EXPLORING THE ROLE OF TELEMEDICINE IN HEALTH CARE DELIVERY IN

EXPLORING THE ROLE OF TELEMEDICINE IN HEALTH CARE DELIVERY IN
HOUGANG AREA, SINGAPORE
©April, 2019

DECLARATION
I declare that research project is my original has been done to the best of my ability and
knowledge and it is my original work. It has never been submitted by any other person.
Signature...................................................... Date:..........................................................
The Supervisor Approval
This project has been submitted for examination with my approval as University Supervisor.
……………………………………………. ……………………………..
Signature Date
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TABLE OF CONTENTS
DECLARATION.......................................................................................................................................ii
TABLE OF CONTENTS.........................................................................................................................iii
LIST OF TABLES.....................................................................................................................................v
LIST OF FIGURES..................................................................................................................................vi
Figure 1: Conceptual framework……………………………………………………………...….5........vi
ABBREVIATIONS..................................................................................................................................vii
ABSTRACT............................................................................................................................................viii
SECTION 1................................................................................................................................................9
1.0 INTRODUCTION...............................................................................................................................9
1.1 Information Background....................................................................................................................9
1.2 Statement of the problem.................................................................................................................2
1.3 Study Objectives................................................................................................................................3
1.3.1 General objective........................................................................................................................3
1.3.2 Specific objectives.......................................................................................................................3
1.4 Research Questions...........................................................................................................................3
1.5 Hypothesis.........................................................................................................................................4
1.6 Conceptual Framework......................................................................................................................4
SECTION 2................................................................................................................................................5
2.0 LITERATURE REVIEW...................................................................................................................5
2.1. Theoretical Framework.....................................................................................................................5
2.1.1 Anderson’s Health Behaviour Model..........................................................................................5
2.2 Definition of Telemedicine.................................................................................................................6
2.3 History of Telemedicine.....................................................................................................................6
2.4 Health Information Technology and Telemedicine............................................................................7
2.5 Benefits of Telemedicine...................................................................................................................8
2.6. Disadvantages of Telemedicine......................................................................................................11
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SECTION 3..............................................................................................................................................12
3.0 METHODOLOGY............................................................................................................................12
3.1 Research Design.............................................................................................................................13
3.2 Area of Study...................................................................................................................................13
The study was carried out in Hougang Area, Singapore (Figure 2).......................................................13
Figure 2: Map of study area (Source; Google map, 2019)....................................................................13
3.3 Study Population.............................................................................................................................14
The target population for this study was all the adult (above 18 years) resident of Hougang Area,
Singapore...............................................................................................................................................14
3.4 Sampling Techniques.......................................................................................................................14
3.4.1 Sample Size...............................................................................................................................14
A sample random sampling technique was used to select the 384 participants..................................14
3.4.2 Sample size determination.......................................................................................................14
3.4.3 Sampling Method.....................................................................................................................14
3.4.4 Recruitment Method................................................................................................................14
3.5 Data Collection Instrument..............................................................................................................15
3.6 Data Collection................................................................................................................................15
3.7 Data Analysis and Management......................................................................................................15
3.8 Ethical Considerations.....................................................................................................................15
SECTION 4..............................................................................................................................................16
4.0 ANALYSIS AND FINDINGS...........................................................................................................16
4.1 Response Rate.................................................................................................................................16
4.2 Personal Details of the Respondents...............................................................................................16
4.3 Usability of Telemedicine................................................................................................................18
SECTION 5..............................................................................................................................................19
5.0 DISCUSSION AND EVALUATION................................................................................................19
SECTION 6..............................................................................................................................................23
6.0 CONCLUSION & RECOMMENDATIONS...................................................................................23
6.1 CONCLUSION...................................................................................................................................23
6.2 RECOMMENDATIONS......................................................................................................................23
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REFERENCES........................................................................................................................................24
APPENDICE............................................................................................................................................28
Appendix I: Consent for the Participant.................................................................................................28
Appendix II: Questionnaire....................................................................................................................29
LIST OF TABLES
Table 1: Sociodemographic data of the respondents……………………………………………16
Table 2: Usability of Telemedicine ……………………………………………………….…….17
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LIST OF FIGURES
Figure 1: Conceptual framework……………………………………………………………...….5
Figure 2: Map of study area……………………………………..…………….…………………12
Figure 3: Distribution of respondents by gender…………………………………………..…….15
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ABBREVIATIONS
ATA American Telemedicine Association
HIT Health Information Technologies
H0 Null Hypothesis
H1 Alternative Hypothesis
ICT Information, Communication Technology
IT Information Technology
SSN Statistics Singapore Newsletter
WHO World Health Organization
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ABSTRACT
Telemedicine amalgamates communication over distance through telephones, telegrams,cables
and broadcast so as to make available use of medical information and Telemedicine is a fast
growing system. Telemedicine is widely used in health, learning and in administration sectors.
