University of Ghana http://ugspace.ug.edu.gh UNIVERSITY OF GHANA USER PERCEPTION ON HEALTHCARE MOBILE APPLICATION AMONG RESIDENTS IN ACCRA BY ROBERT KOFI DOH (10166640) A LONG ESSAY SUBMITTED TO THE UNIVERSITY OF GHANA BUSINESS SCHOOL IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF A MASTER OF ARTS IN MANAGEMENT AND ADMINISTRATION AUGUST, 2019 University of Ghana http://ugspace.ug.edu.gh DECLARATION I hereby declare that, this dissertation is my own research and has not been submitted by anyone for the award of any academic degree in this or any other University. All references used in the work have been duly and fully acknowledged. ………………………………… …………………………………. ROBERT KOFI DOH DATE SIGNED (10166640) i University of Ghana http://ugspace.ug.edu.gh CERTIFICATION I certify that this dissertation was done under my supervision and in accordance with the guidelines on supervision of thesis laid down by the University of Ghana. ……………………………………………. ………………………………… Prof. Kwesi Amponsah-Tawiah DATE SIGNED (SUPERVISOR) ii University of Ghana http://ugspace.ug.edu.gh DEDICATION I dedicate this work to my family, friends and colleagues of the UGBS MGAD class of 2018/2019 iii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT I am very grateful to the Almighty God for the wisdom, guidance and protection afforded me towards the completion of this course. Also, I owe a huge debt of gratitude to Prof. Kwesi Amponsah-Tawiah my supervisor who encouraged and guided me to finish my work on schedule. I also wish to thank all friends and course mates who also assisted me during this course for their immeasurable support. iv University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS DECLARATION ............................................................................................................................... i CERTIFICATION ............................................................................................................................. ii DEDICATION ................................................................................................................................. iii ACKNOWLEDGEMENT ................................................................................................................ iv TABLE OF CONTENTS................................................................................................................... v LIST OF TABLES .......................................................................................................................... viii LIST OF ABBREVIATIONS ............................................................................................................ix ABSTRACT ...................................................................................................................................... x CHAPTER ONE ............................................................................................................................... 1 INTRODUCTION ............................................................................................................................. 1 1.1 Research Background ......................................................................................................... 1 1.2 Research Problem .............................................................................................................. 2 1.3 Research Purpose .............................................................................................................. 3 1.4 Research Objectives ........................................................................................................... 3 1.5 Research Questions ............................................................................................................ 4 1.6 Scope of the Study ............................................................................................................ 4 1.7 Significance of Study ......................................................................................................... 4 1.8 Chapter Disposition ............................................................................................................ 5 CHAPTER TWO .............................................................................................................................. 6 LITERATURE REVIEW .................................................................................................................. 6 2.1 Chapter Overview .............................................................................................................. 6 2.2 Evolution of ‘Mobile Phone’ Technology ........................................................................... 6 2.2.1 Use of Mobile Phone Technology .............................................................................. 7 2.3 Mobile Applications (Mobile Apps) ................................................................................... 8 2.3.1 Categories of Mobile Applications (Mobile Apps) ...................................................... 9 v University of Ghana http://ugspace.ug.edu.gh 2.4 Mobile Health Technologies ............................................................................................... 9 2.5 Mobile Health Applications .............................................................................................. 11 2.5.1 Types of Mobile Health Applications........................................................................ 12 2.6 The Use of Mobile Health Apps ....................................................................................... 13 2.7 Challenges in Using Mobile Health Applications .............................................................. 15 2.8 Summary ......................................................................................................................... 17 CHAPTER THREE ......................................................................................................................... 18 METHODOLOGY .......................................................................................................................... 18 3.1 Introduction ..................................................................................................................... 18 3.2 Research Design............................................................................................................... 18 3.2.1 Research Design Strategy ......................................................................................... 19 3.3 Population ........................................................................................................................ 20 3.3.1 Sample Size ................................................................................................................. 