Understanding the acceptance of teleconsultation technology in Malaysian government hospitals

348 Pages·2013·9.08 MB·English

University of Wollongong
Research Online
University of Wollongong Thesis Collection University of Wollongong Thesis Collections
2013
Understanding the acceptance of teleconsultation
technology in Malaysian government hospitals
Nurazean Maarop
University of Wollongong
Recommended Citation
Maarop, Nurazean, Understanding the acceptance of teleconsultation technology in Malaysian government hospitals, Doctor of
Philosophy thesis, School of Information Systems and Technology, University of Wollongong, 2013. http://ro.uow.edu.au/theses/
3748
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UNDERSTANDING THE ACCEPTANCE OF
TELECONSULTATION TECHNOLOGY IN MALAYSIAN
GOVERNMENT HOSPITALS

A thesis submitted in partial fulfilment of the
requirements for the award of the degree

DOCTOR OF PHILOSOPHY

from

UNIVERSITY OF WOLLONGONG

by

NURAZEAN MAAROP
B.Sc. (CS)., M.Sc. (CS)

SCHOOL OF INFORMATION SYSTEMS AND TECHNOLOGY
2013
CERTIFICATION

I, Nurazean Maarop, declare that this thesis, submitted in partial fulfilment of the
requirements for the award of Doctor of Philosophy, in the School of Information
System and Technology, Faculty of Informatics, University of Wollongong, Australia. I
declare that there is no conflict of interest in the sense of the requirements for this thesis
and publications of the findings. The thesis is wholly my own work unless otherwise
referenced or acknowledged. The document has not been submitted for qualifications at
any other academic institution.

Nurazean Maarop
March 2013

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Abstract

The overall aim of this study is twofold, firstly to explore the phenomenon of
teleconsultation acceptance in Malaysia and then to develop an understanding of the
important aspects constituting the phenomenon. This study seeks to identify the main
issues concerning teleconsultation acceptance particularly in which the technology
utilization takes place in the public health care facilities and the technology operates
over a nation-wide network. This also entails an understanding of the complexities of
human behaviour confined in the health care environment and work practice.

The study was conducted based on the mixed methods concurrent triangulation design
involving qualitative and quantitative data. These entailed interviews with key
informants and questionnaires survey of health care providers who practiced in the
participating hospitals in Malaysia. Thematic analysis involving hierarchical coding
was conducted on qualitative data whilst several procedures were performed on
quantitative data involving descriptive statistics, testing for mean differences between
groups and correlation testing. Subsequently, both data were merged, compared and
interpreted. In particular this study utilized a qualitative priority such that a superior
emphasis was placed on the qualitative method. Thus, the qualitative method was used
to conclude the overall result.

Based on theory-driven and prior-research approach, a conceptual framework was
developed and used to facilitate the data collection and analysis processes. The
underlying framework derived from a combination of several aspects adopted from
three theoretical models couple with contextual factors. These models were Technology
Acceptance Model, Unified Theory of Acceptance and Use of Technology and Theory
of Planned Behavior. The framework derived from the reviews of four areas of concerns
and these being (1) general teleconsultation and health Information Technology
perspective, (2) contextual Malaysian perspective, (3) developing countries perspective
and (4) theoretical perspective. In turn, nine factors from seven respective themes
appeared to be important in describing and understanding the teleconsultation
acceptance phenomenon in Malaysia. These factors were behavioral intention, attitude,
perceived usefulness, perceived ease of use, service need, facilitating conditions,
ii
perceived behavioral control, trust in technology and demographic influence. Whilst
prior technology acceptance research both in general technology and health Information
Technology has put more attention on the centrality of perceived attributes of
technology such as perceived usefulness and ease of use, this study revealed that the
central issues of teleconsultation acceptance in the government hospitals in Malaysia
were more focused on actionable and actual aspects rather than the perceived attributes
of the technology. These aspects were service need, contextual facilitating conditions,
trust in technology and demographic influence.

The success of teleconsultation use does not happen in isolation. Understanding the
overall stage of teleconsultation technology use in the participating hospitals is crucial
to further explain teleconsultation acceptance. Even though technology acceptance was
often discussed at the individual level, this study provided important information
concerning acceptance of the technology at the organizational level. Thus this study
demonstrated the importance of understanding teleconsultation core activity, processes
in teleconsultation use, functions of stakeholders, procedures in the environment,
teleconsultation work flow, requirements in conducting teleconsultation and interplay
between dimensions and stages in teleconsultation acceptance. In turn, the study
suggested that the strategies for environment, implementation, technological and
individual should need broader and long-term perspectives to ensure the sustainability
of teleconsultation initiatives.

The outcome of this study increases understanding concerning teleconsultation
technology acceptance and adoption thus contributes to both researches in telemedicine
management and technology adoption in hospitals. Research limitations and future
directions for researchers with similar research interests are also discussed.

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Publications from this Thesis

Full Paper Acceptance:
1. Maarop, N., Win, K.T. (2012). “Understanding the Need of Health Care Providers
for Teleconsultation and Technological Attributes in Relation to The Acceptance of
Teleconsultation in Malaysia: A Mixed Methods Study”, Journal of Medical
Systems (J MED SYST), 36 (5) , ISSN: 0148-5598

2. Maarop, N., Win, K.T. (2012). “The Interplay of Environmental Factors in the
Acceptance of Teleconsultation Technology: A Mixed Methods Study”, Open
International Journal of Informatics (OIJI). Vol 1 (2012), Universiti Teknologi
Malaysia.