Telemedicine is of greatly assistance in integrating electronic medical records thus leading to the
decrease in the number of cases where doctors cannot access patient's records. It has also aided
in fast and delivering of quality service in health sector. The research adopts a cross-sectional
survey study and simple random sampling approach to recruit 370 respondents. Questionnaire
was the main tool for data collection and the collected data were keyed in EpiData (Version 3.1)
database, and then analysed with the SPSS software. The majority of interviewees were male
(62.2%) and most popular age group was 30-39 years (36.8%). Majority (75.3%) of the
respondents were also aware of telemedicine system. Further, majority of the respondents
reported that the system was more reliable and satisfy their needs. Thus, the success of
telemedicine implementation in Hougang Area, Singapore will enable majority of her population
to receive a faster health care services, hence this will help in propelling the idea of universal
health care.
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SECTION 1
1.0 INTRODUCTION
1.1 Information Background.
Health informatics and communication applications have positively impacted the healthcare
industry worldwide. The ICT revolution of the late 1990s, lead to the resurfaced of
Telemedicine, an invention that was likely to play a vital part in revolution and changes in health
informatics systems in the coming years. Telemedicine innovation is an important element in
health sector and technology. It covers also social and economic sectors, Telemedicine systems
are problem solvers for daily challenges faced in health sector and the high demand of health
information among individuals (Novillo-Ortiz, 2016).
Telemedicine system is of importance to medical experts and patients who cannot go to health
facilities because of no means of transport or being busy with other commitments, practicality or
any other issue that may play out (Sarhan, 2009). The telemedicine use in many areas shows that
quality management of health care for long term and patients being satisfied ,in several areas has
proved thus enabling enable patients access to quality health care and equipped with right
information to managed sickness. Telemedicine provides information flow between health
experts and patients, this increases quality of service delivery and high output. There is no need
patient and expert to meet physically most of communication and experts direction are done on
telemedine system. Health management systems encourages patients to manage and monitor
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their health condition for a system detecting pressure level and application detecting insulin
levels of diabetes patients. This systems are cheap and cost friendly even poor people can afford
and are user-friendly to use .Telemedicine systems ensures patients get quality services and are
easy to get soft wares which encourages the patients to responsible of their health. Telemedicine
systems has helped healthcare experts to respond to patients health state fast, provides patients in
rural areas with quality health information local and cost friendly services , makes health service
available and easy to access information, ensure after discharge care to know status of patients
and healing progress, improves accuracy and integrity of health records for patien (Alvandi,
2017).
Telemedicine system is of great importance during transfer of useful medical related
data .Medical expert can communicate with other experts from other countries on telemedicine
system(Rangasamy et al., 2011). With the numerous issues arising in medical sector ,emerging
of complicated diseases telemedicine plays vital role in promoting faster learning and this
helps in saving patients’ lives by minimizing health problems .Telemedicine system can be
applicable in military. For example when soldiers are at war where there is no near by health
centres or facilities telemedicine application can be of great help to them.Soldiers can use
telemedice to diagnose diseases .Telemedicine system can be used everywhere and in every part
of the world. (Rangasamy et al., 2011).
1.2 Statement of the problem.
The growth of telemedicine use globally is to improve quality of health sector. Telemedicine
help to improve in treatment of people and enable patients in rural areas to access health services
easily. There has been use of traditional way of communicating using telephone, messenger and
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fax. Telemedicine system uses current innovation. To benefit from telemedicine applications, the
application be used by patients and health care providers.
McClellan and colleagues (2008) reported that health care effective cost and great quality action
taken to improve health care are not effective utilized locally, nationally and globally. This leads
to wastage and underutilization of hospital resources. (Heinzelmann et al, 2006). In Hougang
Area, Singapore, a few studies concerning the roll out rate of telemedicine have been conducted
but none have been carried out to determine the wider role played by telemedicine and its
acceptance level, hence this necessitated this present study.
1.3 Study Objectives
This study has objectives below.
1.3.1 General objective
To explore telemedicine roles in health sector service delivering in Hougang Area, Singapore.