20 3.4 Sampling Techniques ....................................................................................................... 21 3.5 Data Collection Instrument ........................................................................................... 21 3.5.1 Data Collection ............................................................................................................ 22 3.6 Data Analysis ................................................................................................................... 22 3.7 Ethical Consideration Observed in Conducting the Study ................................................. 23 CHAPTER FOUR ........................................................................................................................... 24 PRESENTATION OF FINDINGS AND ANALYSIS ..................................................................... 24 4.1 Introduction ..................................................................................................................... 24 4.2 Demographic profile of respondents ................................................................................. 24 4.3.1 Awareness of mobile application on health ............................................................... 24 4.3.2 Gender distribution of respondents ........................................................................... 25 4.3.3 Age distribution of respondents ................................................................................ 25 4.3.4 Marital Status of respondents .................................................................................... 26 4.3.5 Highest Educational Level Attained .......................................................................... 26 4.3.6 Monthly Earnings ..................................................................................................... 27 vi University of Ghana http://ugspace.ug.edu.gh 4.3.7 Why respondents Use the Healthcare Mobile Application ......................................... 28 4.3.8 Length of Use of the application ............................................................................... 28 4.3.9 Frequency in the Use of the Application .................................................................. 29 4.3.10 Overall usage of the application(App) ....................................................................... 29 4.4 Findings based on the research Questions ......................................................................... 30 4.4.1 Research questions 1: Most Used Healthcare Mobile Application ................................. 30 4.4.2 Research question 2: Impact of Healthcare Mobile Application(App) on Health ........... 31 4.4.3 Research question 3: Challenges in Using Healthcare Mobile Application(Apps) .......... 34 CHAPTER FIVE ............................................................................................................................. 35 DISCUSSION, CONCLUSION AND RECOMMENDATIONS...................................................... 35 5.1 Introduction ..................................................................................................................... 35 5.2 Discussion of Findings ..................................................................................................... 35 5.2.1 Most Used Healthcare Mobile Application................................................................ 35 5.2.2 Why they use the Healthcare Mobile Application...................................................... 36 5.2.3 How often they use the Healthcare Mobile Application ............................................. 37 5.2.4 Impact of Healthcare Mobile Application(App) on Health ........................................ 37 5.2.5 Challenges in Using Healthcare Mobile Application(Apps)....................................... 37 5.3 Summary of the Study ...................................................................................................... 38 5.4 Conclusion ....................................................................................................................... 39 5.6 Limitations of the Study ................................................................................................... 40 5.7 Suggestions for Future Research....................................................................................... 41 REFERENCES................................................................................................................................ 42 vii University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 4. 1 : Awareness of mobile application on health ...................................................... 25 Table 4. 2: Gender distribution of respondents .................................................................... 25 Table 4. 3: Age of distribution of respondents .................................................................... 26 Table 4. 4: Marital Status of respondents ............................................................................ 26 Table 4. 5: Highest Educational level of respondents .......................................................... 26 Table 4. 6: Monthly Income earnings of respondents .......................................................... 27 Table 4. 7: Why respondents use the healthcare mobile application .................................... 28 Table 4. 8: Length of Use of the Healthcare Mobile Application ........................................ 29 Table 4. 9:Frequency in the Use of the Application ............................................................ 29 Table 4. 10: Overall usage of the application(App) ............................................................. 30 Table 4. 11: Most Used Type of Healthcare Mobile Application......................................... 31 Table 4. 12: Satisfaction with healthcare mobile application ............................................... 32 Table 4. 13: Time involved in seeking healthcare ............................................................... 32 Table 4. 14: Cost involved in seeking healthcare ................................................................ 33 Table 4. 15: Impact of Healthcare Mobile Application(App) on Health ............................. 33 Table 4. 16: Challenges in Using Healthcare Mobile Application(Apps)............................. 