3. Maarop, N., Win, K.T. and Hazara-Singh, S-S (2011). “Teleconsultation
Technology and Its Benefits: In the Case of Public Hospitals in Malaysia”. In
Proceeding of the International Conference on Information Resources Management
in association with the Korea Society of MIS Conference (Conf-IRM). Seoul, Korea.
12th June -14th June 2011, ISBN: 978-0-473-18895-5.

4. Maarop, N., Win, K.T, Masrom, M. and, Hazara-Singh, S-S. (2011). "Exploring
Factors That Affect Teleconsultation Adoption: In The Case Of Malaysia". In
Proceeding of the 15th Pacific Asia Conference on Information Systems (PACIS),
Brisbane, Australia, 9th July - 11th July 2011, ISBN: 978-1-86435-644-1.

5. Maarop, N., Win, K.T, Masrom, M. (2011). “Exploring Teleconsultation
Acceptance: A Comparison Study between Emergency and Non-Emergency
Setting”. In Proceeding of the IEEE Second International Conference on Research
and Innovation in Information Systems (ICRIIS). Kuala Lumpur, Malaysia, 23rd
November - 24th November 2011, ISBN: 978-1-61284-295-0

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6. Maarop, N. and Win, K.T. (2011). "The Interplay of Facilitating Conditions and
Organizational Settings in the Acceptance of Teleconsultation Technology in Public
Hospitals in Malaysia". In Proceedings of the 22nd Australiasian Conference on
Information Systems (ACIS). Sydney, Australia, 30th November - 2nd December
2011, ISBN 978-1-74210-239-9.

7. Maarop, N., Win, K.T. (2009). “A Review of Telemedicine in Developing
Countries: Introduction and Implementation Issues”. In Proceedings of 6th
Conference on Asia Pacific Association of Medical Informatics (APAMI).
Hiroshima, Japan, 22nd November - 25th November 2009, p. 85-92. (Award: Bursary
Recipient under Young Author Category)

8. Maarop, N. and Win, K.T., Hazara-Singh, S-S., and Masrom, M. (2009).
“Teleconsultation Service Utilization Key Issues in the Context of Malaysia: An
Organizational Perspective”. In Proceeding of the International Conference on
Research and Innovation in Information Systems (ICRIIS), Johor Bahru, Malaysia,
8th December - 9th December 2009, pp. 81-86, ISBN: 978 983 42794 4 8.

v
Acknowledgement

This dissertation would not have been possible without the guidance and the help of
numerous individuals who in one way or another contributed and extended their
valuable assistance in the preparation and completion of this write-up.
First and foremost, my utmost gratitude to my principal supervisor, Dr. Khin Than Win,
who with consistent guidance and encouragement that I will never forget. I am also
grateful to both of my external supervisors, Dr. Sukdershan Singh Hazara-Singh and
Associate Professor Dr. Maslin Masrom who have assisted me during data collection in
hospitals in Malaysia as well as in data analysis.
The financial supports for tuition fees, living allowances and conference funding from
the Ministry of Higher Education Malaysia, University of Technology Malaysia and
University of Wollongong are gratefully acknowledged.
The cooperation from the Ministry of Health Malaysia and all participants during the
data collection, I will never forget.
I owe my loving thanks to Mak (mother) and my late Abah (father) as well as my family
members who have been my inspiration as I hurdle all the obstacles in the completion of
this research work. And, I wish to extend my sincere thanks to all friends and colleagues
who have assisted me and prayed for me.
Last but not the least, the one above all of us, All Praise to God, the Al-Mighty, for
answering my prayers for giving me the strength to plod on. Thank you.

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Table of Contents

CERTIFICATION ...............................................................................................................................i
ABSTRACT ..........................................................................................................................................ii
PUBLICATION FROM THIS THESIS .............................................................................................iv
ACKNOWLEDGEMENT ..................................................................................................................vi
TABLE OF CONTENTS ....................................................................................................................vii
LIST OF TABLES ...............................................................................................................................xiii
LIST OF FIGURES .............................................................................................................................xv
ACRONYMS AND ABBREVIATIONS ............................................................................................xvi

CHAPTER ONE: INTRODUCTION
1.1 Overview ........................................................................................................................................... 1
1.2 Background and Problem Statement ................................................................................................. 1
1.3 Research Aim, Objectives, and Questions ........................................................................................ 7
1.4 Motivation of the study ..................................................................................................................... 8
1.5 Philosophical Assumption and Study Design .................................................................................. 9
1.6 Outline of the Thesis ....................................................................................................................... 10
1.7 Chapter Summary ........................................................................................................................... 11

CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction ..................................................................................................................................... 12
2.2 An Overview of Telemedicine ......................................................................................................... 12
2.2.1 Definition of Telemedicine, Telehealth, Teleconsultation ..................................................... 13
Telemedicine and Telehealth ........................................................................................................... 13
Teleconsultation .............................................................................................................................. 15
2.2.2 Types of Telemedicine ........................................................................................................... 16
2.2.3 Benefits of Telemedicine ....................................................................................................... 18
Supportive Benefits: Usefulness of the Technology ........................................................................ 19
Critical Benefits: The Need for Technology .................................................................................... 21
2.3 Health Care in Malaysia ................................................................................................................... 24
2.3.1 Telehealth in Malaysia ........................................................................................................... 26
2.3.2 The Chronology of Teleconsultation Implementation in Malaysia ....................................... 27
2.4 Important Issues of Telemedicine ................................................................................................... 30
2.4.1 Barriers to Telemedicine Implementation and Adoption ...................................................... 31
Cost Effectiveness Dilemma ........................................................................................................... 31
Lack of Telemedicine Guidelines ................................................................................................... 32
Legal Liability, Licensure and Reimbursement Concerns ............................................................. 33
User Reluctance and Acceptance ................................................................................................... 34
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