1.3.2 Specific objectives
i. To determines awareness level of telemedicine delivery as a particular approach to health
care in Hougang Area, Singapore.
ii. To determine the reliability of telemedicine as a method of health care delivery among
residents of Hougang Area, Singapore.
iii. To determine satisfaction level and future use of telemedicine as a method of health care
delivery among residents of Hougang Area, Singapore.
1.4 Research Questions
i. How to know awareness levels in telemedicine delivery as a particular approach to health
care in Hougang Area, Singapore?
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ii. Is telemedicine a reliable method of health care delivery among residents of Hougang
Area, Singapore?
iii. What are the satisfaction levels and future usage of telemedicine as a method of health
care delivery among residents of Hougang Area, Singapore
1.5 Hypothesis
H0: Telemedicine is not the actor in delivery of health care in Hougang Area, Singapore
H1: Telemedicine is the actor in delivery of health care Hougang Area, Singapore
1.6 Conceptual Framework
Independent Variables Dependent Variable
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Role of Telemedicine
Awareness level
Reliability
Satisfaction level and future
use

Figure 1: Conceptual framework of independent and dependent variables in the understanding of
the action of delivering health care by Telemedicine system in Hougang Area, Singapore
(Source; Author, 2019)
SECTION 2
2.0 LITERATURE REVIEW
This section surveys then reviews different ideas, reasons and ability to see something of
different from different researchers, roles played by telemedicine in the health care delivery.
2.1. Theoretical Framework
This study adopted Anderson’s Health Behaviour to explain and analyze delivering of health
care by telemedicine systems..
2.1.1 Anderson’s Health Behaviour Model
Anderson’s (1995) health behaviour model postulates that a certain characteristics contribute to,
or determine utilization of the available health care services. He divides these characteristics into
three dynamics that is, predisposing factors, enabling factors, and need. Resources are defined as
enabling, as they make health care services available to the targeted population. Many residence
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of Hougang Area, Singapore tends to sought out health care services via telemedicine system due
to the enabling environment that is present. In this study, the enabling environment encompasses
the awareness level, reliability in usage and satisfaction in usage of telemedicine system. Thus,
with the availability of enabling environment it helps in meeting the needs of the users of
telemedicine in Hougang Area, Singapore.
It’s postulated that some people are more likely to seek services of telemedicine system than
others and the likelihood can be predicted by individual characteristics. People who are aware of
benefit associated with the use of telemedicine system will at all times sought out health care
services via telemedicine system. Also attitudinal- belief factors, where individual have stronger
faith in quality of services one will be more inclined to utilize a particular health services
(Anderson, 1995).
2.2 Definition of Telemedicine
A lot of telemedicine definitions focuses on how to improve accessibility of health care resources
by using technology of telecommunication. Logan (1998) defined telemedicine as a simply a tool
that permitted more equitable distribution of comprehensive specialty and sub-specialty
healthcare services to remote populations. Also, the American Telemedicine Association (ATA,
2017) defines Telemedicine it is communication process where information flows from medical
experts to targeted patient who requests health service from their location and patients get quality
health services by use of telecommunication technologies.
2.3 History of Telemedicine
The beginning use of telecommunication health sector started in 1900s when telegraph was
introduced. The emergencies and natural catastrophe alert in form of codes moved from one
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vessel to another in ocean. Telemedicine was used to send alerts in ocean to inform captain of a
probability of disaster (Farnham, 2006). Telemedicine being used nowadays began its operation
in early 60s from projects in health sector field, the topic of project was how to include
Telemedicine in health sector in delivering of service. The project was done in United States of
America in an institute which deals with mental illness, emotional disturbance and abnormal
behaviours problem (Craig & Patterson, 2006). Telemedicine tool was used in communication
during consultations, guiding and advising patients. Health experts provided services and
information through telemedicine application. The system was installed at hospital (Farnham,
2006). Another project was used at a hospital in Massachusetts and Airport called Logan
international which is found state of Boston. Health expert communicated and advised patients
from hospital to Airport through telecommunication device. (Craig & Patterson, 2006).
