COMPARATIVE ANALYSIS ON THE BARRIERS AND FACILITATORS OF TELEHEALTH ADOPTION IN URBAN AND RURAL AREAS OF NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

It is no doubt that rural areas in Nigeria are home to populations that are vulnerable to compromised health. Based on data from the World Bank, almost 103 million people in Nigeria, accounting for 45% of the population in 2023, lived in rural regions. Pollard et al., 2017 recorded that  more than 70% of Nigeria's land area was classified as rural or nonmetropolitan. Due to their geographical position and limited resources for long-distance travel, these families often lack access to sustainable medical services. While it is common for doctors to concentrate in urban regions where there is a greater need for their services, data indicates that only 12% of emergency physicians work in rural Nigeria. Furthermore, out of this tiny percentage, only 28% have received formal training in emergency medicine (Tokunbo, 2018). 

Conversely, Izunna & Megan (2021) argued that not only is there a scarcity of medical treatment in rural communities in Nigeria, however this problem is also widespread worldwide. For example, in Malawi, there is a scarcity of almost all healthcare providers, while in Uganda, the ratio stands at one healthcare worker for every 600 individuals. There is a ratio of one doctor for every 70,000 Malawians, and more than half of the posts for medical professionals, specifically 51%, are vacant. Furthermore, the majority of healthcare professionals opt to work at central and district hospitals, due to the scarcity of resources in rural areas (Bisson, Teixeira & Matemba, 2017). Access to medical care is frequently restricted in rural regions, which poses significant risks to the lives of residents in those areas

According to Okon (2017) rural towns sometimes have resource deficiencies, a dearth of local physicians, and remote geographical locations, which pose challenges in delivering healthcare services. Umana (2022) averred that the nature of rural professions frequently makes it difficult for them to take time off work to make the long journey to see a doctor. Similar challenges are present at the international level, where typical jobs in rural areas including farming, building, and mining carry intrinsic dangers that can lead to higher chances of becoming injured or killed (World Health Organization, 2018). Therefore, due to the tendency of rural people to delay seeking treatment, certain medical problems that may have been addressed more effectively may advance to critical or incurable stages. Rural locations exhibit elevated rates of infant mortalities, psychological problems, and preventable lifestyle-related cancers, while also facing deficiencies in cancer screenings for some types of cancer (Warshaw, 2017). The development of these health problems is only hastened by frequent exposure to pollutants, pesticides, and infectious diseases that are typically seen in rural populations (World Health Organization, 2018). Consequently, to enable healthcare practitioners who come across people with severe issues and reduced initial stages of illness, telemedicine has been introduced spearheaded by substantial increase in reaction to the COVID-19 epidemic. 

Telehealth has been included into healthcare systems in numerous nations as a supplementary service to in-person treatment. Telemedicine, as defined by the World Health Organization (WHO), refers to the practice of providing medical care remotely. It employs bidirectional video and audio communication to link physicians situated in diverse geographic areas with other healthcare workers, medical institutions, and patients in their own residences (Pollard, Karimi, & Ficcaglia, 2017).  It enables the delivery of medical services and education using telecommunication technology, offering cost savings without compromising the quality of medical solutions. This is particularly beneficial for families with limited access to medical care like those in rural area. 

1.2 Statement of the Problem

In recent times, telemedicine has presented a hopeful resolution to the healthcare access gaps between urban and rural areas in Nigeria.  Ojo (2020) mentioned that whereas urban locations generally have advantages in terms of healthcare infrastructure, technological improvements, and the density of healthcare experts, rural regions frequently encounter notable difficulties, such as insufficient healthcare establishments, restricted availability of specialists, and deficits in infrastructure.  One challenge related to the implementation of telehealth in rural areas in Nigeria is the presence of illiteracy, language hurdles, and the willingness of the rural community to embrace telehealth services (Remilekun, 2023). 

According to Remilekun (2023), the effectiveness of telehealth relies on both the preparedness of healthcare professionals and the willingness and technological proficiency of patients. A significant segment of the Nigerian populace may encounter restricted availability to digital technology, which presents a hurdle to the execution of telehealth. Remilekun (2023) found that the implementation of telemedicine faced obstacles due to patients in remote areas lacking confidence in communicating in an unfamiliar language. Ekpenyong et al (2024) state that patients need to have proficiency in two specific areas of literacy in order to participate in telehealth services. First and foremost, individuals should possess a high level of competence in conventional literacy, encompassing the skills of reading, writing, and effectively communicating in their mother tongue. Furthermore, individuals should possess a more extensive literacy that includes knowledge of the technical prerequisites for efficiently utilizing a mobile device, as well as knowing their health issues and treatment.

On the other hand, Seun (2023) asserts that the lack of development in rural areas of Nigeria poses a significant obstacle to the implementation of telehealth technology in these regions. Akanimoh (2023) observes that there is a notable absence or inadequate availability of technology infrastructure in both rural and urban parts of Nigeria, with a special emphasis on the problem of unreliable energy. According to Richmond (2024), it may be necessary to enhance the technology infrastructure before using telehealth in order to ensure reliable network infrastructure, remote accessibility, and smooth connectivity for rural areas in Nigeria. An important concern that requires attention is the unequal implementation of telehealth services in both urban and rural regions of Nigeria (Sammy et al., 2023).  