34 viii University of Ghana http://ugspace.ug.edu.gh LIST OF ABBREVIATIONS CPOE - Computerized Physician Order Entry Systems EMRs - Electronic Medical Record Systems PACS - Picture Archiving and Communication Systems PDA - Personal Digital Assistant ix University of Ghana http://ugspace.ug.edu.gh ABSTRACT Mobile application have the potential to make a necessary change in global delivery and management, being beneficial to both patients and governments. The benefits it brings to patients is that quality of delivered healthcare can be enhanced, making it easier to access and use medical services The purpose of the study was to explore user perception of impact that healthcare mobile applications have on residents in Accra who have adopted it to manage their health in Ghana. In view of this a quantitative research approach using questionnaires was adopted for the study. A total of 150 questionnaires were distributed through a convenient sampling approach. Out of the 150 questionnaire administered 120 were returned and only 100 were deemed fit to be used for final analysis. Data collected from respondent were analysed using Statistical Package for Social Science (SPSS) software. Data was analysed and presented using descriptive statistics tables. Overall, in was indicative that the first 3 most used healthcare mobile applications by respondents was healthcare mobile applications that enables a person to perform physical exercises or to workout. Followed by reproductive health apps, which are generally, use by women to track their reproductive cycles, and then application that provided individuals with Updates or news on their general wellness and wellbeing. For example, the first of the most used application was expected as most of the respondents were females and so one would expect that having an application to monitor their reproductive cycle in not farfetched. The impact that the healthcare mobile application had on their lives was first identified not be significant. Individuals do not find satisfaction with application in improving their health. x University of Ghana http://ugspace.ug.edu.gh Additionally, individuals did not also find the applications as aiding them to reduce the time involved in seeking healthcare. Individuals did not also find the application as aiding them to in reduce the cost involved in seeking healthcare. On the whole, user of healthcare mobile applications did so see the application to be impacting on their health. Regarding challenges, the study found out that the first three most challenges that respondents were faced with was Bad network connectivity, followed by high cost in using the application and then the lack of technical support in using the application. xi University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE INTRODUCTION 1.1 Research Background The advancement in technology has enabled the development of healthcare solutions with which healthcare resources are shared. The solutions provided have created some level of efficiency and flexibility as compared to the traditional ways of providing healthcare which is characterised by paper-based form of healthcare delivery (Pussewalage & Oleshchuk 2016). These new forms of technology enabled healthcare solutions are mostly facilitated by mobile devices (Qiang, Yamamichi, Hausman, Altman, & Unit, 2011). According to Coppock (2009), the use of mobile technologies in health delivery also known as “mHealth” refers to the delivery of healthcare services via mobile communication devices’. Another definition according to Istepanian, Jovanov, and Zhang, (2004) is the use of mobile computing, medical sensor and communications technologies for healthcare delivery. Mobile applications have the potential to make a necessary change in global delivery and management, being beneficial to both patients and governments. The benefits it brings to patients is that quality of delivered healthcare can be enhanced, making it easier to access and use medical services. For governments, it lowers the cost of delivery of healthcare due to higher efficiency. Further, mHealth cannot only help to deal with diseases, but also offers various tools to help people to prevent diseases from occurring (Thapa, 2015). Due to the popularity of the use of smartphones there has been an increase in the use of mHealth (mobile health) and smartphone applications (Lupton 2014a; Milosevic, Shrove, & Jovanov 2011; O’Reilly & Spruijt-Metz 2013). 1 University of Ghana http://ugspace.ug.edu.gh Such health application(apps) are designed for health and wellness management, though there are designs for other health reasons as well as for reasons such as medical reference or for health management (Milosevic et al. 2011). The availability, portability and wide use of smartphones together with their sophisticated features and capabilities make them ideal devices for these tasks the purposes that they serve (Kranz et al. 2012). In view of this, countless number of applications have been developed to aid individuals in living healthy lifestyles and behaviour (Lupton 2016). In the mist of all these benefits and reasons for their development and use, an important question however remains; what is the impact of healthcare mobile applications in providing and managing healthcare? This is what this study seeks to explore. 1.2 Research Problem The mobile technology space has evolved in the past decade. With its increasing sophistication, the time spent by mobile phone users continues, leading to the spending of less time in using traditional personal computers (Huberty, et al. 2011). In this age, smartphones vary and offer various added features such as built-in cameras, global positioning systems and most importantly application(apps). According to Bąkała, and Michalski, (2015), the use of mobile technologies in everyday life is increasingly reflecting how they use healthcare management systems and applications to check their health. Further, in the view of Smith and Page (2015), about sixty-four percent of adults in the United States own a smartphone and more than 60 percent of adults with a smartphone report accessing the internet from their phone. Smartphones also have a wide range of potential for influencing health outcomes (Bort-Roig et al. 2014; Riley et al. 2011). 2 University of Ghana http://ugspace.ug.edu.gh Healthcare professionals on their part also spend some considerable amount of time to attend to patients who seek healthcare while technologies that can assist them in performing these duties lie stationary. Additionally, research on the use of digital health technologies is an emerging field and there is currently not many studies that have been done to explore how healthcare mobile applications (mobile apps) in general populations improves healthcare delivery (Lupton 2014a, 2016). Hence, in as much as mobile technology has advanced coupled with a variety of available mobile based applications, there is still the need to explore the current position of how mobile healthcare mobile applications are designed to aid in monitoring and tracking patients’ health conditions, to share patients information and as well as accessing healthcare information (Abu-Dalbouh, 2013). 1.3 Research Purpose The purpose of this study is to examine user perception on the impact of healthcare mobile applications on a cross-section of uses in the business city of Accra who have adopted it to manage their health in Ghana. 