Telemedicine’s Potential to Support Good Dying in Nigeria: A Qualitative Study

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Abstract

Objectives

This qualitative study explores Nigerian health care professionals’ concepts of good dying/a good death and how telemedicine technologies and services would fit the current Nigerian palliative care practice.

Materials and Methods

Supported by the Centre for Palliative Care Nigeria (CPCN) and the University College Hospital (UCH) in Ibadan, Nigeria, the authors organized three focus groups with Nigerian health care professionals interested in palliative care, unstructured interviews with key role players for palliative care and representatives of telecom companies, and field visits to primary, secondary and tertiary healthcare clinics that provided palliative care. Data analysis consisted of open coding, constant comparison, diagramming of categorizations and relations, and extensive member checks.

Results

The focus group participants classified good dying into 2 domains: a feeling of completion of the individual life and dying within the community. Reported barriers to palliative care provision were socio-economic consequences of being seriously ill, taboos on dying and being ill, restricted access to adequate medical–technical care, equation of religion with medicine, and the faulty implementation of palliative care policy by government. The addition of telemedicine to Nigeria’s palliative care practice appears problematic, due to irregular bandwidth, poor network coverage, and unstable power supply obstructing interactivity and access to information. However, a tele-education ‘lite’ scenario seemed viable in Nigeria, wherein low-tech educational networks are central that build on non-synchronous online communication.

Discussion

Nigerian health care professionals’ concepts on good dying/a good death and barriers and opportunities for palliative care provision were, for the greater part, similar to prior findings from other studies in Africa. Information for and education of patient, family, and community are essential to further improve palliative care in Africa. Telemedicine can only help if low-tech solutions are applied that work around network coverage problems by focusing on non-synchronous online communication.

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Most cited references 21

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Treatment of cancer in sub-Saharan Africa.

T. Kingham, Olusegun I Alatise, Verna Vanderpuye … (2013)

Cancer is rapidly becoming a public health crisis in low-income and middle-income countries. In sub-Saharan Africa, patients often present with advanced disease. Little health-care infrastructure exists, and few personnel are available for the care of patients. Surgeons are often central to cancer care in the region, since they can be the only physician a patient sees for diagnosis, treatment (including chemotherapy), and palliative care. Poor access to surgical care is a major impediment to cancer care in sub-Saharan Africa. Additional obstacles include the cost of oncological care, poor infrastructure, and the scarcity of medical oncologists, pathologists, radiation oncologists, and other health-care workers who are needed for cancer care. We describe treatment options for patients with cancer in sub-Saharan Africa, with a focus on the role of surgery in relation to medical and radiation oncology, and argue that surgery must be included in public health efforts to improve cancer care in the region.

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Effectiveness of mHealth behavior change communication interventions in developing countries: a systematic review of the literature.

Amira A. Roess, Avia E. Rubin, A Gurman (2011)

Mobile health (mHealth) technologies and telecommunication have rapidly been integrated into the health care delivery system, particularly in developing countries. Resources have been allocated to developing mHealth interventions, including those that use mobile technology for behavior change communication (BCC). Although the majority of mobile phone users worldwide live in the developing world, most research evaluating BCC mHealth interventions has taken place in developed countries. The purpose of this study was to conduct a systematic review of the literature to determine how much evidence currently exists for mHealth BCC interventions. In addition to analyzing available research for methodological rigor and strength of evidence, the authors assessed interventions for quality, applying a set of 9 standards recommended by mHealth experts. The authors reviewed 44 articles; 16 (36%) reported evaluation data from BCC mHealth interventions in a developing country. The majority of BCC mHealth interventions were implemented in Africa (n = 10) and Asia (n = 4). HIV/AIDS (n = 10) and family planning/pregnancy (n = 4) were the health topics most frequently addressed by interventions. Studies did not consistently demonstrate significant effects of exposure to BCC mHealth interventions on the intended audience. The majority of publications (n = 12) described interventions that used two-way communication in their message delivery design. Although most publications described interventions that conducted formative research about the intended audience (n = 10), less than half (n = 6) described targeting or tailoring the content. Although mHealth is viewed as a promising tool with the ability to foster behavior change, more evaluations of current interventions need to be conducted to establish stronger evidence.

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'Mobile' health needs and opportunities in developing countries.

S. J. Kahn, James G. Kahn, J Yang (2010)

Developing countries face steady growth in the prevalence of chronic diseases, along with a continued burden from communicable diseases. "Mobile" health, or m-health-the use of mobile technologies such as cellular phones to support public health and clinical care-offers promise in responding to both types of disease burdens. Mobile technologies are widely available and can play an important role in health care at the regional, community, and individual levels. We examine various m-health applications and define the risks and benefits of each. We find positive examples but little solid evaluation of clinical or economic performance, which highlights the need for such evaluation.

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Author and article information

Contributors

Fiona Harris: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 1 June 2015

Publication date Collection: 2015

Volume: 10

Issue: 6

Electronic Location Identifier: e0126820

Affiliations

[1 ]Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands

[2 ]Centre for Palliative Care Nigeria and Hospice and Palliative Care Unit, University College Hospital, Ibadan, Nigeria

[3 ]Hospice and Palliative Care Unit, University College Hospital, Ibadan, Nigeria

[4 ]Department of Telemedicine, University College Hospital, Ibadan, Nigeria

[5 ]Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands

[6 ]Department of IQ Healthcare, Ethics Section, Radboud University Medical Center, Nijmegen, Netherlands

University of Stirling, UNITED KINGDOM

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: JG OS KO SD MS JH. Performed the experiments: JG OS KO SD JH. Analyzed the data: JG OS KO SD JH. Wrote the paper: JG OS KO SD EL KV MS JH.

* E-mail: Jelle.vanGurp@ 123456radboudumc.nl

Article

Publisher ID: PONE-D-14-52405

DOI: 10.1371/journal.pone.0126820

PMC ID: 4452265

PubMed ID: 26030154

SO-VID: 357bb8b1-9894-47e9-ab80-55da78839ef6

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 21 November 2014

Date accepted : 7 April 2015

Page count

Figures: 1, Tables: 2, Pages: 15

Funding

The Netherlands Organisation for Scientific Research (NWO) funded this research (File number 313-99-120). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability Due to ethical restrictions and Dutch law regarding respondent privacy, de-identified data are available upon request to qualified researchers. Requests for data can be directed to Professor Kris Vissers (Head of the Palliative Care and Pain Center Nijmegen; Kris. Vissers@ 123456radboudumc.nl ) or the first author (Jelle van Gurp).

Telemedicine’s Potential to Support Good Dying in Nigeria: A Qualitative Study

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Abstract

Objectives

Materials and Methods

Results

Discussion

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PLOS Climate

Most cited references 21

Treatment of cancer in sub-Saharan Africa.

Effectiveness of mHealth behavior change communication interventions in developing countries: a systematic review of the literature.

'Mobile' health needs and opportunities in developing countries.

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