT-SERVQUAL techniques to evaluate the perceived effectiveness or impact of wireless information communication technologies in healthcare service delivery. The results of the study have indicated that the questionnaire can generate the data required to analyse the evaluation of the percieved effectiveness and acceptance of wireless information communication technologies in healthcare service delivery. This is reected in the respondents acknowledgement of the effective use and apparent improvement of serve in using the wireless information communication technologies for healthcare service delivery.

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Chapter 1 INTRODUCTION
1.1 Background
Wireless healthcare delivery is the choice to go in the developing world due to the advantages that it offers in terms of deployment. However as the need for these technologies increase there are equally no methods of evaluating their impact in healthcare servive delivery. The introduction of wireless information and communications technologies (WICT) in the healthcare environment has led to an increased accessibility to healthcare professionals, more efcient tasks and processes and higher quality of healthcare services (Kern and Jaron, 2003) [24]. The wireless-enabled healthcare is therefore already with us and almost every health professional even in Uganda already uses a mobile phone, and many also have laptops, notebooks or Personal Digital Assistants (PDAs) with at least the potential to be linked wirelessly. The potential of wireless technology in health comes from enabling health professionals to conveniently access information and knowledge, irrespective of their location. In this research the terms used in the document concerning wireless communication technologies are dened and explained below: Wireless technology refers to the use of radio signals instead of physical connections to transmit data. Wireless also implies that the system is always connected and that the data are real time (Newbold, 2004) [31]. The range of technologies collectively termed wireless include Personal Digital Assistants (PDAs), robots, telehealth apparatus, pagers, telephones, tablet computers, subnotebook computers (smaller, lighter, portable computers), smart telephones, wireless networks, mobile hardware peripherals, and all related software (Newbold, 2004) [31]. 1

Healthcare is the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical and allied health professions (Stedmans medical dictionary, 2004) [37]. E-health is a process of providing healthcare via electronic means, in particular over the Internet (Broderick, 2003) [30]. The term e-health has been used to describe the variety of activities related to the electronic exchange of health-related data, voice or video. E-health is an emerging eld in the intersection of medical informatics, public health and business, according to Eysenbach (2001) [13]. Teleradiology refers to a facilitated remote consultation, diagnosis and management of patients using telecommunication technologies. Digital images are transmitted over a distance using standard telephone lines, satellite connections, or local area networks (LANs)(Stedmans medical dictionary, 2004) [37]. In this study, we will look at Mulago hospital which is the largest healthcare organization in Uganda with over 2,000 bed capacity, 2,300 employees and about 300 doctors with a total of over 6 billion US Dollar total assets (Mullan, 2005) [29]. Acording to that annual report , Mulago hospital is dened as a nationtal referral and teaching hospital which is a not-for-prot, publicbased network of hospitals, primary healthcrae centre and practices, rehabilitation clinic , senior health centre, and Accident and Emergency surgery centre and a medical research institute which provides quality, safe patient care supported by medical education and scientic research

1.2 Statement of the Problem

Wireless information communications have been deployed in some hospitals in Uganda to facilitate quick access of critical and vital patient information. It is assumed that the wireless communication technologies installed by the hospitals are functional and in use and these are supposed to impact positively on healthcare delivery. However to our knowledge since their deployment, no study has been carried out to ascertain the impact these technologies have had on the quality of healthcare given by health practitioners. Hence there is need to carry out this study and to develop a reliable questionnaire for on-going evaluations in healthcare.

1.3 Main objectives

In this project we will evaluate the attitudes to wireless communication and information technologies on the service quality of healthcare service delivery and their perceived effectiveness by health workers in selected healthcare centres in Uganda.

1.3.1 Specic Objectives

(i) To investigate the deployment environment of the wireless communication technologies (ii) To evaluate the attitudes of healthcare professionals to the deployment of wireless communication technologies. (iii) To evaluate the perception of healthcare professionals on the effect of the deployment of wireless technology on the quality of healthcare service. (iv) To develop a research instrument for use in evaluating the effect of wireless technology in healthcare service provision.

1.4 Scope of the Study

The study will look at ICTs in healthcare focusing on wireless technologies only. The technologies that will be targeted in this case will be PDAs, mobile phones,teleradiology sets and any wireless technology. The geographical coverage will be urban and or rural connectivity because of the diversity in resource distribution like human, nancial and infrastructure. In this study one urban facility (Mulago hospital), which has specialists and infrastructure, will be investigated. As noted earlier, e-health covers many stakeholders like the healthcare professionals, the patient, government, IT vendors, marketers in health products and stokeholders. However, this study will be concerned with the perceptions of healthcare professionals.

1.5 Signicance of the study

Developing countries have an overwhelming need for the provision of medical and healthcare services especially in areas outside the cities and urban centres. The fast growing telecommunication services through MTN, Celtel, UTL and many other new ones still coming up will offer an economical means of achieving the national policy objective Health for all with due regard to improvement and or extension of medical and healthcare services up to rural health centre IVs. Therefore, there is more than ever a greater need and drive by government to apply ICT in health sector due to the cost reduction that comes alone with it.On the basis of the reasons advanced above, it is of public and private interest to investigate the impact of wireless communication technologies in e-health. There is need to develop a reliable research instrument for on-going evaluation of the attitudes to, and percieved effectiveness of the use of wireless technology. This area has always been over looked as organizations only look at acquiring new technologies but have no idea on the concerns about the expectation and perceptions of the healthcare professionals in service delivery.

Chapter 2 LITERATURE REVIEW

2.1 Wireless technologies and Healthcare
The primary rationale for the development of e-health is to serve the population that have for geographical location, nancial, or socio-economic reasons limited access to traditional, high quality consultative, diagnostic, therapeutic and market medical services and or products such as drugs and sundries. E-health can be delivered by using various technologies which include wireless communication devices like pagers, blackberries, PDAs and cellular phones or use landlines like telephone lines, local area networks, wide area networks and virtual private networks. In fact, a new World Bank report notes 77 percent of the worlds population already lives within range of a mobile network. (Albon, 2006) [2]. In recent years wireless technology has exploded in the southern hemisphere including the subSaharan Africa where telecommunication infrastructure is less developed or lacking completely. Uganda, like many developing countries lack the infrastructure readily available in the developed world and is leapfrogging traditional xed-line communication networks and adopting mobile, cellular technologies to provide communication links to remote locations. According to Gardner (1994) [16], nancial, political and regulatory problems are some of the main obstacles to communication system deployment in developing countries (Anvekar et al.,1996) [3]. However, the demand for communication and information services in developing countries is increasing (Anvekar et al. (1996) [3], Meadows 1999) [28], but conventional copper wire infrastructures are too expensive to install and maintain in the rural less developed areas. Wireless communi5

cation systems offer greater exibility in network design, faster deployment, and are more suitable in difcult terrain and climates (Javed et al.,1994) [23]. The healthcare discipline is increasing the use of new information and communication technologies. One of the technologies talked of that has transformed the activities of healthcare service is the wireless technology. This change is described as a revolution within the healthcare industry.(Raghupathi, 2003) [35]. The introduction of wireless technology in healthcare service is a relatively new entry in the overall IT infrastructure. Chris Kent, the Director of the Technical Services Group of Daou Systems, Inc.USA(Gillete, 2004) [17] maintains that The history of this kind of technology in healthcare goes back a decade or so years. The versatility of having ethernet speed connectivity without wires is driving the adoption of wireless data networking by healthcare industry. This functionality is particularly useful in healthcare service because of the high degree of mobility involved in the health sector. With the growing acceptance of electronic medical records (EMRs), the healthcare providers are nding it easy to access huge amounts of patient data at the point of care, as well as from the ofce or home. To better accommodate computers on carts and pocket PCs, many healthcare organizations in developing countries are deploying wireless technologies into the settings. Installations were typically based on partnerships between an enthusiastic doctor and a specialist IT vendor. Until then, some projects attracted funding from central government but most were supported, at a local level, by individual hospitals. Budget constraints meant that there was little scope for designing custom hardware and many wireless e-health projects, especially those that focused on heart monitoring, used equipment that was originally designed to monitor the performance of athletes. The wireless version of Polar Electronics heart monitoring wristband was particularly popular and was used in a system that remotely monitored the health of women during pregnancy (Baker, 2003) [6]. In United Kingdom, according to Gardener (1994) [16] the successful break through to healthcare and IT became fashionable during the 1990s e.g the UKs Connecting For Health IT program became a prime example. This saw healthcare IT funding co-ordinated at a national level and was used to build applications that increased workow rather than only to enhance patient monitoring. While wireless took a share of spending programs, for example the use of Cisco WLAN and wireless VoIP technology, most applications differed little from those being deployed by companies in 6