1.4 Research Objectives The objectives of this study are as follows’ 1. To identify the healthcare mobile applications that individuals use the most 2. To identify the impact of healthcare mobile applications in managing health of those who have adopted it in Ghana. 3. To identify the challenges that individuals face in using healthcare mobile applications in Ghana. 3 University of Ghana http://ugspace.ug.edu.gh 1.5 Research Questions In order to meet the objectives of this study the following questions were posed; 1. What is the healthcare mobile application that individuals use the most? 2. What is the impact of healthcare mobile applications in managing health of those who have adopted it? 3. What are the challenges that individuals face in using healthcare mobile applications? 1.6 Scope of the Study This study focuses on individuals in Ghana who have adopted various healthcare mobile applications that enables them to check and management their health. The study was limited to persons living in the business city of Accra in Ghana. This study adopts and exploratory and descriptive approach. 1.7 Significance of Study The primary goal of this study is to identify the impact of healthcare mobile applications in managing health of those who have adopted it in Ghana. This study is significant in a number of ways. Firstly, there are arguably not enough studies that have been done on the impact of technology in managing healthcare especially from the context of a developing country. Again, this study will add to the body of knowledge by identifying and guiding the development and implementation of technology in healthcare delivery in Ghana. Additionally, this study provides 4 University of Ghana http://ugspace.ug.edu.gh guidelines for policy makers and stakeholders in relation to the use of technology in healthcare from the context of a developing country. Finally, software developing companies especially those in mobile applications development could benefit from applying some of the ideas presented in this study to developing and fine tuning the software they develop. 1.8 Chapter Disposition The dissertation is organised into five chapters; these are; Chapter one, which is the introduction and it provides a background on the research, presents the research problem, its purpose and objectives and also possess research questions being asked. The chapter also presents the significance of this study. Chapter two is literature review and it focuses on presenting a review of relevant literature regarding the study. Chapter three is the methodology and it discusses the methodology employed in the study in order to find answers to the research questions and to meet the objectives of the study . Chapter four is the analysis of the study and it presents an analysis and discussion of the study. Chapter five is the summary, conclusion and recommendation of the study and it discusses, summarises and provides conclusion on the study. This chapter also highlights some recommendations of the study that could explored in future studies. 5 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO LITERATURE REVIEW 2.1 Chapter Overview This chapter presents a review of relevant literature regarding research on health app use, and what has been discovered about apps as they relate to health outcomes are presented. These include definitions, evolution of mobile technology, evolution of heath apps and the advantages of health mobile apps for managing health. 2.2 Evolution of ‘Mobile Phone’ Technology The use of mobile technology has evolved drastically with the introduction of the first smartphone named “Simon” in 1993 (Tynan 2005). Some of the features of the phone include E-mail, pagers, notepad, address book, calendar, and calculators (IBM, 1994). A few years on, there was another transformation in the development of mobile phones that saw the introduction of the personal digital assistant (PDA). PDA was first introduced in 1996 and became popular because of some special features they had that included; low price and their ability to connect to computers via serial cables. Newer models of PDAs later emerged with improved features. By the year 2000, the first modern mobile operating system (OS) called the Symbian was introduced (Nokia 2002). A series of Mobile OS further emerged and by the year 2010 mobile operating systems such as iOS, Android, webOS, Bada, and Windows emerged (Mathew, 2012). Consumers Have not been using smartphones to make telephone calls only, but also use it for the purpose of data and media services (Chan 2011). These data services can be done a little much easier using a tablet, as most tablets have larger display screens than smartphones the screen size of the normal smartphone. 6 University of Ghana http://ugspace.ug.edu.gh Tablets have gained popularity among consumers basically due to their attractive form factors. The larger display area on tablets enables user to easily the surf web, browse, play video games and applications, and create content such as use word processers (Gartner, 2012). 2.2.1 Use of Mobile Phone Technology According to Smith and Page (2015), In the United States of America, about 64 percent of adults own a smartphone and more importantly, 62 percent of these adults have used their smartphone to look up health information online. The use of smartphones is more prevalent for people of younger age, higher education, and higher income. Blacks are more likely to own smartphones than whites, though there is no significant difference between whites and Hispanics. Smith’s and Page’s (2015) report shows that 10 percent of U.S. adults rely on their smartphone for internet access and they do not have broadband or high speed internet access at home. Blacks and Hispanics are more likely to be dependent on their smartphones for internet access than whites. mobile phone features have demonstrable effects on health, particularly when it comes to healthcare delivery and these sorts of outcomes are not necessarily reliant on health apps (Patrick, Griswold, Raab, & Intille, 2008). Patients can be reminded of medical appointments or to remind them to take their medicines via text message. Health information and public health concerns can also be disseminated through text. People can access health information over the internet using their phones. For example, a study by Lepp, Barkley, & Karpinski, (2014) on 305 students shows that there is physical lower level activity when they use mobile phones. Students who used their phones more often were more likely to forgo physical activity and participate in more sedentary behaviours. This same study shows that relatively lower use may actually motivate physical activity, though. These students instead used the phone as communication devices that connected them to peer groups that help to support physical activity. 