Telemedicine essentially combines state-of-the-art electronics, ICT and associated applications
in the field of healthcare delivery and also helps in providing education to patients and healthcare
professionals. Telemedicine applications can be classified into two basic types: First, store-and-
forward or asynchronous type and second, real-time or synchronous type. In the former there is
exchange of pre-recorded data between two or more individuals at different times/places,
whereas in the latter there is a real time exchange of information by methods such as in
videoconferencing. These two basic approaches to telemedicine can be applied to a wide array of
clinical services, including disease diagnosis, triage, management and follow up of diseases
(WHO, 1998). The Information Computer Technology devices are low technical and high
technical devices. The low technical devices are simple to use and includes mobile phone, fax
system, cameras for taking video and simple computers. The high technical devices are complex
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and require technical skills to operate them. They includes complex computers, transferring
images by digital means, use of internet and satellite system (WHO, 1998).
2.4 Health Information Technology and Telemedicine
Craig and Patterson (2006) noted that all telemedicine interventions are based on patients or
professionals obtaining an opinion on treatment or care from someone who is more experienced
or an expert in a particular field. The goals and activities of telemedicine and health IT are
complementary and synergistic. Telemedicine is a method of delivering health care that makes
use of health information technologies to accomplish its goals (ATA, 2006). Conversely, health
information technologies (HIT) are an enabling component to the delivery of health services over
distances, providing fundamental tools and systems. In short, HIT greatly enhances the utility of
telemedicine.
It is also important to acknowledge a distinction, telemedicine is not a type of HIT. Certainly
telehealth is dependent on the use of telecommunications and related forms of advanced
technologies but it fundamentally describes the delivery of patient and consumer care. In some
respects the distinction reflects a difference between clinicians and the IT world. It is important
that the differences be recognized, understood and accepted so that telehealth and HIT can work
together in order to optimize the delivery of health care (ATA, 2006; 2017).
2.5 Benefits of Telemedicine.
Telemedicine system can be used as a remote in monitoring health conditions of old patients for
examples using surveillance cameras and soft wares that use analytics technologies to monitor
and notifies (health experts) people who are taking care of old people about change in their
health conditions .The remote monitoring reduce costs of travelling to physically see the health
expert. The age people can just be monitored and given quality care at their own home without
need of visiting hospital. Most of old patient are very weak and delicate to travel for long
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distance so this system is so useful to them Garrett & Martini, 2007). Using telemedicine
encourage patients to be responsible of their own health status by equipping patients will skill
and a lot of health care in formation this helps them to manage condition. (Demiris, 2006).
Bashshur (2001) argued that telemedicine has contributed significantly to reducing barriers in
information sharing among healthcare professionals. In this way, constraints in accessing care for
large numbers of patients across wide areas has been reduced. Equally, exponential rises in
global costs of healthcare and considerabl variation in standards of care has been controlled
(Heinzelmann et al., 2006). On the other hand, Clough (1999) stated that telemedicine and
telecare have already encompass a wide range of applications using varying degrees of
technology, from standard telephone equipment to complex scanners and communication
satellites. Telemedicine is useful in professional consultation of service. For example a patient
request on information about the diseases which is affecting them and they can get advices and
given solution remotely by health experts. Telemedicine is being practised in many field of
health sectors for example in maternity, antenatal and postnatal pregnant women are monitoring
during and after delivering so the is no need to frequently visit gynaecologist physically.
Elford and team (2000) proposed that the telemedicine vital benefits are for patients leaving in
remote areas of the country whose accessibility to standard health service is difficult so
telemedicine enables them to easily get this services in their home. Sick individuals do not have
to move for long distance and make long queues at hospital for only 30 minute consolations
service from health experts. What they need is to request for all information they need and health
experts can advise them in short period. Telemedicine enable interactions among different
stakeholders in different sectors of health for example nurses interacting with patients, a doctor
requesting test samples from Laboratory. Telemedicine encourages faster discharging of patents
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and this reduces cost of staying at hospital by paying a lot of bills and amount of time
wastage .Patient can seek service they want on telemedicine application at their home this
enables them to cut cost of being treated at hospital or any health facilities .Treatment at hospital
is very expensive compared to being treated at your own home. (Elford et al., 2000).
Telemedicine is the best choice of influencing and measuring quality delivery of health care
services. Telemedicine ensure proper utilization of resources.
Telemedicine ensures there is no need of resources to be wasted on transportation. A patient can
Communicate to a health experts using telecommunication devices such as telephone, funds and
time meant for transportation are saved. Patients can still get quality services without move to
health facility.
No need to take off duty with telemedicine health is able offer consultation service .The health
experts can give directions and advices by not attending hospital but still offer same services
they would have offered while on duty.
Easy Accessibility to Specialists, this system enables patients who need the care of specialists to
be attended to with ease unlike other patients who travel from far by wasting a lot of time in in
travelling but still get the same services.
