WITS BUSINESS SCHOOL Perceived Value and Barriers to use of Personal Health Records by Patients in South Africa Mia Erasmus A research report submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Business Administration Johannesburg 2014 ABSTRACT Context: Electronic PHR is a new concept in South Africa and there is little research of how individuals perceive PHR in South Africa. The study fills a gap in that there are no published PHR utilisation studies done in South Africa, likely due to the fact that there were very few PHR systems available before 2012. Problem statement: Investigate the perceptions of personal health records amongst patients in South Africa. First Sub-problem: The first sub-problem is to determine the perceived value of personal health records to patients in South Africa. Second Sub- problem: The second sub-problem is to determine the perceived barriers to use of personal health records. Method: The research methodology chosen is an online survey with analysis of the ordinal data using the Distribution-Fitting Algorithmic Approach. The research analysed a survey sent by email to registered individual users on the My Healthspace database. Key findings: Perceived value of PHR to patients: 1) PHR had enough interactive features. 2) Respondents likely to access their PHR again. 3) Respondents want to be able to access their health records online. 4) Respondents agreed most with usefulness of access to their summary file. 5) Respondents disagreed with PHR decreasing the need to see their doctor in person. 6) Respondents wanted PHR to provide reliable health information. Perceived barriers to use of PHR: 1) Respondents disagreed that they did not access their file online due to a lack of interest. 2) Respondents saw themselves as computer literate. 3) Respondents agreed that they have regular access to a computer or smartphone. 4) Respondents disagreed with the statement that they were worried about the security of their health information online. 5) Respondents agreed that they are happy to use an online health system as long as it is protected by a password and encryption. 6) Respondents strongly disagreed with paying a monthly fee for access to their online health records. 7) Respondents disagreed that advertisers should be able to target a specific group with adverts. i Conclusion: In conclusion the survey confirmed some of the findings in international research with regards to patient- perceptions about PHR such as respondents desire to have access to their medical information online and for PHRs to provide reliable health information. Similar to other studies it found that patients do not want to pay for access to a PHR. It differed from the international literature in that patients disagreed with the value of PHR reducing the need to see their doctor in person. This survey also did not demonstrate a lack of trust in the privacy of information as a barrier to use of PHRs. ii DECLARATION I, Mia Erasmus, declare that this research report is my own work except as indicated in the references and acknowledgements. It is submitted in partial fulfilment of the requirements for the degree of Master of Business Administration in the University of the Witwatersrand, Johannesburg. It has not been submitted before for any degree or examination in this or any other university. ------------------------------------------------------------- Mia Erasmus Signed at Johannesburg On the 26 day of February 2014 iii DEDICATION I dedicate this research report to my husband Pierre. iv ACKNOWLEDGEMENTS I would like to thank my supervisor Anthony Stacey for his all help with the analysis of the data as well as his guidance and support throughout the research report. I would also like to thank Terri Carmichael for her advice during the research proposal phase. I would like to thank all the patients who completed the survey, as well as all those who apologised to me because they never found time to complete it – without their support there would have been no research. I would like to thank My Healthspace for allowing me to email the patient database with the online survey. I would like to thank my business partner, Dr Holly, for all the times she stood in for me during the MBA and all her support. I would like to thank my husband for all his support during the MBA and specifically during this research report. v TABLE OF CONTENTS ABSTRACT ...................................................................................... I DECLARATION .................................................................................... III DEDICATION .................................................................................... IV ACKNOWLEDGEMENTS ........................................................................... V TABLE OF CONTENTS ............................................................................. VI LIST OF TABLES .................................................................................... IX LIST OF FIGURES .................................................................................... IX CHAPTER 1: INTRODUCTION ............................................................. 1 1.1 PURPOSE OF THE STUDY .................................................................................... 1 1.2 CONTEXT OF THE STUDY .................................................................................... 1 1.3 PROBLEM STATEMENT ...................................................................................... 3 1.3.1 MAIN PROBLEM.......................................................................................................... 3 1.3.2 FIRST SUB-PROBLEM .................................................................................................... 3 1.4 SIGNIFICANCE OF THE STUDY............................................................................... 3 1.5 DELIMITATIONS OF THE STUDY ............................................................................ 4 1.6 DEFINITION OF TERMS ...................................................................................... 5 1.7 ASSUMPTIONS ............................................................................................... 6 CHAPTER 2: LITERATURE REVIEW ..................................................... 7 2.1 INTRODUCTION .......................................................................................... 7 2.2 DEFINITION OF TOPIC OR BACKGROUND DISCUSSION. .................................... 8 2.3 PERCEIVED VALUE OF PHR ........................................................................ 9 2.3.1 INDIVIDUAL/PATIENT INTEREST IN ACCESSING THEIR HEALTH RECORDS ..................... 9 2.3.2 PATIENT EXPECTATIONS OF PHR ............................................................................ 9 2.3.3 WHAT ASPECTS OF THE PHR OFFER VALUE TO INDIVIDUAL PATIENT USERS? ............. 9 2.3.4 WHAT DO PATIENTS USE THE INFORMATION FOR? .................................................. 11 2.3.5 RESEARCH QUESTION 1 ....................................................................................... 11 2.4 PERCEIVED BARRIERS TO USING A PERSONAL HEALTH RECORD .................... 11 2.4.1 EDUCATIONAL LEVEL AND COMPUTER LITERACY ..................................................... 12 2.4.2 SOCIO-ECONOMIC STATUS. ................................................................................... 12 2.4.3 HEALTH STATUS ................................................................................................... 13 vi 2.4.4 PRIVACY OF MEDICAL INFORMATION ...................................................................... 13 2.4.5 RESEARCH QUESTION 2: ...................................................................................... 13 2.5 CONCLUSION OF LITERATURE REVIEW ....................................................... 13 2.5.1 RESEARCH QUESTION 1: ...................................................................................... 14 2.5.2 RESEARCH QUESTION 2: ...................................................................................... 14 CHAPTER 3: RESEARCH METHODOLOGY .......................................... 15 3.1 RESEARCH PARADIGM .............................................................................. 15 3.2 RESEARCH DESIGN .................................................................................. 16 3.3 POPULATION AND SAMPLE......................................................................... 17 3.3.1 POPULATION ........................................................................................................ 17 3.3.2 SAMPLE AND SAMPLING METHOD ........................................................................... 17 3.3.3 THE RESEARCH INSTRUMENT ................................................................................ 17 3.4 PROCEDURE FOR DATA COLLECTION .......................................................... 18 3.5 DEMOGRAPHIC PROFILE OF RESPONDENTS ................................................ 19 3.6 DATA ANALYSIS AND INTERPRETATION ....................................................... 21 3.7 LIMITATIONS OF THE STUDY ....................................................................... 21 3.8 VALIDITY AND RELIABILITY ......................................................................... 23 3.8.1 EXTERNAL VALIDITY .............................................................................................. 23 3.8.2 INTERNAL VALIDITY ..............................................................................................