the nancial services or retail sectors thus still creating a gap in wireless technologies in healthcare (Brewin 2004) [7]. The wireless healthcare market is now moving into a new phase. According to Newbold (2004) [31], healthcare professionals have realised that the only way to achieve the sort of cost savings seen in other sectors of the economy if technology is used, is to push care out to the edge of the healthcare network. The logic here is that, using remote healthcare, professionals can treat an increasing number of patients while at the same time downsizing their core infrastructure. This new strategy, to either intercept the patient before they enter the healthcare system or if that fails to care for the patient in their own home, is highly dependent on the successful deployment of wireless based medical devices. Ugandas wireless health care initiative is an expansion of SATELLIFE trials with personal digital assistants (PDAs), or handheld computers, which began in 2001. In a recent AvantGo survey (2003) [4] in Dublin, PDAs were recommended for use in our environments where computers are impractical, because they are powerful tools that can provide critical, timely information to African health workers. The PDAs were found to be especially useful in health administration, ordering and tracking medical supplies, and delivering new treatment guidelines. In scaling up the project to provide nationwide coverage for the health care initiative, a central wireless server was installed in Ugandas capital, Kampala. It is linked to computer systems at the Ministry of Health, and at Health Net Uganda, a local SATELLIFE afliate housed at Makerere University, also in Kampala. The server manages the entire network and communicates with wireless server called Jacks in the eld over commercial cellular phone networks (GSM) (Ladd 2003) [19]. Before 1996, Ugandas communication infrastructure was among the least developed, not only in the world but also in sub-Saharan Africa (Wasukira et al, 2002) [39]. Further more, 70 percent of the telecommunication services were concentrated in the urban areas, leaving the rural areas with the least or totally no access to these services. As a result of liberalisation policies adopted by the government of Uganda during the 1990s, the communication infrastructure situation has changed to some extent. It is generally accepted that communication and information systems are major factors for economical and social development, but still are underdeveloped in many developing countries. A nationwide launch of wireless network to improve Ugandas ability to treat patients and com7

bat the spread of disease was announced in September 2003. The network is built around the countrys well-established cell phone network, inexpensive handheld computers, and innovative wireless servers. This technology allows healthcare workers to access and share critical information in remote facilities without xed telephone lines or regular access to electricity (Hardy et al, 2003) [12].

2.2 Application of wireless technology in healthcare

The Healthcare network administrators in UK where already nding that wireless access to data boosts the number of patients served, improves the quality of physician diagnosis, and speeds payments and billing cycles (Cox, 2002) [10]. According to Forrester Research (Brown, 2004) [30], wireless and mobile technologies are top spending priorities for health care organizations. Although wireless LANs (WLAN) were used in hospitals for some time in the UK, the rollouts are getting bigger and the applications are more sophisticated. In a 2003 survey by the Healthcare Information and Management Systems Society, the report agrees that technology can assist in addressing patient safety issues, and a big percentage of respondents believed that reducing medication errors was the best use of technology (HIMSS, 2003) [18]. Lastly according to a study published in the British medical journal by researchers from London School of Hygiene and Tropical Medicine (2005) [8], the process of implementation of the wireless technologies has been suboptimal, leading to reports of low morale by the NHS staff responsible for implementation. The overall timetable was unrealistic, and hospitals became uncertain about their implementation schedules. The study further concludes that socio-cultural implementation challenges were neglected but is as daunting as the technical and logistical ones.

2.3 Measuring attitudes to technology and quality of service

According to Oliver,(1997) [32] Satisfaction is a judgment that a product or service provides a pleasurable level of consumption-related fulllment, including levels of under- or over-fulllment. According to Prybutok and Spink (1999) [34] Customer satisfaction is one key attribute in quality healthcare. In an information system (IS) setting within an organization, user satisfaction (US) is measured by a comparison of user expectations (or needs) of the IS with the perceived performance (or capability) of the IS on a number of different facets of the IS (Landrum and Prybutok, 2003) [34]. User Satisfaction is thus measured as the gap between user expectations and the perceptions of the system.

2.4 UTAUT and SERVQUAL Models.

Wireless information communication technologies are new technologies in the Ugandan setting which were introduced in less than a decade ago. According to Lee et al.,(2003,) [26]and Lu et al.(1999) [27],technology acceptance and use is one of the most researched areas in the eld of information systems.The models like Technology Acceptance Model (TAM)assumes perceived usefulness, rather than ease of use, as a strong indicator of usage. The end user satisfaction model was developed to measure the end user satisfaction in a mandatory environment, and to test the usefulness versus ease of use assumption (Adamson and Shine, 2003) [1].The Unied Theory of Acceptance and Use of Technology(UTAUT)model by Venkatesh et al.(2003) [38]is an acceptancy model that was developed due to a need for a review and synthesis in order to progress toward a unied view of user acceptance. According to Venkatesh et al.(2003), the objectives of the UTAUT was to understand the individual acceptance of new information technologies, compare these models, formulate a unied theory of acceptance and use of technology, and validate UTAUT by testing it. The methodology looks at four major dimensions that contribute to technology acceptance which are performance expectance, effort expectance, social inuence and lastly facilitating conditions in the environment. The variables were gender, age, experience and voluntariness of use. According to Rosen (2004) [36] UTAUT was used successfully in studying the willingness of an individual in using or trying out a new information technology. In this case its

possible to explain the process of adoption and use of a new technology in information system/ technology. According to Westland and Clark (2000), the presence of computer and information technologies in todays organizations has expanded dramatically. Yet,for technologies to improve productivity, they must be accepted and used by employees in organizations.Parasuraman et al. (1988) [33] developed a multi-item scale for measuring customer/ user perceptions of the service quality. The two words of service and quality were combined to form what is now known as the SERVQUAL technique. It is an empirically derived method that may be used by service organisations to improve service quality. The method involves the development of an understanding of the percieved service needs of the target group. SERVQUAL takes into account the the perceptions of the customer/user of the relative importance of service attributed. The methodology was originally based around ve key dimensions (tangibles, reliability, responsiveness, assurance, empathy).according to Zeithaml et al., (1994) [41] The current one which was used in this design is made of a series of questions based around a number of key service dimensions such as tangibles, reliability, responsiveness, competence, courtesy, credibility, feel secure, access, communication and understanding the customer. Satisfaction can be measured by performance, which in itself is a measure of quality service. It is therefore upon this background that the study to evaluate the impact or percieved effectiveness of the wireless technologies on the enhancement of healthcare service delivery will use the combination of UTAUT and SERVQUAL model, which has not been done before.

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Chapter 3 METHODOLOGY
3.1 Overview
Methods of evaluation of customer satisfaction widely used by the IS/IT industry are several and include sample survey techniques, focus group methods, evaluation and suggestion slips, Delphi or normal group methods,and complaints analysis (Babbar, 1992; Yang, 2003) [5], [40]. Among these methods, the survey by questionnaire and the complaints analysis are more popular than others. However, because the complaints analysis is a passive method which does not allow understanding the status of customers satisfaction completely, more and more organizations are using the questionnaire survey method. Hence in this study we will combine the SERVQUAL and UTAUT questionnaire to develop a research instrument/ tool for use in evaluating wireless information communication technologies in healthcare delivery by IT managers. The questionnaires will be tested in the health centres / hospitals to assess the quality of healthcare service wireless technology can deliver. The data collected will be used to process valuable information on the current impact of wireless information communication technologies in healthcare service delivery. The questionnaire will also be validated.