7 University of Ghana http://ugspace.ug.edu.gh On the other side, the positive effects on mobile phone use shows that mobile phones are useful devices in the delivery of healthcare and healthcare interventions (Klasjna & Pratt 2012; Patrick et al. 2008). Thus, the benefits in using mobile phones have to have more health benefits as opposed to negative ones, but this an important area for research (Gartner, 2012). 2.3 Mobile Applications (Mobile Apps) Mobile applications on mobile devices is gaining grounds in the area of global information and communication technology. Typically, mobile applications are developed from building blocks software codes or programmes that are installed on mobile devices in order to for the application to perform a specific user task. Some of the general benefits of mobile applications is that they are user friendly, easy to use, inexpensive, easily downloadable and able to run on most mobile phones including inexpensive and entry-level phones (Gartner, 2012). Further, many mobile applications have had a wide use for their enormous functionalities. Some of which include, making calls, sending messages, surfing the internet, chatting, social networking and communication, playing audio and video as well as gaming (Islam, Islam, & Mazumder, 2010). These applications can be used from everywhere provided there is internet availability. Further, these mobile application run in a mobile environment and the ability to use for different users is based on a number of factors including; their screen size and resolution, hardware limitations, ability to purchase internet data, internet connectivity issues as limited interaction possibilities. In recent years however, developers of mobile applications as well as developers of mobile devices have made strides in trying to develop applications higher storage, better screen resolution, better connectivity all in an attempt to provide better user experience and functionally (Inukollu, Keshamoni, Kang, & Inukollu, 2014). 8 University of Ghana http://ugspace.ug.edu.gh 2.3.1 Categories of Mobile Applications (Mobile Apps) In the view of Islam, Islam, and Mazumder, (2010), mobile applications can be placed in the following categories below; a. Communications: This refers to applications that are used for internet browsing, emailing or social networking. b. Games: This refers to applications that are used for gaming such as puzzles, cards, action or adventure. c. Multimedia: This refers to application used for capturing and viewing or playing audio and presenting videos. d. Productivity: This refers to application used for word processing, calculations, calendars. Diary or notepads. e. Travel: This refers to application used as city guides, currency converting, translating, GPS/mapping, itineraries / scheduling r weather forecasting. f. Utilities: This refers to application used for profile managing, screen saving, address task management, call management, file management or health management. 2.4 Mobile Health Technologies According to Elsevier Clinical Solutions (2015), mobile health apps puts patients at the centre of healthcare delivery process as the processes that leads to the recovery is made available to them through tools such as mobile applications and devices. For many healthcare professional, combining data analytics and mobile technologies create seamless ways for them to provide the needed healthcare possible which is less expensive, such as finding a physical space for hospitals and doctors’ offices, and limiting the travel time to seek healthcare and to work for patients and physicians respectively. 9 University of Ghana http://ugspace.ug.edu.gh The types of mobile health technologies according to Elsevier Clinical Solutions (2015), include; a. Cloud-Based Technologies: The type of mobile health technology which provides data storage capability in the cloud through the use of the internet thereby providing access to useful and efficient means of computing that occurs remotely thereby doing away with localised servers and computing systems. Further, with cloud-based technologies, there is the possibility of an integration with mobile applications that can easily access information in the cloud storage space. Example of recent sue f this technologies is the use of mobile applications that have enable sought to enable doctors to integrate the data of their patients with geolocation information about different diseases and illnesses such drug availability to cure a disease or patterns of resistance; all of which have a storage place in the cloud. This type pf mobile health technology put the “m” letter in mobile by giving person in the health sector and including patients themselves useful opportunities such as patient- specific information literally in the palm of their hands. b. Healthcare Portals: This type of mobile health technologies provides and an opportunity to patients to access information about their health online. Physicians and healthcare facilities also in turn use portals to access allow patients medical records. In a broader sense, examples of portals such as the Microsoft HealthVault which is designed to enable patients access their medical history from across different physicians they have consulted or healthcare facilities they have visited. Such portals also serve as a platform where mobile applications are able to tap into and provide access to users everywhere. 10 University of Ghana http://ugspace.ug.edu.gh 2.5 Mobile Health Applications The popularity of healthcare apps is increasing by the and is becoming beneficial for both clinicians and patients alike. Healthcare apps can improve the ease and speed with which healthcare professionals can access, analyse, and respond to clinical data and reference information (Lohnari, Patil, & Patil, 2016). “Mobile Health (mHealth) was defined as wireless telemedicine involving the use of mobile telecommunications and multimedia technologies and their integration with mobile healthcare delivery systems” (Istepanian & Lacal 2003, p.3). This definition is seen to cover any mobile technology that is used to assist in the provision of healthcare and to bridge the barriers in healthcare delivery such quality of service, cost in delivery, matching of resources, and behavioural norms. Mobile health (m-health) applications serve as a convenient healthcare solution for the information intensive healthcare sector. Many in the software development sector made up of software vendors and developers are eager to cater to the needs of healthcare providers and have launched numerous apps for various device models. For example, in the Android market, nearly 600 apps are available under the medical category from Google Play store. Clinicians use smartphones for patient care and for updating their own medical knowledge (Boulos, Wheeler, Tavares, & Jones, 2011). Recent advancements in mobile technology and have made it possible for clinicians to adopt this technology. Again, information systems such as electronic medical record systems (EMRs) and picture archiving and communication systems (PACS) can be accessed using smartphones (Baumgart, 2011). Tablets for example offer a simple, and convenient touch screen interface for the user to use to access information. Additionally, with the large screens on tablet, they are become ideal for displaying patient clinical information, a task that is challenging with smartphones. For physicians, carrying a tablet would be similar to carrying a paper chart. 