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ORIGINAL ARTICLE Table of Contents  
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Smartphone use and perception towards the usefulness and practicality of its applications amongst ghanaian anaesthetists


1 Department of Anaesthesiology and Intensive Care, SMD, CHS, Kwame Nkrumah University of Science and Technology; Directorate of Anaesthesia, School of Anaesthesia, Komfo Anokye Teaching Hospital, Kumasi, Ghana
2 Department of Medicine, Viswabhatathi Medical College, Kurnool, Andhra Pradesh, India
3 Department of Public Health, School of Public Health, CHS, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
4 Directorate of Anaesthesia, School of Anaesthesia, Komfo Anokye Teaching Hospital, Kumasi, Ghana

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Date of Submission17-Apr-2022
Date of Decision29-Apr-2022
Date of Acceptance14-May-2022
Date of Web Publication11-Jul-2022
 

  Abstract 


Background: In recent years, smartphone applications (apps) have generated an increasing interest worldwide. Anaesthesia, as a profession, has been one of the first to adopt new technologies. Aims and Objectives: This study aimed to assess the pattern of smartphone use in anaesthesia practice (duration, frequency and purpose of use), determine the perception of its use and identify factors influencing smartphone usage in anaesthesia practice and installation of anaesthesia-related apps amongst anaesthetists in Ghana. Materials and Methods: A cross-sectional survey of 284 randomly selected Ghanaian anaesthetists was conducted from January 2018 to August 2018, using a previously validated perception domain to measure the perception towards the usefulness and practicality of smartphones. To find the predictors of smartphone use and the installation of medical-related apps in anaesthetic practice, logistic regression models were used. Results: Two hundred and seventy-two anaesthetists responded with a response rate of 95.8%, and 75.9% installed anaesthesia-related apps, whereas 46.1% utilised them. The perception of anaesthetists towards the usefulness and practicality of smartphones in anaesthesia practice was 57.3 ± 18.6 and 61.2 ± 16.8, respectively; the overall percentage mean score was 59.3 ± 17.6, which was less than satisfactory. Only 17.4% of anaesthetists reported a positive level of perception towards smartphone use and practicality. Smartphone usage was 25.4% amongst anaesthetists with negative perceptions towards its usage. The mean total perception mean score was a significant predictor of both smartphone usage (β = 0.031, P < 0.001) and the installation of anaesthesia apps (β = 0.032, P < 0.001) after controlling for possible confounders. Conclusion: Smartphone utilisation in anaesthesia practice is low amongst Ghanaian anaesthetists. This could be ascribed to their less than satisfactory level of perception towards smartphone use in anaesthesia practice. On the other hand, their use and installation of apps in anaesthesia practice were predicted by the perceived usefulness and practicality of their use.

Keywords: Anaesthetist, applications, perception, practicality, smartphone


How to cite this URL:
Singh S, Shaifulla P, Singh A, Owusu-Ansah I. Smartphone use and perception towards the usefulness and practicality of its applications amongst ghanaian anaesthetists. Hamdan Med J [Epub ahead of print] [cited 2022 Aug 19]. Available from: http://www.hamdanjournal.org/preprintarticle.asp?id=350631





  Introduction Top


Mobile phone technology is spreading rapidly around the globe. Today, almost 5 billion individuals have a variety of mobile phone sets globally, and more than half of them are smartphones.[1] Although smartphone possession can vary widely, people in developed and developing countries have smartphones and are likely to utilise many applications (apps). The influence of smartphone technology is not restricted to the developed world's professionals but is also visible amongst anaesthetists in developing countries such as Ghana. Four hundred and seventy-seven million mobile subscribers were registered in sub-Saharan Africa in 2019, reaching more than half a billion in 2022 and accounting for >45% of the population of sub-Saharan Africa.[2] The rising demand for healthcare programmes through technology products and services has resulted in the development of multifunctional smartphone apps and the increased functionality of embedded sensors on smartphones. In 2021, there were about 2.87 million applications available on the Google Play Store alone. More than half a billion individuals globally have at least one app out of >100,000 available mobile health apps.[3] Many smartphone apps are medical related and valuable in various medical practices.