3.2 Research Design

There are several evaluation methods used to measure customer satisfaction and in this research we will employ the survey methodologies similar to suit the wireless technologies for healthcare. A

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combination of two questionnaires of UTAUT and SERVQUAL will be used to form a questionnare to address the attitudes and perceptions of healthcare professionals on healthcare delivery using wireless information communication technologies.Observations and follow-ups interviews will be used as required.

3.3 Study Area

The study will focus on investigating the impact of wireless technologies in Mulago hospital, which is the national teaching and referral urban healthcare facility in central Uganda. The other centre studed will be Rakai health facility, which is a small remote rural healthcare centre, connected with the deployed wireless technologies selected for that reason. The study aims at addressing urban and or rural information sharing using wireless technology. But due to time and resources factors available, rural centres will be studied later

3.4 Study Population

The Healthcare professionals will be interviewed to nd out their view or perception on the impact of these wireless technologies deployed. In this research, healthcare workers will be selected based upon statistical sampling techniques to participate in the survey. These will be medical ofcers, nurses and allied health professionals. Other stakeholders like the patients, administrators, local authorities, network service providers and IT vendors may be involved in a later research but are not included in this project for reasons of time and reduce costs.

3.5 Validity and Reliability

The validity of an instrument as will be used in this study is consistent with denition provided by Miles and Huberman (1994) [21], as the extent to which the items in the instrument measures what they are set out to measure. Therefore existing instruments mentioned earlier will be amended to develop a draft instrument.The supervisor will then establish the validity of the questionnaire and a pilot study will be conducted. The reliability still, according to Miles and Huberman (1994) [21],

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has to do with the extent to which the items in an instrument generate consistent responses over several trials with different audiences in the same setting or circumstances. The reliability will be established through statistical analysis of the responses in the questionnaire.

3.6 Procedure of Data Collection

Permission will be sought from relevant areas to allow the study to be carried out. A requesting letter will be written. An introductory or covering letter from the deputy dean, graduate studies will be obtained. The identied respondents will be informed of the purpose of the study and obtain an oral consent from them. Condentiality of their information and identity will be maintained.

3.7 Data Analysis

The quantitative data that will be collected from the questionnaire will be summarised and tabulated. Basic SPSS will be used to analyse responses and Microsoft Excel statistical spreadsheets will be used to prepare graphics to aid description of key variables. The data generated from the investigations will be analyzed, discussed and recommendations will be made where necessary. Thereafter the results will be disseminated to the faculty.

3.8 Ethical Considerations

The ethical considerations will be pursued during the study focused on upholding social science and applied science research namely: anonymity and condentiality, and informed consent of the respondents.

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Chapter 4 PRESENTATION AND FINDINGS.

4.1 Introduction
The results presented were obtained from a sample of 20 respondents at Mulago hospital. The results are according to the objectives which are stated below. The specic objectives of the study which are being addressed are as follows:

(a) To investigate the deployment environment of the wireless communication technologies (b) To evalute the attitudes of healthcare professionals to the deployment of wireless communication technologies. (c) To evaluate the perception of healthcare professionals on the effect of the deployment of wireless technology on the quality of healthcare service. (d) To develop a research instrument for use in evaluating the effect of wireless technology in healthcare service provision.

4.2 Developing questionnaire

The research instrument was designed and used to carried out the study. The questionnaire that was developed from the two research techniques of UTAUT and SERVQUAL had initially eighty ve questions all together. These questions were curved out from these set of questions originating 14

from UTAUT and SERVQUAL as shown below: The sample questions to ask were generated from Table 4.1: Shows the Technology acceptance model using UTAUT technique Acceptance dimension Sample of questions to ask Performance Expectancy: Concerns percieved usefulness, job-t, relative advantage and Outcome expectations Effort Expectancy: Concerns Percieved ease of use, complexity and ease of use Social Inuence: Concerns subjective norm, social factors and image Facilitating condition: Concerns percieved behavioural control, facilitating conditions and complexity those dimensions in the above table and are as follows: Performance Expectancy: Performance expectancy is dened as the degree to which an individual believes that using the system will help him or her to attain gains in job performance. Percieved Usefulness: The degree to which a person believes that using a particular system would enhance his or her job performance. 1. Using the system in my job would enable me to accomplish tasks more quickly. 2. Using the system would improve my job performance. 3. Using the system in my job would increase my productivity. 4. Using the system would enhance my effectiveness on the job. 5. Using the system would make it easier to do my job. 6. I would nd the system useful in my job. Job-t: How the capabilities of a system enhance an individuals job performance. 1. Use of the system will have no effect on the performance of my job. 2. Use of the system can decrease the time needed for my important job responsibilities. 3. Use of the system can signicantly increase the quality of output on my job. 4. Use of the system can increase the effectiveness of performing job tasks. 5. Use can increase the quantity of output for the same amount of effort. 6. Considering all tasks, the general extent to which use of the system could assist on the job. 15

Relative Advantage: The degree to which using an innovation is perceived as being better than using its precursor. 1. Using the system enables me to accomplish tasks more quickly. 2. Using the system improves the quality of the work I do. 3. Using the system makes it easier to do my job. 4. Using the system enhances my effectiveness on the job. 5. Using the system increases my productivity. Outcome Expectation: 1. I will increase my effectiveness on the job. 2. I will spend less time on routine job tasks. 3. I will increase the quality of output of my job. 4. I will increase the quantity of output for the same amount of effort. 5. My coworkers will perceive me as competent. 6. I will increase my chances of obtaining a promotion. 7. I will increase my chances of getting a raise. Effort Expectancy: Effort expectancy is dened as the degree of ease associated with the use of the system. Percieved Ease of Use: The degree to which a person believes that using a system would be free of effort. 1. Learning to operate the system would be easy for me. 2. I would nd it easy to get the system to do what I want it to do. 3. My interaction with the system would be clear and understandable. 4. I would nd the system to be exible to interact with. 5. It would be easy for me to become skillful at using the system 6. I would nd the system easy to use. Complexity: The degree to which a system is perceived as relatively difcult to understand and use. 1. Using the system takes too much time from my normal duties. 2. Working with the system is so complicated, it is difcult to understand what is going on. 3. Using the system involves too much time doing mechanical operations. 4. It takes too long to learn how to use the system to make it worth the effort. Ease of Use: The degree to which using an innovation is perceived as being difcult to use. 16

1. My interaction with the system is clear and understandable. 2. I believe that it is easy to get the system to do what I want it to do. 3. Overall, I believe that the system is easy to use. 4. Learning to operate the system is easy for me. Social Inuence: Social inuence is dened as the degree to which an individual perceives that important others believe he or she should use the new system. Subjective Norm: The persons perception that most people who are important to him think he should or should not perform the behavior in question. 1. People who inuence my behavior think that I should use the system. 2. People who are important to me think that I should use the system. Social Factors: The individuals internalization of the reference groups subjective culture,and specic interpersonal agreements that the individual has made with others,in specic social situations. 1. I use the system because of the proportion of coworkers who use the system. 2. The senior management of this business has been helpful in the use of the system. 3. My supervisor is very supportive of the use of the system for my job. 4. In general, the organization has supported the use of the system. Image: The degree to which use of an innovation is perceived to enhance ones image or status in ones social system. 1. People in my organization who use the system have more prestige than those who do not. 2. People in my organization who use the system have a high prole. 3. Having the system is a status symbol in my organization. Facilitating Conditions: Facilitating conditions are dened as the degree to which an individual believes that an organizational and technical infrastructure exists to support use of the system. Perceived Behavioral Control: Reects perceptions of internal and external constraints on behavior and encompasses self efcacy, resource facilitating conditions, and technology facilitating conditions. 1. I have control over using the system. 17

2. I have the resources necessary to use the system. 3. I have the knowledge necessary to use the system. 4. Given the resources, opportunities and knowledge it takes to use the system, it would be easy for me to use the system. 5. The system is not compatible with other systems I use. Facilitating Conditions: Objective factors in the environment that observers agree make an act easy to do, including the provision of computer support. 1. Guidance was available to me in the selection of the system. 2. Specialized instruction concerning the system was available to me. 3. A specic person (or group) is available for assistance with system difculties. Compatibility: The degree to which an innovation is perceived as being consistent with existing values, needs, and experiences of potential adopters. 1. Using the system is compatible with all aspects of my work. 2. I think that using the system ts well with the way I like to work. 3. Using the system ts into my work style.