Preventions of nosocomial infections-Telemedicine minimizes the risk of acquiring hospital
related infections especially in crowded waiting doctor’s room since the patient is able to consult
the doctor at home.
Short time spend in experts room-If patient makes appointment via phone call .Patient will book
time to consult an expert and reducing time wastage on queues at the doctor’s officer.
Better Health-This system enables patient to see his/her health expert at any time of their
preference no need to visit expert work place, thus pat as often as possible without the
challenges of getting into the office, thus the patient treatment or control of diseases or disorder
can be managed by patients themselves. Disease likes pressure and diabetes which need frequent
monitoring and consulting health expert this is the best tool to use in such conditions. For
example patients can measure their own sugar levels and inform health expert remotely.
More source of income- This system enables a doctor to attend to more clients in a short period
of time hence increasing chances to earn more.
Increased Flexibility-Telemedicine enables doctors to have a choice to either extend office hours
or even add weekend’s appointment since video visits can be done anywhere and anytime.
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Protection from Competition-Giving patients the option of telemedicine is an effective way to
protect against competition from retail clinics.
Improves Life Balance-This system enables doctor’s to work at home as part-time thus enabling
them to plan for their time well for other activities such as travelling and time for their families
knowing they can still be accessed when needed by the patient.
Improves working conditions-with Telemedicine a doctor is able to create a conducive working
environment with less pressure since he/she is able to handle patient comfortably unlike pressure
from the office.
No Impact on Family Duties-With telemedicine patients with children are able to be treated and
still take care of their responsibilities unlike office visits which is a challenge with children.
2.6. Disadvantages of Telemedicine.
Electronic malfunction-Since telemedicine uses electrical current to operate; poor weather can
disrupts internet connection or cause power shortage thus interrupting consultation with the
doctor.
Inadequate physical examination-This system limits a Doctor to perform a complete medical
examination since the patient is not physically present. This may make the Doctor to miss the
exact diagnosis of the patient.
It’s costly-Since this system requires trained personal to operate, a lot of money and time will be
spent by the health facility offering the telemedicine option to facilitate the training
Lack of patient’s follow up-With telemedicine patients can consult different doctors at a time
thus limiting proper medical follow up. This may worsen the patient’s health condition.
Licenses requirement-employees operating this system may be required by their country to have
a valid licenses to be able to access the system.
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Unemployment-This system causes unemployment to employees such as the secretaries, security
personal, causal workers and doctors whom haven’t met the telemedicine requirements.
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SECTION 3
3.0 METHODOLOGY
This section provides an in-depth review of the research design used, study area, target
population, the sample size and sampling technique, data collection procedure, data analysis and
management methods used in the study. It further elaborates clearly all the procedures that the
researcher undertook before being permitted to extract information from the respondents.
3.1 Research Design
The study adopted a cross-sectional survey method. The design was selected for this study as it
allows for investigation of numerous variables at the same time (Moule & Goodman, 2014). This
is important for this study because it aims at looking into various variables, such as awareness
level, reliability, satisfactory level and future use in relation to the role of telemedicine. Crosse-
sectional studies are also trusted because they provide high level of evidence about a
phenomenon, especially when there is randomization and large sample size (Curtis & Drennan,
2013). Hence, the evidence that was generated by this study has a higher significant level of
reliability. The approach was also less expensive as it requires a little time.
3.2 Area of Study
The study was carried out in Hougang Area, Singapore (Figure 2).
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Figure 2: Map of study area (Source; Google map, 2019)
3.3 Study Population
The target population for this study was all the adult (above 18 years) resident of Hougang Area,
Singapore.
3.4 Sampling Techniques
3.4.1 Sample Size
A sample random sampling technique was used to select the 384 participants.
3.4.2 Sample size determination
The study recruited 384 residents of Hougang Area, Singapore. This number was determined by
adopting the formula as used by Fisher and colleagues (1998);
n = Z2 pd
d2
Where;
n = sample size for a population;
Z = z-value corresponding to a 95% level of significance = 1.96;
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p = expected proportion of population of Hougang Area, Singapore = 0.5; q = (1-p) = (1-
0.5) = 0.5; and
d = absolute precision, set at 5%.
Therefore,
1.962*0.5*0.5 = 384 residents of Hougang Area, Singapore
0.052
3.4.3 Sampling Method
A simple random sampling technique method was used such that each resident within Hougang
Area, Singapore had the same probability of being chosen at any stage during the sampling
process.