Technology acceptance model (TAM) explains how users come to accept and use technology and a particular technology improves job performance.[4] However, proper utilisation of these apps in anaesthesia practice varies in degrees of success and is usually based on easy to learn and utilisation.

Anaesthesia is a knowledge-based speciality; smartphone utilisation has grown exponentially in anaesthesia practice with the improved accessibility of smartphone devices and mobile apps. More involvement of smartphone technology in anaesthesia practise reduced the number of medical errors.[4],[5] Smartphones are commonly used for referring and calculating drug doses.[6] Digital mHealth apps help assess intraoperative neuromuscular blockade (NMB) assessment,[7] patient-reported outcome measures (PROMs) for pain and satisfaction, [8] and improve performance in high-stress situations.[9] Smartphones with their accessories are also used as fibre optic bronchoscopes,[10] point of care learning of anaesthetic procedures such as peripheral block and life support.[10],[11] Scanners plugged with a smartphone for bedside ultrasound of patients have been found to improve decision-making.[12] In addition, communication among staff is a common use of smartphones by anaesthetists in developed countries, however uncommon among anaesthetists in developing countries.[13],[14]

Apprehension regarding smartphone use in the operating room (OR) has been raised in many studies.[15],[16],[17],[18] The disadvantages of such a steady network with smartphones include distraction from patients' care. In addition, anaesthetists may be hindered by personal calls, texts, E-mails, social networks and apps. Furthermore, smartphones may put patients' privacy and safety at risk and interfere with OR and critical care unit equipment. Others consider the smartphone as a critical source of nosocomial infection for patients.[16],[17] Unfortunately, no straightforward reply to the question 'whether smartphones are distracting gadgets or valuable gadgets for anaesthesia practice' has been provided. For example, is it safe to use smartphones to read anaesthesia articles or literature hunts during patient management? In the OR, there is a need for guidelines and education on professional conduct and the use of personal devices. Despite these concerns about mobile phone use, an increased dependency on smartphones has been noticed amongst Ghanaian anaesthetists. However, no studies on the impact of smartphones on anaesthesia have been conducted in Africa. However, no study on the impact of smartphones on anaesthesia has been conducted in Africa. Furthermore, there is a paucity of literature on smartphone use in anaesthesia practice in Ghana. Accordingly, anaesthetists' feedback is expected to understand smartphone utilisation better and change anaesthesia practice in Ghana. Therefore, this study aimed to assess the pattern of smartphone use in anaesthesia practice (duration, frequency and purpose of use), determine the perception of its use and identify factors influencing smartphone usage in anaesthesia practice and installation of anaesthesia-related apps amongst anaesthetists in Ghana. Logistic regression models were used to find the predictors of smartphone use and the installation of medical-related apps in anaesthetic practice.


  Methods Top


A prospective cross-sectional study was embraced after obtaining ethical approval from the Research and Development Unit, Komfo Anokye Teaching Hospital, from January 2018 to August 2018. We designed questionnaire forms based on a preliminary literature search.[17],[19],[20] With a 50% favourable perception, a 95% confidence level and a 5% margin of error, the anticipated sample size that would statistically be convenient in this study is 237 anaesthetists registered with the Ghana Medical and Dental Council (GMDC). In addition, we included a 20% dropout rate to make up for incomplete surveys or withdrawals. Two hundred and eighty-four surveys were distributed amongst randomly selected anaesthetists, every third from the compiled list of registered 837 anaesthetists with GMDC. Anaesthetists were informed, consent was taken and the data were collected in a confidential manner without disclosing the participant's identity or any other information to anyone.