Bizarrely, while most studies has argued that urban locations possess the requisite infrastructure and resources to facilitate telehealth services which in most case both region suffer network issues, on the contrary rural areas frequently encounter both technological and human obstacles that impede their progress on telemedicine. Therefore, the necessity for this investigation arises.

Objectives of the study

The primary objective of this study is to critically analyze the barriers and facilitators of telehealth adoption in urban and rural areas of Nigeria. Specific objectives of this study are to:

To assess and compare the level of awareness and understanding of telehealth in urban and urban areas in Nigeria.

To identify and compare the barriers to telehealth adoption in urban and rural areas in Nigeria.

To identify and compare the facilitators that promote telehealth adoption in urban and rural areas in Nigeria.

To provide strategies for overcoming barriers and enhancing facilitators to improve telehealth adoption and usage in both urban and rural areas of Nigeria.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the level of awareness and understanding of telehealth in urban and urban areas in Nigeria?

What are the facilitators that promote telehealth adoption in urban and rural areas in Nigeria?

What are the challenges patients face in adopting telehealth services in Nigeria?

What are the strategies for overcoming barriers and enhancing facilitators to improve telehealth adoption and usage in both urban and rural areas of Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: There is no significant difference in the barrier and facilitators of telehealth adoption  in urban and urban areas in Nigeria 

Ha: There is significant difference in the barrier and facilitators of telehealth adoption  in urban and urban areas in Nigeria

1.6 Significance of the study

The significance of this study lies in its capacity to tackle the discrepancies in healthcare access between urban and rural communities in Nigeria. The study seeks to uncover the specific obstacles and factors that promote the adoption of telehealth in various situations. Its objective is to develop a plan for adopting telehealth solutions that improve access to high-quality healthcare services for all Nigerians, regardless of where they are located. The report will provide a fundamental reference point for policymakers, the general public, students, and scholars.

The results of this comparative analysis will provide significant knowledge for policymakers, healthcare administrators, and stakeholders engaged in the development and execution of telehealth services. Gaining a comprehensive understanding of the distinct requirements and difficulties faced by urban and rural locations can provide valuable guidance for creating customized policies, regulatory structures, and funding mechanisms that promote the adoption and long-term viability of telehealth.  Gaining a thorough comprehension of the obstacles and factors that promote the adoption of telehealth will allow for a more judicious distribution of resources. The study can assist in ensuring the efficient implementation of telehealth projects and their accessibility to the populations that will derive the greatest benefits by pinpointing the locations where investments in infrastructure, training, and technology are most crucial.

Furthermore, the study's analysis of the disparities and commonalities in the adoption of telehealth in urban and rural areas can provide valuable guidance for developing more efficient implementation techniques. Customized strategies that take into account the distinct attributes of each environment can enhance the adoption and usage of telehealth services, resulting in improved health results and heightened patient contentment. The study aims to enhance patient-centered telehealth services by comprehending patient perspectives and experiences with telemedicine in both urban and rural settings. Ensuring patient concerns, preferences, and expectations are taken into account is essential for building trust and promoting acceptance of telehealth, thus improving its overall effectiveness.

Furthermore, examining the viewpoints of patients about the adoption of telehealth adds to the expanding corpus of research on telehealth in developing nations such as Nigeria. The study offers tangible data and valuable insights that might inform future research efforts, innovations, and enhancements in telehealth technologies and services.

1.7 Scope of the study

Broadly, this study focuses critically analyze the barriers and facilitators of telehealth adoption in urban and rural areas of Nigeria. Specifically, this study seeks to assess and compare the level of awareness and understanding of telehealth in urban and urban areas in Nigeria and identify and compare the barriers to telehealth adoption in urban and rural areas in Nigeria. 

Further, this study will focus on identifying and comparing the facilitators that promote telehealth adoption in urban and rural areas in Nigeria and it also seeks to provide strategies for overcoming barriers and enhancing facilitators to improve telehealth adoption and usage in both urban and rural areas of Nigeria.

1.8 Limitations of the study

As is typical in any human endeavour, the researchers faced minor limitations during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data for comparative analysis on the barriers and facilitators of telehealth adoption in urban and rural areas of Nigeria. Hence, a significant investment of time and effort was necessary to locate appropriate materials, publications, or information and gather data.

 Moreover, this study is constrained by its small sample size and narrow geographic scope, namely focusing solely on Nigeria. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation. 

Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities.

1.9 Definition of terms

Telehealth: Telehealth involves the delivery of healthcare services using digital technologies and telecommunications.

Telemedicine: Telemedicine encompasses a range of electronic communication methods, such as video calls, phone conversations, and online messaging, that enable the diagnosis, treatment, and management of patients without the requirement of face-to-face appointments 

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