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Table 4.2: Shows the SERVQUAL 10 dimensions used in healthcare service Quality dimension Samples of questions to ask Tangibles: Appearences of physical facilities, equipment, personnel and information Reliability: Ability to perform promised service dependably and accurately Responsiveness: Willingness to help user to provide prompt healthcare service Competence: Possession of the required skill and knowledge to perform service Courtesy: Politiness, respect and consideration Credibility: Trustworthiness, believability, honesty of the healthcare service provider Security: Free from danger, risk or doubt Access: Approachability and ease of contact Communication: Listening to patient and acknowledging their comments/ concerns/ queries Understanding the patient/ client: Making the effort to know patients and their needs The 10 dimesions were used to generate samples of questions to ask which are in the following order as shown in table 4.2 Tangibles: 1. Are the healthcare facilities attractive? 2. Are the healthcare professionals knowledgable? 3. Are the wireless technologies modern? 4. Is the sent information easy to understand? Reliability: 1. If a response is assured to a patient at a certain time, does it happen? 2. Is the information free of errors? 3. Is the healthcare service offered or performed right the rst time? 4. Is the level of healthcare service the same at all times of the day 19

Responsiveness: 1. When there is a problem, do the healthcare centre respond quickly? 2. Are healthcare professionals willing to answer patient questions? 3. Are public situations treated with care and seriousness? Competence: 1. Can the heathcare professionals provide service through wireless technology? 2. Can the professionals use the technology quickly and skillfully? 3. Do the healthcare professionals appear to know what they are doing? Courtesy: 1. Are the responses on wireless technologies considerate and polite? 2. Do the healthcare professionals observe consideration of the property and value ptients? 3. Do the healthcare professionals refrain from acting busy? Credibility: 1. Do healthcare centres have a good reputation? 2. Are the consultations/ responses in healthcare given accurately and consistently with other reliable sources? 3. Does the healthcare centre gurantee its services? Security: 1. Is it safe to use the wireless technologies? 2. Are the information relayed on wireless technology secure? 3. Can patients be condent that e-health provided was done correclty? Access: 1. How easy isit to communicate to a consultant/ that knowledgable healthcare professional? 2. Is it easy to access the healthcare professional on wireless technology? 3. Are the healthcare service access points conviniently located? Communication: 1. Do healthcare professionals avoid using medical jargons when communicating? 2. Do healthcare professionals call if scheduled appointment will be missed/ changed? Understanding the patient: 1. Is the level of service and cost of service consistent with the requirements and affordability? 2. Are healthcare professionals exible enough to accomomdate patients schedule? We looked at all of them and related their relevancy to the this reaseach and came out with 66 questions. We subjected these questions to a number of healthcare professionals from around 20

Kampala and Mulago hospital in the pilot study. Over ten questionnaires were given out for this purpose, 6 were returned with comments and suggestions. There were some questions which the respondents said meant almost the same in that they stressed on the same point. The questions that we felt were emphasizing the same point were dropped. We ended up with 45 questions that addressed issues concerning technology acceptance, service quality and deployment environment in healthcare services. See questionnaire Appendix 1

4.3 Findings and characteristics of healthcare professionals.

The new questionnaire were then distributed in Mulago hospital and some sent to Rakai healthcare a rural setting. After a period of four weeks, 20 questionnaires were recieved from Mulago Hospital and non from the rural health centre. The health professionals in Rakai health centre did recieve the questionnaires but have not had time to respond to the them due to their busy schedules of duty. Therefore results presented here were exclusively obtained from a sample of 20 respondents out of 25 at Mulago hospital showing response rate of 80 percent. This chapter covers the testing of the questionnaire, selected background characteristics of the respondents such as sex, profession and years of experience. It further covers the deployment environment of the wireless technology, attitude of the respondents towards the use of the technology and the perception. The results are according to the objectives which are stated in chapter 4.1 above.

4.3.1 Analysis of the questionnaire by relationship

From the data collected analysis was done using SPSS to study the relevancy of the questionnaire since it is a combination of two model questionnaires. The chi-square obtained by looking at the relationship of the variables in UTAUT and SERVQUAL were signicant in that they have level of signicancy of below 0.05. The gure 4.1 below clearly indicates that the questionnaire is valid and can provide the necessary information it is intended to generate for the study of the evaluation of wireless information communication technologies. 21

For more relationships relating to the questions in the questionnare please check the Appendix 2 on Chi-Square comparing some items.

Figure 4.1: Shows the Relationships and Chi-Square value .

4.3.2 Validity and reliability

The questionnaire was subjected to the respondents in the initial stage, then a pilot survey was carried out. Following these stages basing on the new questionnaires all the respondents responded well and understood what the questions meant. An interview with four respondents who had earlier participated in the survey showed that questions were in keeping with what they were intended for. The responses were consistent with the earlier responses proving its reliability. Secondly these were questions adopted from UTAUT and SERVQUAL techniques which have been tested and proved to be valid and reliable. Most errors can be avoided by use of good techniques, this therefore has tested validity. 22

4.3.3 Characterictics of Healthcare professionals.

Table 4.3: Percentage tics Charateristics Sex Male Female Total Profession Medical doctor Nurse Pathologist Physiotherapist Radiographer Radiologist Total Years of Experience -5 5-9 10-14 15+ Total distribution of the respondents according to background characterisFrequency 12 8 20 8 1 1 3 3 4 20 1 10 4 5 20 Percentage 60 40 100 40 5 5 15 15 20 100 5 50 20 25 100

Gender

Sex is one of the background characteristics included in this study and it was categorized as male and female. The results presented in Figure 4.2 and Table 4.3 Show that the majority of the respondents are males as represented by 60 percent whereas the females constituted 40 percent of the respondents.The questionnaires were given out at random focusing mainly the different departments of speciality. Note that gender did not play a key role as a variable since the use of these technologies are not sex dependant.

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Figure 4.2: Shows the gender of respondents. Profession

Several healthcare disciplines were involved in this survey and majority of them were the medical doctors (40 percent), followed by radiologists (20 percent). On the other hand, the proportion of respondents who were physiotherapists by profession was the same as the proportion of respondents who were radiographers (15 percent) respectively. The least score was registered by those whose profession was nursing and pathologists that constituted 5percent respectively. 5 questionnaires were given out in the various departments although the responses did not portray that since some respondents did not complete the questionnaire at the time of collecting the data. It was noted that profession determined the exposure and frequency of use of some of the wireless technologies. Medical doctors were more exposed to using PDAs and mobile phones while the radiologists used teleradiology and mobile phones.

Years of Experience

Over 50 percent of the respondents had an experience of 5 years with majority at 5-9 years of experience. The difference in size of the sub samples in terms of experience was by coincidence. 24

The respondents had years of experince ranging from one to twenty one years. See table 4.3 and 4.4 The respondents among others were a senior consultant with vast years of experience and also Table 4.4: Brief background of the respondents No Post Holding Department Sex Years of Experience ICT Awareness 1 Senior Consultant Radiology Male 25 Over 2 yrs 2 Consultants Radiology Female 16 Over 2 yrs 1 Consultant Pathology Male 12 Over 2 yrs 2 Medical ofcers S.G Surgery Male 10-15 Over 2 yrs 1 Medical ofcers S.G Medicine Female 14 Over 2yrs 1 Medical ofcers S.G Radiology Female 16 Over 2 yrs 5 Medical Ofcers Mixed Mixed 6-16 Over 2 yrs 2 Senior Physiotherapists Physiotherapy Male 9-14 Over 2yrs 1 Physiotherapist Physiotherapy Female 6 Over 2 yrs 2 Radiographers Radio1ogy Male 1-2 Over 2yrs 1 Teaching Assistant Medical School Male 1 1 yr 1 Senior Nurse Ofcer Private Wing Female 20 Over 2 yrs 20 involved with issues concerning ICTs in health sector. A good number of doctors were involved ranging from consultants down to the general medical practitioners with at least six years of experience and over two years of ICT awareness in hospital setting. Other healthcare cadres were also involved from the nurse to the allied health profesionals who are always in contact with the patient. See table 4.4 below

4.3.4 Available wireless communication technologies

The existing wireless communication technologies in this study included PDA, Mobile phones and teleradiology. The results presented in the Figure 4. shows that amongst the healthcare professional the mobile phone has been available for over 2 years represented by over 90 percent of the respondents whereas wireless teleradiology was the least used with over 60 percent of the respondents having not used it before. A number of the respondents indicated that they have never used PDAs and teleradiology.