There were three sections in the study and 45 questions:

  1. Demographics: These include anaesthetist gender, age (years), education (diploma or graduate/post-graduate) and experience of anaesthesia practice (years) – characteristics were collected as independent variables or exposures
  2. Pattern of usage and purpose domain: Include possession of smartphones, anaesthesia related apps or any other portable devices (such as iPad and tablets), frequency of usage and time spent per week in hours etc.
  3. Perceived usefulness (PU) and perceived ease of use (PEOU): Previous studies in developed countries that measured the perception of the usefulness and practicality of smartphones in clinical settings were used for anaesthesia practice.[4] Perception score was calculated for the responses by a four-point Likert-type scale ranging from 0 to 3 points: for strongly agree – 3 points, agree – 2, disagree – 1 and strongly disagree – 0 point. The response calculated the total score for each anaesthetist, and then, a percentage was calculated. This percentage score was categorised into negative perception <50%, neutral 50%–75% and positive perception >75%.


In this study, Stata/SE 13.1 statistical software (StataCorp LP Statistics/Data Analysis StataCorp 4905 Lakeway Drive Special Edition College Station, Texas 77845 USA 800–STATA–PC http://www.stata.com, [email protected]) was used. This study represented all independent variables using descriptive statistics such as mean, standard deviation, frequency and percentages. Analytic statistics were used to test associations between the anaesthetist's perception of smartphone use and the installation of medical applications. The Student's t-test and Chi-square test were used for quantitative and qualitative data. The logistic regression model was applied to identify the predictors of mobile phone use and installation of anaesthesia-related apps. P < 0.05 was considered statistically significant.


  Results Top


The questionnaires were sent to 284 anaesthetists registered with GMDC. In this study, 272 anaesthetists responded to assess their perception of mobile phone use in anaesthesia care, with a 95.8% response rate. The majority of respondents were aged <40 years (56.3%), female (64.3%), married (72.1%), graduate (93.4%) and had work experience of 10–20 years in anaesthesia (71.3%) [Table 1].
Table 1: Demographic characteristics of anaesthetists (n=272)

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Almost all anaesthetists registered with GMDC possessed one or more smartphones (94.9%), and 77.6% had android smartphones. However, only 75.9% installed anaesthesia-related apps, whereas 46.1% utilised them in anaesthesia practice. The anaesthetists owned 1, 2–5 and >5 anaesthesia-related apps in their anaesthesia practice were 30.3%, 46.2% and 23.5%, respectively. Regarding the frequency of smartphone use during work, only 25.2% of anaesthetists reported always using anaesthesia-related apps in their practice. 20.1% and 5.4% use it sometimes and rarely, respectively. However, only 49.3% reported never using a smartphone during work. Regarding the duration of smartphone use, only 55.7% reported using the smartphone <1 h per day, whereas 44.3% used more than 1 h per day in their practice. The three most common reasons for the use of smartphones in the anaesthesia practice (not mutually exclusive) were as follows: calling colleagues for assistance (67.1%), drug dosage calculation/information (56.9%), searching for reference/books (31.8%) and disease diagnosis (29.5%) [Table 2].
Table 2: Ownership and utilisation of smartphones by anaesthetists

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When asked the question kind of apps they would like to use in the future, the drug-related apps formed a significant preference among the anaesthetists with 33.8%, whereas patient education apps formed the least preference for anaesthetists with 2.6% [Table 3].
Table 3: Types of future apps preferred by anaesthetists (n=272)

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[Table 4] compares the age and utilisation of smartphones in their anaesthesia practice. Anaesthetists in the age group of <40 years reported 17.4% (always) use of smartphones in their anaesthesia practice, whereas anaesthetists more than 50 years reported only 0.8% (always) use of smartphones in their anaesthesia practice.
Table 4: The utilisation of smartphones as per age and frequency (n=258)