11 University of Ghana http://ugspace.ug.edu.gh Medical applications such as computerized physician order entry systems (CPOE), electronic prescribing, EMR systems, alerts, and communication systems, can be accessed through tablets. The touch screen capability available on tablets can eliminate the need for keyboards. Using mobile apps that are customized for each medical specialty on tablets can further enhance user experience during patient encounters. 2.5.1 Types of Mobile Health Applications The types of mobile health apps currently available, and in development, generally break down into two areas (Elsevier Clinical Solutions, 2015). a. Health and Wellness Consumer Applications: These applications offed patients a number of ways to help them manage their health. The application can be in the form of a simple exercise tracker, heart rate monitor, diet, and calorie counting applications. Some of these applications can be linked to the system of their healthcare service providers. For example, UnitedHealth Group offers members multiple mobile applications, including one that helps people manage chronic disease and required medication via text messaging. b. A Wide Range Of Mobile Applications And Technologies: These are application that are aimed at medical professionals, including those that give remote access to medical reference information, images and drug data, those that deliver patient information to professionals wherever they are, and those that improve workflow and productivity. For example, a study in the Journal of the American Medical Directors Association found that 90 percent of nursing home physicians surveyed reported that they have avoided at least one harmful drug reaction by looking up prescription information on their mobile devices (Handler, Boyce, Ligons, Perera, Nace, & Hochheiser, 2013). 12 University of Ghana http://ugspace.ug.edu.gh 2.6 The Use of Mobile Health Apps Qiang, Yamamichi, Hausman, Altman, and Unit, (2011) identify a number of ways in which mobile health application are used in health care management. These are discussed below; a. Treatment support: mHealth services are used to facilitate treatment of health problems rather than to make diagnosis or to prevent the occurrence of health problems. An example of such treatment support application is a compliance reminder, which uses phone calls or SMS to send reminders to patients to take their medications. Another example of a treatment support application is one that instructs patients and health workers on rational drug for prescribing, dispensing, and administering. For example, Medic Mobile uses text messages to provide cost-effective support to community health workers in rural areas. According to Mahmud, Rodriguez, and Nesbit (2010), in Malawi, a number of workers using the system saved 2,048 hours and $2,750 in transportation costs, and were able to double the capacity of tuberculosis treatment programs in six months. b. Patient tracking: Another way mobile health application are used is to digitally track the medical records of patients geared towards healthcare providers and pharmacists reduces errors in diagnosis, treatment, and prescribing. Additionally, patients can be monitored from a central location into community health workers feed data collected at their regular visits. Health workers through such feeds are also able to receive alerts or updates about their patients to help them plan their rounds. c. Supply Chain Management: Health applications also serve as a means to collect data on sales and inventory to enable and inform the reorder and purchase of supplies. 13 University of Ghana http://ugspace.ug.edu.gh These applications can also track shipments and monitor distribution of healthcare materials. Most importantly, healthcare applications help protect against counterfeiting were consumers, health workers, and retailers are able to use such applications to check fraudulent products that can be have expired and dangerous to their health. Consumers can use mobile devices to check prices of medical products and services especially for consumers living in remote areas dominated by individual retailers or providers. d. Health Financing: Health application can also provide means to insurance and health savings products. This includes use of smartcards, vouchers, insurance, and lending for health services linked to mobile platforms. An example of such a platform is Kenya‘s M-PESA also known as mobile money technology. Other similar industries where application are used include the agriculture sector agriculture sector where mobile phones help to deliver micro insurance products to consumers. Consumers can also receive vouchers or service discounts for medical services using mobile applications. e. Emergency Services: Mobile healthcare applications also provide access to a rise in the provision of efficiency in the delivery of health emergency services and responses, including ambulance services. f. Disease Prevention: Mobile health application aid in emergencies where persons who are involved in an emergency can use mHealth applications to report urgent health emergency situations. Through mHealth applications, consumers can also receive information on locations of health facilities such as pharmacies, clinics and hospitals as well as healthcare resources. Applications also foster social networking connection between patients and healthcare providers to share knowledge and experiences. 14 University of Ghana http://ugspace.ug.edu.gh g. Education and Awareness: Mobile healthcare application is used in a number of countries to deliver health information. In many of these countries, gaming and quizzes are used to deliver such information. For example, in South Africa, the platform called Young Africa Liv which is a social networking platform hosted by the Vodacom Live portal offers information on HIV/AIDS as well as other health issues using entertainment and social topics. The portal in the year 2010 had more than 300,000 unique subscribers and about 22 million page views and by the end of 2011, it had almost 800,000 unique subscribers and 62 million page views. 