3.4.4 Recruitment Method
The participants were recruited at their residence within Hougang Area, Singapore The
researcher issued those who were randomly selected with an introductory letter explaining the
intent and objective of the research. The participants were further informed that participation is
of one’s own will in the study, and written acceptance permission of conducting interviews from
each of them. The interviews was scheduled at the convenience of the study participants in
terms of time and place. The researcher provided verbal explanations and clarification on the
research to the potential participants to reinforce on getting informed consent.
3.5 Data Collection Instrument
Questionnaire (Appendix II) written in English was the main tool for data collection. The
questionnaires was made up of open and closed ended questions that focused mainly how health
sectors uses telemedicine in delivering service in Hougang Area, Singapore.
3.6 Data Collection
The data was collected from February, 2019 to March, 2019. Training of people to help
researcher in collection of data was do. The questionnaires were drafted using English language;
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while , the data collectors were able to translate questions into language that best suit the
participants, when necessary.
3.7 Data Analysis and Management
The questionnaires were filled with serial numbers, and the principle researcher key in the data in
EpiData (Version 3.1) database, and SPSS is used during analysing. Preliminary frequency were
run then eyeballing to pick out any missing variables. The comparisons were made on some
randomly selected questionnaires with the entered electronic data to verify consistency. A chi-
square test was used to test for significance. The analysed data were presented using tables,
graphs and charts.
3.8 Ethical Considerations
The study took care of all the necessary ethical concerns in research. The consent of doing the
study will sought from the Faculty of Business and Law Ethical Review Committee Board. The
respondents were served with and consent form (Appendix I) from the researcher to seek their
permission to participate in the study. The study protected the privacy of the respondents and the
confidentiality of the information provided by the respondents. Any information collected was
not passed to third parties in any form whatsoever without express permission of the source.
Further, the study did not insist on the identities of the respondents as a precondition for
participation in the study. Respondents had the freedom to withhold their identities. But even for
those who provided their identities, the researcher did not make them salient features while
reporting the findings. The participants were also updated during recruitment stage that there was
no monitory gain, reward, or compensation for participating in the study. Lastly yet importantly,
the researcher remained objective and ensure that findings, conclusion and recommendations
were based solely on the data collected rather than not on personal feelings and prejudices.
SECTION 4
4.0 ANALYSIS AND FINDINGS
This section provides an in-depth review of the study findings and interpretation. The review of
this section was guided by the study objectives.
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4.1 Response Rate
The number of respondents interviewed was 370 from a target of 384 respondents, thus,
representing 96.4% response rate. The other 9 refused to consent for the study while 5 of them
had their questionnaires not properly filled.
4.2 Personal Details of the Respondents
The distribution of respondents by gender is shown in figure 3 below. The majority of the
respondents were male (62.2%) compared to their female (37.8%) counterpart.
Figure 3: Distribution of respondents by gender
As presented in table 1 below, the study established that, most interviewee were from age
bracket of 30-39 years (36.8%). Furthermore, 142 (38.4%) of the study respondents were not
involved any relationship, 7 (1.9%) had lost their spouse through death while more than half
(59.7%) were married. Most of the respondents had secondary education 153(41.4%) while
78(21.1%), 81(21.9%) and 58(15.7%) had no education, primary and tertiary educations
respectively. Last but not least in regards to the sociodemographic details of the participants, it
was also noted that the majority of the respondents who were interviewed were employed
(70.3%) and were living in urban areas (63%).
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Table 1: Sociodemographic data of the respondents
Characteristics No of Respondents
(n=370)
Proportion
(%)
a). Age (in years)
Below 20
20-29
30-39
40-49
Above 50
46
97
136
59
32
12.4
26.2
36.8
15.9
8.6
b). Marital status
Single
Married
Widowed
142
221
7
38.4
59.7
1.9
c). Education background
No Education
Primary
Secondary
Tertiary
78
81
153
58
21.1
21.9
41.4
15.7
d). Occupation
Employed
Unemployed
260
110
70.3
29.7
e). Residence
Urban
Rural
233
137
63.0
37.0
4.3 Usability of Telemedicine
The table 2 below shows, most (75.7%) of interviewees were aware and had used the
telemedicine system. The variables tested for ascertain the usability such as awareness
(p=1.455e-12), reliability (p=2.181e-12) and satisfaction and future use (p=7.41e-13) were all
statistically significant.