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[Table 5] shows the perception of anaesthetists towards the usefulness and practicality of the use of smartphones in anaesthesia practice is 57.3 ± 18.6 and 61.2 ± 16.8, respectively. However, the beliefs of anaesthesia providers about smartphone use in terms of usefulness and practicality were less than satisfactory (overall percentage mean score = 59.3 ± 17.6) [Table 5]. Only 19.1% and 15.9% of anaesthetists reported a positive attitude towards the importance of smartphone use and practicality. However, the overall percentage mean score of 17.4% reported a positive attitude [Table 6].
Table 5: Perception of anaesthetists towards usefulness and practicality of use of a smartphone in anaesthesia practice (n=258)

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Table 6: Levels of perception towards smartphone use in anaesthesia practice (n=272)

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The most common concerns about the usage of smartphones in operation theatre amongst anaesthetists were as follows: nosocomial infection (41%), distraction (24%), affecting patient care (16%) and interference with the medical equipment (13%) [Figure 1].
Figure 1: Anaesthetists are concerned about the usage of smartphones in the operating theatre

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The overall perception level of smartphone use and practicality with a prevalence of its usage showed a coalition [Table 7]. Smartphone usage was 25.4% amongst anaesthetists with negative perceptions towards its usage. This figure was doubled (44.8%, odds ratio 95% CI = 2.32, P = 0.011) and tripled (67.3%, odds ratio 95% CI = 6.15, P < 0.001), amongst anaesthetists with neutral and positive perceptions, respectively. Likewise, the overall perceived level of smartphone use and practicality with the prevalence of apps installation was 19.4% amongst anaesthetists with a negative perception of smartphone use, and this number was doubled (47.3%, odds ratio 95% CI = 3.69, P < 0.001) and tripled (65.8%, Odds ratio 95% CI = 3.69, P < 0.001), amongst anaesthetists with neutral and positive perceptions, respectively [Table 8]. This was seen across the board in both perception domains. The mean total perception mean score was a significant predictor of both smartphone usage (β = 0.031, P < 0.001) and the installation of anaesthetic apps (β = 0.032, P < 0.001) after controlling for possible confounders. Physicians also predicted the installation of medical apps (β = 0.782, P = 0.021) compared with certified registered anaesthetists [Table 9].
Table 7: Rate of smartphone usage according to levels of perception towards usage

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Table 8: Installation of applications according to the levels of perception towards usage

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Table 9: Predictors of usage of smartphones and installation of anaesthesia apps

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  Discussion Top


The widespread adoption of the internet and smartphone devices has changed the way of working in the 21st century. Healthcare-related apps provide extravagant facts and add a new dimension to knowledge. Nowadays, the availability of cheap smartphones and good internet services has dramatically increased medical apps over the past few years. As a result, smartphones are becoming an integral part of our daily lives and anaesthesia practice. As demonstrated in our study, more than 94.9% of anaesthetists have smartphones and use their smartphones regularly at work. In addition, the android phone was the most popular (77.6%) amongst Ghanaians.

In 2015, Patel et al. in the United Kingdom assessed the usage of smartphones amongst surgeons. Surgeons were asked to complete a questionnaire that assessed their smartphone use in the workplace. The study showed that 93.5% of surgeons possess a smartphone and 54.2% possess a medical app; 79.3% stated that they would be willing to use their smartphones for hospital-based work.[19] On the other hand, our study amongst anaesthetists registered with Ghana MDC found higher values of smartphone ownership as 94.9% and apps usage as 82.6%. A possible description for the increased values of smartphone ownership and apps usage amongst Ghanaian anaesthetists compared to the United Kingdom surgeons may be a difference in the professional requirements. Furthermore, the two studies were conducted 4 years apart, and the later timeframe might have contributed to the differences in values obtained due to the continuous advancements in technology.

