Stakeholder Perspectives and Implementation of Telemedicine Projects in Referral Hospitals in Kisumu City, Kenya

Abstract

Despite its major economic and health impacts especially following the global COVID-19 pandemic, the degree of telemedicine implementation globally continues to vary widely between and among the developed and the developing countries. Overall, while Kenya has taken some steps towards telemedicine implementation, there is still a long way to go in terms of widespread implementation and integration. Telemedicine implementation is critically hindered by among other factors, a lack of coordinated and comprehensive stakeholder engagement planning resulting in a lack of timely care, long waiting times, lack of continuity of care and preventive care, lack of access to specialists and high cost of health which remain major barriers to health care access. The objective of this study was to explore the perspectives of various stakeholders and implementation of telemedicine projects in referral hospitals in Kisumu City, Kenya. The specific objectives were to; evaluate the influence of stakeholder attitudes, to explore the impact of stakeholder perceptions, to examine the effect of stakeholder knowledge and to investigate the role of stakeholder experience on the implementation of telemedicine projects in referral hospitals in Kisumu City, Kenya. This study allowed the analyzing of stakeholder management strategies, telemedicine implementation risks, change management strategies, and contribution in refining project management practices, fostering ongoing research, and disseminating best practices in telemedicine implementation. The theoretical frameworks underpinning the study were the Freeman’s Stakeholder Theory and Venkatesh’s Unified Theory of Acceptance and Use of Technology. The study employed a mixed methods approach. The target population was patients and other stakeholders including hospital administrators, healthcare providers, and IT personnel who were in active employ of their various institutions at the time of the study, and who had used telemedicine in the 12 months prior to the start of the study. A sample size of 197 participants was determined using Slovin’s Formula. Simple, stratified and purposive sampling procedures were utilized. Study questionnaires were self-administered and quantitative data collected using the RedCap application software. Data was analyzed using SPSS Version 27. Descriptive statistics for each dimension of stakeholder perspectives including frequencies, means, medians, SD and interquartile range was used to describe the central tendency and variability in responses. Spearman’s rank correlation was used for the exploration of initial patterns and associations. Ordinal logistic regression was used to predict the impact of stakeholder perspectives on telemedicine implementation and for control of confounders. The alpha value was set at 0.05 for statistical significance. Variables with an alpha value of 0.1 by bivariate analysis were candidates for a multinomial logistic regression model. Qualitative data complementing the quantitative data was used to identify patterns in stakeholder perspectives and telemedicine implementation. The data was presented in tables. The results of the study showed that stakeholder attitude is significant in influencing implementation of telemedicine projects (r=0.442; P0.000). Stakeholder perception was determined to be significant in influencing implementation of telemedicine projects (r=0.397; P0.000). The study established that stakeholder knowledge is significant in influencing implementation of telemedicine projects (r=0.474; P0.000) and that stakeholder experience is significant in influencing implementation of telemedicine projects (r=0.376; P0.000). The study concluded that stakeholder attitude, perception, knowledge and experience significantly and positively influence implementation of telemedicine projects in Kisumu City. As a recommendation stakeholder attitude should be positively influenced and if possible changed and perception integrated in all planning to support telemedicine projects implementation. Additionally, stakeholder knowledge should be enhanced through training and capacity building to arm them with the requisite skill-set necessary for the implementation of telemedicine projects. Stakeholder experience should be considered part and parcel in running telemedicine projects to facilitate implementation and performance.