Table 2: Usability of Telemedicine
CHARACTERISTICS YES [n(%)] NO [n(%)] p-value
AWARENESS
a) Have you ever used telemedicine system 280 (75.7) 90 (24.3)
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1.455e-12
b) Telemedicine system is simple to use 210 (75) 70 (25)
c) Telemedicine system is easy to learn to use 250 (89.3) 30 (10.7)
d) I become productive quickly using telemedicine system 202 (72.1) 78 (27.9)
e) Interaction with telemedicine system is much pleasant 198 (70.7) 82 (29.3)
f) I like using the telemedicine system 255 (91.1) 25 (8.9)
g) Telemedicine system is simple and easy to understand 211 (75.4) 69 (24.6)
RELIABILITY
2.181e-12
h) Services provided over the telemedicine system and those of
in-person visits are the same.
146 (52.1) 134 (47.9)
i) It is easy to recover quickly telemedicine system when one
makes mistakes
225 (80.4) 55 (19.6)
j) Telemedicine system is able to do everything one would
want it to do
195 (69.6) 85 (30.4)
k) Telemedicine system give error messages and clearly
outlines how to fix the problem
207 (73.9) 73 (26.4)
SATISFACTION AND FUTURE USE
7.41e-13
m) I am more comfortable using the telemedicine system 240 (85.7) 40 (14.3)
n) Telemedicine is perfectly an acceptable way to receive
healthcare services
180 (64.3) 100 (35.7)
o) I would prefer using telemedicine services again 237 (84.6) 43 (15.4)
p) Overall, I am satisfied with telemedicine system 241 (86.1) 39 (13.9)
SECTION 5
5.0 DISCUSSION AND EVALUATION
The use of telemedicine system is with no doubt has greatly helped in advancing the health care
system worldwide. Telemedicine applications or systems symbolize vital device which helps to
solve problem health sector faces worldwide. Telemedicine system responsibility is optimizing
of health sector resources, improves on managing demand, reducing number of days of patient
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being admitted at hospital and reducing number patients visits hospitals, increasing the usability
of telemedicine technology, this improves effectiveness and efficiencies of health informatics
systems. This study reported high levels of awareness, reliability, satisfaction and future usage of
the system among the respondents interviewed.
Most interviewees of this research were fully aware of functions and roles of telemedicine.
Several scholars have reported that awareness was the key drive for functioning and acceptance
of an innovation (telemedicine) in sector. The research concur with this observation since not
only that majority of residents of Hougang Area, Singapore were aware of the role of
telemedicine, they were also using it. Further, Ghazi and Cross (2015) in their study reported that
telemedicine was universally well accepted by patients and it seemed operational in its
association in improving outcomes of clinics. On the other hand, William (2007) observed that
despite the wide advocacy to embrace telemedicine, most health experts are not using
telemedicine application. He further noted that some experts were not willing to use telemedicine
system because they are used to do their daily activities in a certain way so it is impossible for
them to change until they are able to view importance of its applicability, others perceived that
you cannot compare telemedicine with physical interacting with medical experts. Moreover, he
noted that those who opposes telemedicine applications feared that this application reduces
numbers of medical experts at health facilities and t the number of healthcare professionals
needed and eventually leads to unemployment because treatment of patients can be done where
they live.
Similarly, Hebda and Czar (2009) reported that most of patients are not experts in health or in
technology so in case of system failure there can be a lot of damage due to misuse or not
knowing how to operate and interpret system failure. They further noted that failed to embrace
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and start using telemedicine technology due to fear of using telemedicine because of its negative
impact. Although, this study reports high levels of awareness, Hebda and Czar (2009) reports
that sensitizing patients is very vital to those who have not yet used telemedicine application and
don’t now the telemedicine benefits so they have to be encouraged to use it.. This can be
achieved by healthcare professionals organizing free medical camps and offer free training to
patients this can encourage and increase on telemedicine usage in health sector.
Over the years since it is unveiling, telemedicine has proven to be reliable. Hui and colleagues
(2001) in the study found out that telemedicine was a feasible means of delivering
multidisciplinary care to frail nursing home residents and in turn may result in increased
productivity and significant savings. Many of the respondents in this study agreed that
telemedicine was more reliable since the services it offered were more so the same with those of
face-face visits. It also offered a faster recovery aid. Reliability of telemedicine in terms of
service delivery could best be described by Hebda and Czar (2009) observation that there is rapid
accessibility of information in real time, in all location so long as internet can be accessed, this
helps in improvising service delivery, down slows and poor services are not encouraged .