2.7 Challenges in Using Mobile Health Applications According to Shieh, Tsai, Anavim, Shieh, Lin (2008) as cited in Bhutkar, Karande, and Dhore, (2009), even though m-Healthcare systems provide solutions to several problems in the medical domain, there are many significant challenges in their implementation. These challenges are classified as usability, mobile network as well as ethics, security and privacy challenges. a. Usability Challenges: For most mobile devices, their screens are smaller than a normal desktop computer, thereby limiting the type of information that the user can see, especially for users who have problems with their vision. (Nielsen 2009). Again, the way data is inputted into the systems are through the use of much small or miniaturized, keypads. (Nielsen 2009) thereby making data entry containing special signs as well as symbols is challenging. How long such systems can also be operational in terms of their battery life is a major challenges especially for remote areas where this isn’t constant supply of electricity and where battery-charging facilities are not readily available. Most devices such as PDA have a battery life of 2 and a half to 4 hours of continuous use (Horne 2004). There are also issues of users finding it difficult in searching for specific content. 15 University of Ghana http://ugspace.ug.edu.gh Unlike websites, which are typically optimized for desktop usability, mobile device on which healthcare applications are installed don't follow the same guidelines (Nielsen 2009). For example, pictures may not be show properly on mobile devices; thus failing to provide required information. Also, something report that a medical or clinical in nature such as radiology and pathology reports, progress notes and encounter histories may not show properly (Afrin & Daniels, 2001) and are difficult to display on mobile devices. Such information displayed may appear to be too much condensed. b. Challenges with mobile networks: Using mobile healthcare application re also subject to issues of Bandwidth availability and access. The speed of the m-Healthcare applications seem slower and many a times, mobile devices take a longer time to access patient’s records due to network congestion (Han, Tetard, Harkke, Collan, 2006) Also, bandwidth required for transmitting medical images and other diagnostic test results is not enough on mobile networks (Nversel, 2009). For most devices there are also concerns over mobile network coverage. In as much as mobile network and most especially internet coverage is expanding very fast all across the globe there are still areas that are remotely located where coverage is missing. These are areas where healthcare facilities are not enough and telemedicine can provide a viable solution. And for older mobile infrastructure and devices, they are likely to suffers from signal loss (Nversel, 2009). Also , there are issues of integration where healthcare application have become obsolete and require an upgrade before new feature can be accesses which usually come at a cost (Istepanian et al., 2004) which creates difficulty in operations of m- Healthcare applications. 16 University of Ghana http://ugspace.ug.edu.gh c. Ethical, Security and Privacy Issues: Privacy. Although mobile health technology is advancing at a rapid rate, there are still issues with ethics, especially for applications involving patient-specific data. Privacy and security issues are also a big concern due to fears that personal health information will land in the hands of hackers or inadvertently shared beyond the scope of the patient’s preference (Elsevier Clinical Solutions, 2015). The medical community has serious concerns about managing security and privacy of patient data when clinicians use mobile applications that are not under central control. There is an estimated 62 percent of physicians who have adopted mobile technology and as such use mobile tablets to deliver healthcare services (Terry 2012). 2.8 Summary The purpose of this chapter was to explore of relevant literature regarding research on health app use, and what has been discovered about apps as they relate to health outcomes. The aim was to find the most researched issues such as types, how it’s used and some challenges in using it. The next chapter presents the methodology to be used in conducting the study in order to meet its objectives. 17 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE METHODOLOGY 3.1 Introduction This chapter focuses on the methodology that is used to conduct this study. This includes the processes and techniques used in carrying out the study in order to answer the research questions. The key things presented in this chapter includes the research approach and design strategies, the sampling technique and sample size, the instruments used and method that was used to analyse the data. 3.2 Research Design Research design refers to a map that guides a researcher in the conduct of a study with maximum control over factors that may interfere with the validity of the findings (Burns & Grove, 2003). According to Warfield (2005), researchers group research design into three categories. They are ;(a) Quantitative; (b) Qualitative and (c) Mixed Methods. Quantitative design deals with the investigation of things that can be observed and measured, qualitative design enables researchers to appreciate society and the way people behave, whiles mixed method design on the other hand combines both quantitative and qualitative design methods (Creswell, 2017). This study examines user perception on the impact of mobile application adoption in managing their health. In view of this a quantitative research approach was adopted for the study. The adoption of a quantitative approach in this study is to quantify the problem through the generation of numerical data and to quantify the perceptions, behaviours, as well as make generalisations of the results from the sample population. (Creswell, 2013; 2017). 