E-health barriers as layer 1

E-health is the provision of healthcare services through electronic means. E-health can connect different stakeholders, such as patients, medical staffs, service providers and governmental agencies, through information and communication technologies (Ouhbi et al., 2017). The utilisation of e-health can bring significant advantages to many healthcare sectors. According to several studies, e-health can increase scalability, time efficiency and the capacity to accept more individuals. Moreover, e-health facilitates the provision of healthcare services to individuals with reasonably lower costs (Senor et al., 2012 ; Fernández-Alemán et al., 2013).

Many e-health initiatives have been applied in healthcare. These initiatives involve different technologies, such as electronic records, disease monitoring and cloud computing (Ram, 2014). However, the implementation of such technologies faced different barriers that hinder successful e-health implementation. These barriers are investigated in Chapter Five in a statistical study. As the results from the analyses can benefit different e-health solutions, the resultant barriers are shared using a web portal which we have built to support users managing their illness.

The area of e-health covers a wide domain that includes different aspects related to different diseases, along with its preventions and treatments. That is, due to its effectiveness, e-health solutions can be implemented to overcome different chronic diseases. Examples of such diseases include heart diseases (Wong et al., 2016), cancer (Anderson et al., 2016), Alzheimer’s disease (Chiu et al., 2009) and diabetes mellitus (Jha et al., 2016). Consequently,

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there is a need to apply our integrated framework in a specific domain in order to facilitate its application and measure its effectiveness. Therefore, we aimed our study to focus on particular diseases that serve the second objective of our proposed solution. We set two conditions that diseases should meet in order for them to be our chosen domain of application in Saudi Arabia, and these conditions are as follows:

1. the disease should be prevalent in Saudi Arabia 2. the disease should be self-manageable.

The two conditions outlined above ensure that the application of our integrated framework will be useful to support e-health in Saudi Arabia. In the first condition, many diseases are seen to be prevalent in Saudi Arabia, based on different official and trusted resources. According to the Saudi Arabian Ministry of Health, the top outpatient visits made to PHCs are associated with upper respiratory tract infections, musculoskeletal disorders and diabetes mellitus (Ministry of Health, 2011). The term ‘upper respiratory tract infection’ is used to describe infections that can affect the nose, paranasal sinuses, pharynx and trachea, which can be caused by different viruses and patristics (Sherif B, 2013; Masavkar and Naikwadi, 2016). Musculoskeletal disorders are common health conditions in many countries and include different syndromes, such as tendon inflammations, nerve compression disorders, osteoarthritis, myalgia and lower back pain (Punnett and Wegman, 2004). Diabetes mellitus is a metabolic disorder resulting from the lack of insulin secretion, insulin action or both (American Diabetes Association, 2013). Of the three diseases, diabetes mellitus was considered the highest cause of death in Saudi Arabia in 2013, according to the Institute of Health Metrics and Evaluation (Centers for Disease Control and Prevention, 2016). In addition, Saudi Arabia is considered to be one of the top ten countries in term of the prevalence of diabetes mellitus according to the International Diabetes Federation, with a prevalence of 23.9% (Aguiree et al., 2013).

The term self-management in the medical domain is used to emphasise the patients’ role in controlling their diseases. The term has been used to enable individuals to deal with their chronic illnesses, and its resulted complications, by increasing their knowledge, skills and confidence (Lorig et al., 2000). Self-management also empowers people with different diseases to manage their negative emotions and maintain life roles. It has been applied

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globally and has proved its usefulness to a number of diseases, including different chronic conditions.

All the three diseases, upper respiratory tract infection, musculoskeletal disorders and diabetes mellitus, are proved to be self-manageable. According to Masavkar and Naikwadi (2016), the degree to which individuals are educated and literate about respiratory tract infections plays a significant role in the prevention and control of the disease. For musculoskeletal disorders, a study conducted by Kroenke et al. (2009) showed that self- management and education programmes have shown significant improvement in individuals with this condition. Diabetes mellitus, similarly, has been witnessed to be self-manageable in different studies. In one study, a diabetes self-management strategy was found effective in controlling different aspects of the disease, including fasting blood glucose level, glycated haemoglobin, diabetes knowledge, reducing systolic blood pressure levels and body weight (Deakin et al., 2005).

Even though all diseases mentioned previously meet the two conditions, diabetes mellitus was chosen to be the domain of application in our current study. Diabetes mellitus is chosen, over the other two diseases, because it constitutes more life-threatening health conditions than the other two diseases (Centers for Disease Control and Prevention, 2016). In addition, diabetes mellitus has wider attention in the area of self-management and education from a variety of studies which have demonstrated such programmes in different countries. However, the implementation of diabetes self-management and education in Saudi Arabia is still deficient, especially when considering the vast prevalence of the disease in the kingdom. Consequently, the other two diseases, upper respiratory tract infections and musculoskeletal disorders, can be undertaken in future research.

Nevertheless, the e-health barriers represented in the first layer of our integrated framework still have a major role in our study. These barriers are investigated in Chapter Five to reveal the factors affecting the success of different e-health initiatives in Saudi Arabia. The e-health issues resulted from the questionnaire help when designing the web portal, which is dedicated to incorporating the SECI model into the framework. E-health barriers are incorporated in our web portal which we have built to support users managing their illness.

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