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Figure 4.3: Shows Available wireless communication technologies .

4.3.5 Ownership of the wireless information communication technologies

Among the deployed wireless technologies mobile phones were owned by individual shown by 100 percent, followed by the PDAs (90 percent). While for the teleradiology set, respondents felt it either belongs to the health centre or a private organization. In this case, through interviewing the responsible persons we discovered that it was owned by a private organisation that deployed it at the health facility as a project to pilot connectivity between hospitals for specialised consultation. This was to link Mulago, Mengo and Butabika hospitals. In the survey, the ndings were that the PDAa were either belonging to individuals or provided for by the institution such as the Mulago medical school to medical students and practising doctors at postgraduate level.

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Figure 4.4: Shows Ownership of the wireless information communication technologies .

4.3.6 Current state of use or expected time of use

The respondents in table 4.4 indicate that 95 percent of them use mobile phones which was followed in use by a few who use PDAs. See table 4.4 more more details in gures. The least used is teleradiology more precisely because it is a specialised wireless technology for tranmitting images,video, data/ text and audio using ISDN and the linked to a remote site using wireless connectivity provided by service providers like MTN. Data on the current state of use and the expected time of use was also captured in this study.From the gures in table 4.4, the respondents were optimistic that they would use the unavailable wireless technologies in about ve years time. This an indicator that they are embrassing use of wireless technology which in itself implies that technology is being accepted in healthcare service delivery. Hopefully as the cost of technology goes down the assumption is that a quarter of the healthcare professionals would be using some of the wiereless technologies in two years time.

The Figure 4.4 shows a pie chart with the cummulative percentages of use from all the respondents

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Table 4.5: Shows the percentage distribution of the wireless technologies whether currently in use or expected to be used I currently use Expect in 12 Months Expect in 2 years Expect in 5 years PDA 35 20 25 20 Mobile phone 95 5 Wireless Teleradiology 15 10 25 50 a total with mobile phones most used followed by PDAs.The results presented in the gure 4.4 indicate that all the wireless information communication technologies are currently in use with teleradiology being the least used and mobile phones being the most used.

Figure 4.5: Shows Percentage of usage of the wireless technologies .

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4.4 Deployment environment of the wireless communication technologies

Here we look at the various factors in environment affecting the deployment of the wireless information communication technologies and the attitudes of the healthcare professionals towards the regulatory policies in hospitals, national laws covering use of electronics, lack of fund, the changing technologies and availability of support personal. The attitudes were categorised as strongly agree, agree, no difference, disagree and strongly disagree. See Figure 4.6 and Table 4.5 below

4.4.1 Regulatory policies in healthcare centres

As shown in the Table 4.5, 45 percent of the respondents disagree that regulatory policies in healthcare centres hinders deployment of wireless communication technology in the healthcare centres. One-fth of the respondents agree that it is this regulatory policies that hinders deployment of wireless communication technologies. The proportion of respondents who said that they strongly agree that this policies affects deployment of wireless communication technologies is the same as those who said that there is no difference represented by 10 percent respectively.

4.4.2 National laws covering use of wireless technologies

As shown in the Table 4.5, most of the respondents believe that there is no difference in the national laws concerning deployment of wireless communication technology in the healthcare centres. The proportion that agree and disagree that this laws affect deployment of wireless communication is same (21.1percent) respectively.

4.4.3 Lack of funding

Lack of funding is one of the factors that affect the deployment of wireless information communication technology in healthcare service delivery. The ndings in Table 4.5 shows that 75 percent of the respondents both strongly agree and agree that lack of funding affects deployment of this technologies. On the other hand, there was a signicant number of respondents who felt no differ-

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ence(10 percent) and those who disagree.

4.4.4 Changing technologies

The respondents response on the change of technology disagreed that it could affect deployment. The Table 4.5 shows that 55 percent of the respondent disagreed on the statement that changing technology affects the deployment of wireless information communication technologies. The number of respondents who agreed and those who show no difference to the statement were the same at 15 percent. While 10 percent and 5 percent strongly disagreed and strongly agreed on the issues concerning changing technologies.

4.4.5 Availability of support personal

The presence of support personal featured strongly for purpose of deploying the wireless technology in a healthcare centre. 35 percent of the respondents ll they required a support personal while 10 percent felt it was not necessary.

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Figure 4.6: Shows responses on deployment environment of the wireless technologies .

4.5 Limitations of the Study

There are three important limitations to the study. First, the survey on perceptions and attitudes is of questionable validity but this one used UTAUT and SERVQUAL model of questions. During the pilot survey some staffs felt that a few items needed to be reworded. Since many of the items refer to the concepts of wireless technology and healthcare service delivery, the reliability and validity of the items depends on the strength of reference held by these terms. The designer of the questionnaire attempted to clarify these concepts by providing denitions of them throughout the course of the survey.

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Second, all sample surveys are liable to have biased ndings when response rates are low. This only represents a problem on the Mulago hospital based follow-up survey, since the attitude pilot and tests were administered before and during the Survey. For the test survey, while the evaluator is pleased with the 80 response rate, there is no assurance that these respondents are an unbiased representation of the whole group. Thirdly, the healthcare professionals are very busy people thus unable to respond to large sets of question easily. This questionnaire had 45 questions in all and therefore more time is required to have a good and reasonable response number.

4.6 The attitudes of the respondents in determining the level of technology acceptance by the healthcare professionals
The attitudes of the healthcare professionals towards technology acceptance was assessed in this study. Several dimensions are considered in addressing the attitudes of the professionals towards technology and this include usefulness of technology, quick accomplishment, productivity increase among others.

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Figure 4.7: Shows dimensions of technology acceptance by healthcare professionals .

4.6.1 Usefulness to job

As shown in the Figure 4.7, majority of the respondents agree that the technologies was useful to their jobs. On the other hand, only 5 percent strongly disagree that the technologies are useful to their jobs. These resluts signify that the healthcare professionals accept the use of the wireless technology and nd it useful to their work. Even though some did not have the other wireless technologies available to their disposal but still felt it necessary and useful to their respective jobs.

4.6.2 Enables quick accomplishment

The attitudes of the respondents was also assessed by asking the respondents if the technologies enabled them quickly accomplish their job. This was grouped as strongly agree, agree, no difference, disagree and strongly disagree. The results presented in the Figure 4.7 shows that 85 percent of the respondents agree whereas the rest of the responses had the same score 5 percent.

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4.6.3 Productivity increase

Over 70 percent of the respondents showed that the deployment of wireless information communications has helped to increase productivity at workplace.The wireless communication has increased productivity in that healthcare professional do not need to walk some distance away to consult but make a call and business continues as usual. This greatly increases productivity.

4.6.4 Skilled to perform job

The features show that the healthcare professionals are skilled enough to use wireless information communication technologies. The respondent indicated that they were skilled to use the availble wireless information communication technologies. This was common with those using mobile phone and partly the PDAs. However the teleradiology was much more complex system which some of the respondents felt they are not skilled enough to use it.

4.6.5 Work more interesting

Majority of the respondents indicate that the technologies have made healthcare service more interesting as shown in gure 4.7. This has been so because they seem to embrass the use of new IT technologies and therefore do accept them for the delivery of healthcare service.

4.7 The perception of respondents to determine the service quality when using wireless information communication technologies.
In this study the perception of the healthcare professionals towards the wireless information communication technologies was assessed on quality of healthcare services. subsection Information on wireless technologies are delivered free of errors In Figure 4.8, majority of the respondents disagree that information over wireless communication technologies is free of errors.

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Figure 4.8: Shows Components of service Quality in healthcare service by using wireless technologies .