Satisfaction to the usage of telemedicine has prompted most of respondents in this study to use it
over and over. Frey and Bratton (2002) observed that the future of telemedicine in mainstream
medical care is full of potential. Thus, the future family physician’s practice might be
dramatically different from what it is today. Physicians’ offices, examination rooms and even the
traditional stethoscope might be replaced by private, secure Web sites and digital equipment that
records vital signs and physical findings. Moreover, in the not too distant future, it might be
possible for patients to connect in their own home with a health care provider located at a distant
site.
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SECTION 6
6.0 CONCLUSION & RECOMMENDATIONS
6.1 CONCLUSION
The research comes with a conclusion that telemedicine have a lot of importance to patients and
health experts in health sector. Furthermore, it is also worth to note that telemedicine does not
represent a separate medical specialty, it is rather a tool that can be used by health providers to
extend the traditional practice of medicine outside the walls of the typical medical practice. In
addition, telemedicine offers a means to help transform healthcare itself by encouraging greater
consumer involvement in decision making and providing new approaches to maintaining a
healthy lifestyle. Thus, the success of telemedicine implementation in Hougang Area, Singapore
will enable majority of her population to sought out faster health care services, hence this will
help in propelling the idea of universal health care.It is noticed that telemedicine also has some
few disadvantages because health sector is very sensitive sector where a lot of emphasis are
supposed to be put in place but benefits of it overcomes disadvantages so telemedine is global
encouraged to be used by patients and experts in health field.
6.2 RECOMMENDATIONS
This study highlighted the following recommendations;
i. Although telemedicine has been reported to fast growing, there are still gaps in health
sectors to customize this technology.
ii. Factors such as financial issues that may affect the growth of telemedicine must always
be resolved at the implementation stage.
iii. Technical support must always be made available for all so as to resolve any problems
that might arise.
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iv. Telemedicine applications requires some skills of operating the so research recommends
the users of telemedicine applications to be trained how to use this tool.
v. Research recommends people to be trained and sensitized about benefits and use of
telemedicine.
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APPENDICE
Appendix I: Consent for the Participant
Declaration by the Participant
I hereby confirm that I have heard/or read and understood well the above information given to
me concerning invitation for this study. I have been given verbal and written explanation and
opportunity to ask any questions.
I hereby willingly give consent to participate in this study
Signature or left thumb print ________________Date.____________________
Declaration by the Principle Researcher
I declare that I have discussed the study with the research participant and I feel that he/she has
understood and capable of freely giving consent.
Name_________________ Signature ______________Date.___________
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Appendix II: Questionnaire
Dear Respondent,
I am conducting a study on “Exploring the role of telemedicine in health care delivery in
Hougang Area, Singapore”. I wish to request for your voluntary participation and honest
responses regarding the questions that you will be asked. I would also like to assure you that
your responses will be held in confidence and only statistical results will be revealed. Any and
all identifying information will be discarded upon receipt. The questionnaire will take
approximately 10 to 15 minutes to complete. Kindly, respond to each and every question as
honestly as possible since the results of the study depend on you.
Do you agree to proceed with the interview? 1= Yes [ ] 2=No [ ]
SECTION I: PERSONAL DETAILS OF RESPONDENTS
Please tick (√) appropriate box
1. Sex: [ ] Male [ ] Female
2. Age (years)…………….......
3. Marital status………………..
4. Education level………………
5. Occupation…………………..
6. Residence……………………..
SECTION II: USABILITY OF TELEMEDICINE
AWARENESS YES NO
7. Have you ever used telemedicine system
If Yes, proceed to the next questions
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8. Telemedicine system is simple to use
9. Telemedicine system is easy to learn to use
10. I become productive quickly using telemedicine system
11. Interaction with telemedicine ensures data safely of patients because
patients can treat themselves they now diseases they are ill but no one els.
12. Telemedicine systems attracts patients to use it because of nice colors of
interface, good icons and nice hospital symbols.
13. Telemedicine system meets usability goals for example it is interface is
user-friendly and easy to use.
RELIABILITY
29. Services provided over the telemedicine system and those of in-person
visits are the same.
30. It is easy to recover quickly telemedicine system when one makes
mistakes
31. Telemedicine system is able to do everything one would want it to do
32. Telemedicine system give error messages and clearly outlines how to
fix the problem
SATISFACTION AND FUTURE USE
18. I am more comfortable with functions of telemedicine applications.
19. Telemedicine applications have positive impacts on patients and are widely
used.
20. I shall prefer using services offered by telemedicine applications
21. briefly, telemedicine systems satisfies patients requests
Thank you for taking your time.
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