Davis, in 1989, explained in his study that perceived simplicity of use, PU and information technology (IT) approved by the user in the TAM to assess the consumer's level of acceptance of IT and information system.[20] This model demonstrates five elements as an actual system, attitude (A), behavioural intention, PEOU and PU.[21],[22] According to this model, adopting a framework is based on PU and PEOU variables. The PU is the amount to which particular technology improves job performance, whereas the PEOU is when a specific technology requires no exertion from the user.[4],[20],[21] For example smartphones, digital mHealth apps for intraoperative NMB assessment[7] or PROMs for pain and satisfaction[8] improve the performance of anaesthetists in high-stress situations in lieu of posters, flow charts and checklists effortlessly.[9] In addition, fibre-optic bronchoscopy with smartphones,[10] bedside ultrasound scans of patients[12] and upgrading the communication amongst staff[13],[14] are common uses of smartphones by anaesthesiologists in developed countries. The most common uses of smartphones in anaesthesia practice by Ghanaian anaesthetists were as follows: calling for assistance (67.1%), drug dosage calculation/information (56.9%), searching for reference/books (31.8%), reviewing guidelines and protocol (29.5%), skills training for residents/anaesthetists (19.8%), patient education (12.4%) and others (6.2%).

In our study, 49.3% of all anaesthesia providers reported always using anaesthesia-related apps in their practice. However, 25.2% and 5.4% of them use it sometimes and rarely, respectively. Only 20.1% reported never using a smartphone during work. In contrast, at Queen Mary Hospital in Hong Kong, 7% of doctors never used medical apps in the clinical setting.[23] This high number of anaesthetists who never use smartphones in Ghana may be due to concerns about the use of smartphones in the OR. As per Ghanaian, anaesthetists believe that the disadvantages of smartphone usage include nosocomial infection (41%), risk of distraction (24%), affect patient care (16%) and interference with medical equipment (13%). Smartphones are a distracting element, especially in the OR,[24] but they do not support a comprehensive limitation of smartphone usage in ORs, according to the American College of Surgeons and the American Association of Nurse Anaesthetists. Therefore, anaesthetists need guidelines and education regarding professional conduct and personal device utilisation in the OR.

In this study, 25.2% reported using their smartphone for more than 1 h per day. In contrast, 83% of doctors used apps for 1-2 h per day in Nair et al. study.[23] These variations may be due to professional requirements as their study included doctors from all specialities, and Hong Kong is a highly developed country, so people used to use technology with ease.

In the present study, the results showed that the beliefs of anaesthesia providers about smartphone use in terms of usefulness and practicality were less than satisfactory, with only 17% reporting a positive attitude. This finding might be attributed to the non-existence of a formal system implemented in the anaesthesia training programme in Ghana and the healthcare facilities that allow anaesthetists to be convinced with the use of smartphones as a new technology that could improve anaesthesia quality by giving anaesthesia practitioners instant access to medical and health information. Furthermore, this technology has reduced the number of medical errors, improved decision-making and upgraded communication amongst hospital staff.[9],[10],[11],[12],[13],[14] Prior research has also found a link between attitude towards IT and intention to use IT.[4],[20],[22] This finding supports IT consumerization theory and provides practical support for the argument that anaesthetists' use of smartphones can improve work productivity[11],[12],[13],[14] and enhance the quality of care rendered to patients.[4],[11],[19]


  Conclusions Top


Smartphone use in anaesthesia practice is uncommon amongst Ghanaian anaesthetists. This could be due to their unsatisfactory perception of smartphones in terms of usefulness and practicality. There must be a necessary intervention from the higher health authorities to enforce the importance of smartphones in clinical anaesthesia practice. It is suggested that more studies be conducted in Ghana on the impact of smartphone use on the anaesthesia practice. Such use can improve anaesthetists' perceived work productivity and perceived quality of care rendered to patients.

Ethical clearance

This study was approved by the Research and Development Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana (REG. NO: RD/CR18/179).

Acknowledgement

We would like to thank the members of Ghana Medical and Dental Council and School of Anaesthesia, KATH, Kumasi, for their support.


  Declaration of participantsí consent Top


Anaesthetists were informed, consent was taken and the data were collected in a confidential manner without disclosing the participantís identity or any other information to anyone.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Sanjeev Singh,
Department of Anaesthesiology and Intensive Care, CHS, Kwame Nkrumah University of Science and Technology, Kumasi
Ghana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/hmj.hmj_36_22



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