4.7.1 Same level of healthcare services

In the Table 4.6, majority of the respondents represented by 65 disagree that the level of healthcare services is the same compared to those who agree represented by 35 percent. However, small percentage of the respondents said that there is no difference in the level of healthcare services when using wireless technologies.

4.7.2 Respond faster to x problem

The results in the Table 4.6 shows that over 80 percent of the respondents disagree that the respond to x problems fasters with the healthcare communication technologies. On the other hand, 15 percent of them agree that they respond to x problems faster.

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4.7.3 More care and consideration to patients

The results in the Table 4.4 shows that 45 percent of the respondents disagree that patient are treated with more care and consideration whereas those who strongly disagree with that were represented by 5 percent. Furthermore, 30 percent said that there is no difference as far as patient care and consideration is concerned.

4.7.4 Easier communication to healthcare professionals

The results in the Table 4.6 further indicates that shows that 80 of the respondents agree that wireless information communication technologies have made patient to healthcare professional communication much easier. Furthermore, 15 percent said that there is no difference whereas 5 percent strongly disagree that patient to healthcare professional communication is much easier.

4.7.5 Patient information more secure

The results in the Table 4.6 shows that 30 percent of the respondents strongly disagree that patient information is secure whereas 30 percent of them agree so. On the other hand, 40 percent of them said that there is no difference in patient information security on the wireless technology. Table 4.6 Shows the percentage distribution of the respondents according to the perception of the healthcare professionals to the delivery of quality healthcare services Basing on patient information condentiality, most healthcare professionals feel uncomfortable in sharing that information online using especially wireless technologies. It is common knowledge that information online wireless can be tapped for several reasons, defense and security being one. Therefore one can not ruleout malice. See next page Table 4.6

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4.8 Summary of Findings

1. There was virtually no change between pilot and test items reecting baseline opinions about healthcare and wireless in the hospital.

2. There was no change reported on pilot and test questionnaires in perception or attitude regarding the use of wireless information communication technologies over the course of the Survey.

3. The six participants in the pilot survey showed some minor changes on the two questionnaire items on the pilot survey that reected misconceptions about an healthcare service delivery.

4. Fewer respondents believed that wireless technology were only promoting Technologybased practices; and more respondents understood that wireless information technologies serve the needs of both individuals and public alike especially the PDAs and mobile phones.

5. The Respondents became aware of what they were asked in the questionnaire and some how acted as a comprehensive brief education programs on the following: (a). Expanding knowledge and broadening perspective in use of wireless technology in healthcare service (b). Possible future plans to integrate health informatics into curriculum/classroom (c). Learned to share information with others and give individual opinions, thus increase tolerance (d). The researcher is able to make a presentation or short presentations out of the survey (e). The information will be eventually disseminated and shared with staff

6. The researcher has reported the following positive impacts in their work as a result of applying wireless technologies: (a). Helped break down barriers between healthcare professionals, patients, Medical students, and others. 37

(b). Learned that wireless information technologies increase productivity, work is more interesting and ease of use. (c). More knowledge since remote locations with wireless technologies will have access. (d). Network with others through information sharing using wireless technologies such as teleradiology/ telemedicine (e). PDAs are useful and essential in collecting or gathering research data from the outreaches

7. There has been communications between participants since the Survey was conducted through departmental or unit group discussions and through service and outreach. 8. A majority of respondents enjoyed the survey. 9. Several respondents urged a continuation of the Survey and expanding their exposure in health related information systems.

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Table 4.6: Shows the Percentage distribution of the respondents according to the deployment environment of the wireless technologies Deployment environment Hospital regulatory policies hinders deployment Strongly agree Agree No difference Disagree Strongly disagree Total There are no national laws that cover use Strongly agree Agree No difference Disagree Strongly disagree Total Lack of funding affects deployment Strongly agree Agree No difference1 Disagree Strongly disagree Total The changing technology hinder deployment Strongly agree Agree No difference Disagree Strongly disagree Total Availability of support Human resource Strongly agree Agree No difference Disagree Strongly disagree Total Frequency 2 4 2 9 3 20 3 4 6 4 2 20 8 7 2 3 20 1 3 3 11 2 20 6 2 7 5 20 Percentage 10 20 10 45 15 100 15 20 30 20 10 100 40 35 10 15 100 5 15 15 55 10 100 30 10 35 25 100

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Table 4.7: Shows the percentage distribution of the respondents according to the perception of the healthcare professionals to the delivery of quality healthcare services Service Quality Frequency Percentage Information free of errors Strongly agree Agree 3 15 No difference 3 15 Disagree 9 45 Strongly disagree 5 25 Total 20 100 Same level of healthcare service Strongly agree 1 5 Agree 4 20 No difference 1 5 Disagree 12 60 Strongly disagree 2 10 Total 20 100 Centre responses faster to x problems Strongly agree Agree 3 15 No difference Disagree 13 65 Strongly disagree 4 20 Total 20 100 Patient treated with more care and consideration Strongly agree Agree 3 15 No difference 6 30 Disagree 10 50 Strongly disagree 1 5 Total 20 100 Easier to communicate to healthcare professionals Strongly agree 3 15 Agree 13 65 No difference 3 15 Disagree 1 5 Strongly disagree 5 25 Total 20 100 Patient information more secure Strongly agree Agree 7 35 No difference 6 30 Disagree 5 25 Strongly disagree 2 10 Total 20 100 40

Chapter 5 CONCLUSION AND RECOMMENDATIONS.

5.1 Conclusions
The case study at Mulago hospital revealed that there are PDAs, Mobile phones and teleradiology set in use at the hospital. However these wireless technologies were used by different professionals with the exeption of the mobile phone which is used all over. The PDAs is mainly used in department of medicine, pathology and surgery, while the teleradiolgy is majorly used in the radiology department. There is 100 percent usage of the mobile phones by all the respondents who are practicing healthcare professionals. The wireless technologies that were deployed deliberatey are to some extend the PDAs and Teleradiology which are owned by a private organisation but not the healthcare centre as was earlier thought to be by some respondents. Mobile phones was exclusively owned by individual. The major nding in the deployment environment is that healthcare professionals ll that lack of funding in these technologies to purchase, maintain, repair and technical support were hindering deployment and effective utilisation. Also important to note is that the respondents were not sure about the current laws concering use of information communication technologies in the country. This alone has a negative impact since the administrators and managers tend not be sure of how to proceed once faced with the intent to deploy the technologies. The healthcare professional have to some extend individually embraced the use of wireless in41

formation communication technologies especially mobile phone and PDAs amongst those who have pursued post graduate studies. Most started using the PDAs for gathering information on patients from rural areas. A private organization in collabration with makerere medical school have deployed PDAs and teleradiology in Mulago hospital and some upcountry health centres, notably Mbale hospital and Rakai health centre. The study indicates that the attitudes of the healthcare professionals on wireless technologies is postive thus ascent to technology acceptance as demonstrated by the responses on usefulness to their work, able to quickly accomplish their work, increase in the productivity and have developed more interest in the technologies. A case in study is that medical doctors follow-up their patient using mobile phones. This common is with patients on study, those with identied anomalies in utero, to mention but a few. On the other hand the perception of healthcare professionals on service quality is equally good in that the respondents say that patients are able to access them any where any time without hinderance as it were in a hospital setting where you have to get through many checks and queues before you approach a health professional.Therefore communication has become more easier with the use of the wireless technologies. Never the less most healthcare professionals do not think that wireless technologies improve the level of healthcare. They feel that the level of healthcare has remained the same since its offered by the same people with the same skills and same ethical consideration. The non-wireless technologies for information technology were not the concern of this study but notwithstanding the fact they were used to some extend in healthcare service. These include landline telephone, request and consultation notes and to a lesser extend internet service via e-mail. The dilemma with these system is that they involved being in a xed place say hospital and not all healthcare professionals had access to them at all times. Therefore although wireless information communication technologies are being used in Mulago hospitals it is not fully utilised due to the following reasons:

1. Low level of wireless technologies knowledge amongst the healthcare profefessionals 2. Rigidity to adopt due uncertainity of secure information 3. Lack of administration commitment 42

4. Inadequate resources such as PSAs, teleradiology and mobile phones belonging to health centres 5. Lack of adequate funding of ICT projects 6. Service providers have not promoted or invested in the healthcare as a social responsibilty.

