Determinants of telehealth adoption in the Indian healthcare domain: an exploratory study

Determinants of telehealth adoption in the Indian healthcare domain: an exploratory study

India is a developing country with a large landmass and a huge socio-culturally, economically and ethnically diverse population. The healthcare system for such a diverse and complex country entails challenges and difficulties in execution and outreach. Here, the emerging area of telehealth could afford a place for itself in providing healthcare and health education to a large section of people residing in areas where there is an acute shortage of healthcare professionals. Almost seventy percent of the population in India are in rural areas. The infrastructure in India, similar to other developing countries, is erratic and differs throughout the country.

Similarly, the information and communications technology (ICT) infrastructure in India is developed in urban areas, whereas there are insufficient ICT facilities in rural areas. As telehealth depends on the utilisation of ICT infrastructure, it is essential to conduct a study to find out the determinants of ICT adoption in the Indian telehealth environment. Moreover, as evident from relevant literature, telehealth is in a nascent stage in India, with most of the projects currently at a pilot study level. As such, it would be practical to conduct the study from an organisational point of view because the organisational adoption of ICT will eventually foster the implementation of telehealth in the domain of Indian healthcare. The study focuses on developing a theoretical framework of ICT adoption in the Indian telehealth environment, as limited research has been conducted in this area.

This research study followed a three-step procedure to establish and confirm the determinants of telehealth adoption by healthcare professionals in India. The first step included an extensive literature review relating to telehealth and ICT adoption in healthcare domains worldwide and a review of technology adoption models relevant to healthcare domains. The literature review helped derive the relevant constructs of ICT and telehealth adoption in healthcare domains worldwide. Further, a preliminary conceptual framework was developed with the significant constructs that formed the base of the next step. The second step was a qualitative, in-depth, open-ended, semi-structured interview of Indian healthcare professionals based on the information and constructs derived from the literature review and the preliminary conceptual framework. The interviews helped refine the preliminary conceptual framework to generate hypotheses and the research model, which was then tested in the third stage of the research. The third step was a paper and online mode survey generalising the healthcare professionals' perceptions, expert feedback and relevant literature over a large population, to help establish and confirm the constructs. Accordingly, twelve interviews were conducted in a few states of India and the perceptions of the healthcare professionals were later analysed to arrive at the research model to generate hypotheses. Further, the hypotheses were tested over a large population in a few states of India, through a survey, by statistical testing to establish, reject and confirm the significant constructs influencing telehealth adoption for Indian healthcare professionals. Appropriate ethical approvals were obtained in all stages of the research.

The qualitative interviews were first audio-recorded and later transcribed by the researchers. The transcription was then analysed in three stages of manual coding, Leximancer coding and NVivo coding to establish rigour and validity in developing the research model. Both deductive and inductive reasoning were followed in the qualitative analysis phase. The survey results were analysed with statistical software SPSS to test, establish, reject and confirm the constructs of the research model and find the relationship among the variables. Finally, SPSS-AMOS and Smart PLS were utilised to run the CB based and PLS based structural equation modelling to generate and validate the final theoretical framework of telehealth adoption in the Indian healthcare domain.

The results indicate that Healthcare Practices, Healthcare Facilities and Usefulness are the significant enablers or drivers of telehealth adoption by Indian healthcare professionals (HCPs). The barriers to telehealth adoption were found to be the lack of standardised guidelines, policies and procedures, which have been termed as State Leadership in this research. Further, State Leadership involves promoting the awareness of the inherent benefits of telehealth to remove the primary challenges of inaccessibility to healthcare facilities and deployment of uniform healthcare. This is particularly relevant for the rural and remote parts of India.

The rapid improvement in ICT infrastructure in developing countries can help overcome technology barriers. Further, a national standard for telehealth practice can open ample opportunities culminating in healthcare reform and transformation for better health outreach, access and health awareness development.

The most significant contribution of the research is that it identified the enablers (drivers) and the barriers to telehealth adoption in Indian healthcare. Governmental and non-governmental organisations can use the final theoretical framework to foster and implement telehealth, especially in rural and remote regions of India, where there is a lack of sufficient healthcare facilities and a shortage of healthcare professionals. Notably, this research identified that telehealth could be utilised in times of emergency and natural disasters where healthcare information can be disseminated quickly and efficiently for the initial assessment of the healthcare needs of the affected population.

The limitations of the research are that it tested the research model on healthcare professionals only. Further research can be conducted by governmental and non-governmental organisations on the patient-centric adoption of telehealth. Further, research on adoption perceptions of healthcare professionals and patients relating to specialised telehealth equipment, such as digital stethoscopes and health care applications on smartphones, can be conducted.

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