5.2 Recommendations
From the ndings it was noted by all the respondents that funds were the major issue that hinders deployment of wireless technology in healthcare service. Therefore the researcher recommends that steady and recurrent funding sources be identied to support the use of wireless information communication technologies to improve healthcare service delivery as it has a positive impact. This will help in averting the abandoning some of the technologies like PDAs and teleradiology systems. There is need for a proactive move to inform the healthcare professionals on the regulations and standing laws concerning the use of information systems in the health sector since more were not aware or informed. As patients and visitors continue using wireless technologies in our facilities most healthcare professionals still feel its not right and in some areas they are a no go areas for wireless technologies.As of now, there is dilemma on one hand for use and condentiality on the other hand. Health professionals are not informed whether there policies enacted to ensure legal certainity and security of patient information on wireless technologies. For ICT to become successful in hospitals, it is vital that there is timely, specic and sustainable substantial ICT training programs arranged for health professionals to enhance their percetion and attitudes towards the use of wireless technology in healthcare service delivery and the ability to use them appropriately.This could be sustained by developing a multi-disciplinary curriculum in health informatics that will train both medical and IT professionals who will wish to pursue a career in medical information technology. This could be implemented by a colaboration between the faculty of medicine and faculty of Computing and IT. There is need for the participation of all the stakeholders such as government, NGO private organisations, service providers, health profssionals and patients to paticipate in planning and imple43

mentng of ICT projects in hospitals such that their is shared sense of ownership and committment by all those involved to ensure continuity. Since wireless technologies do not require use of x line infrastructure, it should be recommend by government and be deployed in all hospitals for purposes of communication and conultation. Take for example, all the mobile phones were individually owned but were used for healthcare service delivery at the users own cost. Fewer health processionals owned the PDAs, but the use in healthcare is vital, there is need to subsidize the cost so that more healthcare professionals and medical students could have increased access to health information no matter where they are stationed provided there is wireless network. Lastly, I recommend that a larger sample size is considered to study this to include referral, urban, semi-urban and rural healthcare centres to evaluate the impact of wireless information communication technologies in healthcare service in the great lakes region where the use of cellular phones is ever increasing.

5.3 Summary
This survey was intended to study the impact of wireless information communication technologies in healthcare service. The perception and attitudes of health professionals on technology acceptance and service quality were considered. Hence, a questionnaire was designed based on the combination of the two models of UTAUT and SERVQUAL. The questionnaire was modied, piloted and tested in Mulago hospital. Some useful information was obtained after analysing the data from the 20 respondents who were all health professionals. The survey indicates that wireless technologies were useful in healthcare service delivery and that it helped in faster accomplishment of job at workplace. The survey found out that the use of wireless technology made healthcare more interesting. This was mainly because it was much easier for the healthcare professionals to follow-up thier patient where ever they may be. On the other hand the healthcare professionals feel that the use of more so the mobile phones has made patients communicate effectively with them without any physical limitation any time any where.

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However, healthcare professions are not confortable and sure on the condentiality and security of patient information. The dilemma on policies concerning enacted laws is looming in the health sector due to lack of effective communication. It is my wish to expand the scope of this study with over 300 respondents and also coverage to give use a more accurate impact assessment of wireless information communication technologies in healthcare service. This is a sector which is more neglected in capital development but serves the entire population.

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REFERENCES
1. Adamson, I., and Shine, J. (2003). Extending the new acceptable model to measure the end user information systems satisfaction in a mandatory environment: a banks treasury. Technology Analysis and strategic management, 15(4), 441 457. 2. Chris Albon, 2006: Wireless technologies for health. Updated April 2006, http://www.i4 donline.net/articles/current-article.asp?articleid=631 and typ=Features. 3. Anvekar, D.K., Agrawal, P. and Patel, T. Fixed cellular rural networks in developing countries: a performance evaluation, Proceedings of the 1996 IEEE Internat. Conference on Personal Wireless Communications, pp. 33-38, February 1996. 4. AvantGo Survey Identies Preferences of Tech-savvy Mobile Users. Retrieved February 3rd 2007. From http://www.embeddedstar.com 5. Babbar, S. (1992). A dynamic model for continuous improvement in the management of service quality. International Journal of operations and Production Management, 12(2), 38 -48. 6. Baker, D. B. (2003). Wireless (In) Security for Health Care. HIMSS Advocacy white paper. Retrieved March 15th 2007 from http://www.himss.org/content/les/WirelessInsecurityV11 7. Bob Brewin. (2004). Some wireless phone users shun cisco WLAN gear.Computerworld, Mobile and wireless. March 2004. 8. The British medical journal (August 2005). UK: Staff disengagement could stall UKs health IT programme, says study. E-governance News.Arthur 9. Cohen A.(2000) Research methods in education, 5th edition London: Routledge 10. Cox and Scott (2002). The ofcial report of the 1st Asia Pacic Forum on Quality Improvement in Health Care Retrieved February 20th 2007 from http://www.adc.bmjjournals.com 11. John Crouch, 2002.Healthcare system goes wireless: management and security broaden hand-held deployment - Wireless. Communications News, Sept, 2002 http://ndarticles.com/p/articles/mi 12. Diane Hardy, Leslie Amadio, Holly Ladd (2003). New Use of Wireless Technology: A Giant Leap for Health Care in Uganda. International Development Research Centre (IDRC) Archive, WideRay, Boston, September 24-25, 2003. 46

13. G Eysenbach (2001): what is e-health, Journal of medical Internet research. Vol:3(2.Retrieved March 18, 2007 from http://www.jmir.org/2001/ 14. Gardener A (1994)Wireless technologies set to overhaul healthcare. Updated February 10, 2007 retrieved 08/02/2007.http://www.businessweekly.co.uk/hotspot/detail.asp?id=107 Arthur 15. Erevelles, S., and Leavitt, C. (1992). A comparison of current models of consumer satisfaction/ dissatisfaction, Journal of Consumer Satisfaction, Disatisfaction and complaining behavior, 5, 114 -194. 16. Gardener A (1994)Wireless technologies set to overhaul healthcare. Updated February 10, 2007 retrieved 08/02/2007.http://www.businessweekly.co.uk/hotspot/detail.asp?id=107 Arthur 17. Gillette, B. (2004). Wireless technology serves as next step in care service, Managed Healthcare Executive, 54-55. 18. Healthcare Information Management Systems Society (2003). HIMSS Patient Safety Survey 1 12. 19. Holly Ladd (2000)Satellife,Using PDAs in the sub-saharan Africa. Watertown, MA, USA. Retrieved April 4, 2001 from http://www.healthnet.org/index 20. Hom, Willard (2000). An overview of customer satisfaction models. California research planning and group proceedings, 100 110. 21. Humberman AM and Miles MB (1994). Qualitative data analysis 2nd edition Thousand Oaks: Sage 22. Intel Corp (2003). IEEE 802.16 and WiMAX: Broadband Wireless Access To Every One, 2003. Retrieved April 7th 2007 from www.intel.com/ebusiness/pdf/wireless/intel/802.16wimax 23. Javed, A., OKelly, P., Dick, K., and Lucey, M. Wireless technology evolution and impact on the access network, Proceedings of the 1996 IEEE International Conference on Personal Wireless Communications, pp. 12-16, February 1996.

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24. Kern and Jaron (2006)Using wireless technologies in healthcare: International Journal of Mobile Communications, 2006 - Inderscience Page 1. 354 Int. J. Mobile Communications, Vol. 4, No. 3, 2006 Copyright 2006 25. Kettinger, W. J., and Lee, C.C. (1997). Pragmatic perspectives on the measurement of information systems service quality. MIS Quarterly, 21(2), 223 240. 26. Lee, Y.,Kozar, K.A, and Larsen,K.R.T.(2003) The technology Acceptance Model: Past, Present and Future. Communications of the the Association for Information Systems, 12, 752-780. 27. Lu,J.,Yu,C-S., Liu, C and Yao, J.E. Technology acceptance model for wireless internet. Internet Research, 2003, 13(3), 206-222. 28. CT.Meadow (1999). Perspectives on demand of Telecommunications: Principles, Developments, Prospects Networks and distributed information services Volume 37, Issue 6 , Pages 405 - 408 29. Merry,Mullen and Co.,Chartered Accountants and Registered Auditors,35,Westland Square,Pearse Street,Dublin 2.http://209.85.165.104/search?q=cache:Hvhwt0tqnmQJ: Retrieved March 29th 2007 from www.abdci.gov.ie/Uploads/ Annual.2520report.252005.2520English.pdf+Mulago+Hospital+total+asset+cost and hl=en and ct=clnk and cd=6 and gl=ug 30. Meg. Broderick (2003): E-health dened. HIMSS E-health SIG whitepaper.Retrieved Feb 24, 2007 from http://www.himss.org/ASP/sigs-ehealth 31. Newbold, S.K. (2004). New uses for wireless technology. The Nurse Practitioner, 29(4), 45 46. 32. Oliver, R. (1997). Satisfaction: a behavioral perspective on the consumer. Boston, MA: McGraw-Hill. 33. Parasuraman,A.,Zeithaml, V.A. and Berry, L.L.(1988). SERVQUAL: A multi-item scale for measuring customer perceptions of the service quality. Retailing, Vol. 64, 40. 34. Prybutok, V.R., and Spink, A. (1999). Using the Baldrige Criteria for Self-Assessment Assisted One Health Care Provider with its Quality Advantage Strategy. IEEE Transactions on Engineering Management, 46(3), 299-310. 48

35. Raghupathi, W. (2003). Information technology in healthcare: a review of key applications. In Kevin Beaver (Ed.), Healthcare information systems, 2nd ed. (pp.9-27). London: Auerbach Publications. 36. Peter A.Rosen (2004),The Effect of Personal Innovativeness in Domain IT on the Accep-

tance and use of Technology: A Working Paper. Retrieved May 10, 2007 from http://faculty.evansville.edu/p 37. Stedmans Medical Dictionary (2004), The American Heritage, 2nd Edition Houghton Mifin Company. 38. Viswanath Venkatesh, Michael G. Morris, and Fred D. Davis(2003).User Acceptance of IT. MIS Quarterly Vol. 27 No. 3, pp. 425-478/September 2003 425 39. Wasukira Elisha and Naigambi Wilber (2002). Report on usage of ICT in local governments in Uganda. 40. Yang, C-C. (2003). Improvement actions based on the customers satisfaction survey. TQM and Business excellence, 14(8), 919 930. 41. Zeithaml, Parasuraman and Barry (1994), Alternative scales for measuring service quality: A comparative assessment based on psychometric and diagnostic criteria. Journal of marketing 70 (3)Fall. 201-230

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APPENDIX 1 QUESTIONNAIRE

QUESTIONNAIRE This questionnaire is designed to collect perceptions of the inuence of wireless communication technologies (PDAs, Mobile Phones and Wireless Teleradiology) on delivery of health care services. Your contribution to this survey is valuable and appreciated. All information provided will be treated with utmost condentiality.

(1) Name of Health centre.................................................................................... (2) Your Profession..................................................................................... (3) Your years of experience in this profession................................................ (4) Respondents gender....................................................................................... (5) Please tick the most appropriate box to describe how long each of the 3 technologies has been used in your centre for work purposes.

Not Used Personal Digital Assistant(PDA) Mobile phone Wireless Teleradiology

1-6 Months 7-12 Months

1-2 Years

Over 2 Years

(6) Please tick one or more boxes to describe who owns each of the wireless information communication technologies in use at your centre.

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Health centre Private Organisation Service Provider Personal Digital Assistant(PDA) Mobile phone Wireless Teleradiology

Individual

(7) Please tick to describe the intend to use the wireless information communication technologies in the next number months or years.

I Currently use Next 12 months Next 2 years Next 5 years Personal Digital Assistant(PDA) Mobile phone Wireless Teleradiology

For each of the statements below, please tick the term that best ts the statement as it applies to your experience at your current workplace.

(8) I nd the wireless technologies useful to my job. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(9) The wireless technology use in my job has enabled me to accomplish my job more quickly Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(10) The wireless technology use in my job has increased my productivity Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(11) I am skilled to use the wireless technology in my job. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(12) Learning to operate the wireless technology was easy for me. Strongly agree........ Agree........ Undecided..... 51 Disagree........ Strongly disagree........

(13) The wireless technology(s) makes my work more interesting Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(14) People whose opinion I value think that I should use the wireless technology my job. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(15) Health professionals accept the use of wireless technologies in my centre. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(16) The senior management of this organisation has been very helpful in the use of the wireless technology. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(17) In general, my organisation has supported the use of the wireless technology in my job. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(18) I have the resources necessary to use the wireless technology in my job. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(19) I have the knowledge necessary to use the wireless technology. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(20) The wireless technology is not compatible with other systems I use at my work place. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(21) There is a specic person or group available for assistance in case of difculties in use of the wireless technologies at my workplace. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

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(22) I could use all the available wireless technologies even if there is no one to tell me what to do at my work place. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(23) I could use all the available wireless technologies in my job if there is someone I can call for help. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(24) I could use all the wireless technologies in my job if I had a lot of time to complete the task. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(25) I feel apprehensive about using the wireless information communication technology. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(26) It scares me to think that I may loose condential information using the wireless technology. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(27) I hesitate to use the new wireless technologies for fear of making mistakes I cannot correct. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(28) The new wireless technologies are somewhat intimidating to me. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(29) Regulatory policies of hospital hinder the use of wireless technologies in my centre Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(30) There are no laws that cover the use of Healthcare service online or over wireless technologies in the country. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

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(31) Lack of funding affects the introduction of wireless technology in my centre, Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

(32) The fact that technology is changing hinders the introduction of wireless technologies in my centre. Strongly agree........ Agree........ Undecided..... Disagree........ Strongly disagree........

The remaining questions concern any change in the service provided to patients at your centre because of the introduction of the wireless technologies.

(33) Our healthcare centre looks more modern to patients because of the new wireless technologies. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(34) Overall, the information given to patients is more likely to be free of errors now. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(35) The level of healthcare service provided is more likely to be the same for all patients. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(36) The level of healthcare service provided is more likely to be the same for all patients at all times of the day because of the new wireless technologies. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(37) When there is a problem with our services, the centre responds faster to x it up. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(38) Patients are treated with more care and consideration now. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

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(39) Health professionals here provide healthcare service more competently now. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(40) Health professionals at this centre value patients more now. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(41) The healthcare centres reputation is better now. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(42) The responses given to patients are more likely to come from reliable sources because of the use of the new wireless technologies. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(43) Information about patients is more secure because of the use of wireless technologies. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(44) It is easier for patients to communicate with a health professional because of the use of wireless technologies. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

(45) The cost of services is now cheaper because of the wireless technologies. Strongly agree........ Agree........ No difference..... Disagree........ Strongly disagree........

I am indeed grateful to you for sparing your precious time in answering this questionnaire Thank you.

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APPENDIX 2 CHI-SQUARE VALUES

CHI-SQUARE VALUES

Figure 5.1: Shows Resource necessary to use vs new technology making health centre look modern .

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Figure 5.2: Shows Time to complete all tasks vs same level of healthcare .

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Figure 5.3: Shows Being able complete task alone vs Faster response to s problem .

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Figure 5.4: Shows Patient treated with care and consideration vs management supportive .

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Figure 5.5: Shows Competence of healthcare provided vs technology acceptance .

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Figure 5.6: Shows the valuing of patients by healthcare professionals vs the technology .

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Figure 5.7: Shows skilledness to use technology vs competence in providing healthcare .

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Figure 5.8: Shows the reputation of healthcare centre vs quick accomplishment of the work .

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Figure 5.9: Shows the reliability of patient information source vs quick accomplishment of the job .

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Figure 5.10: Shows the reliability of patient information source vs helpfulness of management .

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Figure 5.11: Shows ease of patient communication vs technology acceptance .

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Figure 5.12: Shows the cost of healthcare vs quick accomplishment of the work .

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Figure 5.13: Shows the cost of healthcare vs helpfulness of senior management .

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