18 University of Ghana http://ugspace.ug.edu.gh 3.2.1 Research Design Strategy In order carry out an effective research, strategies need to be adopted. According to Turner, (2010) the common research strategies include experiments, surveys using structured questionnaires, purposive sampling, interviews, participant observation or focus groups discussions and case studies. This study adopts a survey using structured questionnaire because it provides an easy and convenient way for respondents to answer the questionnaire . A survey is defined as a research strategy that encompasses any measurement procedure that involves asking questions from respondents (Powell & Connaway, 2004). When surveys are used, respondents are contacted directly or indirectly by using systematic methods of measurement such as questionnaires and interviews. Due to the large size of the intended population, the survey method was employed to aid the collection of quantitative data for analysis and the results obtained also gives high level of reliability. In using a survey the researcher can make generalization from the sample perspective to the entire population. According to Leedy and Ormrod, (2001), using a survey has a major advantage as it allows data to be collected on a large population within a short period of time. Survey also provides a quantitative or numeric description of trends, attitudes, or opinions of a population by studying a sample of the population. From the results of the sample, the researcher can then make generalize about the population on the findings of the study (Creswell, 2009). The decision to adopt a survey approach was also based on the limited time available to undertake this study as it allows for the investigation of a particular phenomenon in within a short period of time but into details. Considering the population under study which is large in nature, the use of a survey enabled the researcher to explore the views of a large population under study (Stroh, 2000). Additionally, made it convenient, easier and cheaper for the researcher to collect sizable amount of data from a population (Boateng, 2019). 19 University of Ghana http://ugspace.ug.edu.gh 3.3 Population According to Kumekpor (2002), a study population basically refers to the total number of units that are being investigated of which all other possible observations are made. In this study the population consisted of persons in the business city if Accra who intent or are making use of healthcare applications(apps) that are mobile based in checking and managing their health. The population was in West Legon enclave where the researcher lives. 3.3.1 Sample Size Sampling is a systematic way of selecting cases for inclusion in a study (Neuman, 2011). Some of the advantages of sampling include reduction in the cost involved in conducting the study and also serves as a means to quickly but efficiently gather vital data within limited time in conducting a study. There is no defined answer to what constitutes an acceptable or sufficient size for a sample (Fraenkel & Wallen, 2000). However, a sample should be large enough to enable the researcher obtain reasonable responses within reasonable expenditure, time, energy and financial resources. According to Alreck and Settle (1985) most researchers use a sample size of about 200 to 1000 respondents for a population of 10,000 or more. Hence in this study since the objective is to examine user perception on the impact of mobile application adoption in managing their health, a sample size of 150 was more than enough to be a representative of users who use some form of healthcare mobile application(app) in managing and checking their health. 20 University of Ghana http://ugspace.ug.edu.gh 3.4 Sampling Techniques With regards to the selection of respondents for the survey, the study employed purposive and convenient sampling techniques. This was due to the peculiarity of the population under study and more particularly its focus on only users who use healthcare mobile applications to check and manage their health in Ghana. The questionnaire was administered in person and manually distributed to respondents. 3.5 Data Collection Instrument The study employed the use of questionnaires as the main instrument for data collection from respondents. Questionnaires were considered as a very important means to use in collecting data as far as the field survey is considered. This is done by collecting data from the field from individuals who use mobile healthcare applications(apps). The questionnaires designed had both closed ended and open ended questions. The questionnaire was manually administered by printing hardcopies of it and distributing it to respondents. The questionnaire for the survey was designed into 5 sections. These are; Sections A,B,C,D and E. Section A collects data on the awareness of mobile application in healthcare. Section B touches on the background of respondents by asking questions on their gender, age, education level, marital status. Section C covers the use of healthcare mobile application on health. Section D touches on the impact of healthcare mobile application on health. Whiles section E touches on the challenges of using healthcare mobile applications. 21 University of Ghana http://ugspace.ug.edu.gh 3.5.1 Data Collection Saunders, Lewis and Thornhill, (2009) define data as raw facts, opinions and statistics that have been collected together and recorded in order to be analysed and meanings made out of it. This study largely depended on primary data through the use of questionnaires in order to get the perceptions of the respondents to the study. Data was be collected using printed hard-copies of the a questionnaire. Reponses were gathered using face to face interactions. For respondents who could complete the questionnaire right away their contact details were taken and a follow up was done to pick the answered questionnaire at later date. At the close of a 4 weeks period (15th March, 2019 - 15th April, 2019) of circulating the 150 questionnaires, 120 were returned/received with 115 being valid to be used for preliminary and subsequently, detailed analysis. The remaining 5 were not fit for the purpose of analysis. The responses that were not used for the analyses were response that were not properly answered. 3.6 Data Analysis The data collected from respondent were quantitatively analysed using Statistical Package for Social Science (SPSS) software. Results were presented in frequency distribution and tables. Findings from the analysis were presented through the use of means and standard deviation, percentages. 22 University of Ghana http://ugspace.ug.edu.gh 3.7 Ethical Consideration Observed in Conducting the Study Ethics refers to the standards and codes that guides the researcher in conducting a study (Fisher, 2010). Some of the ethical considerations observed in this study include; a. Respondents’ consent were sought before data was collected. b. Respondents were assured with a declaration that data being collected was solely for academic purposes only and also, the intent of the study was explained to participants as part of the questionnaire. c. The anonymity of respondents was highly upheld thereby serving as a guarantee to the protection of respondents. d. Participation in the study was strictly voluntary. 23 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR PRESENTATION OF FINDINGS AND ANALYSIS 4.1 Introduction This chapter presents the findings of the study based on the responses that was received from respondents. The key things captured in this chapter are; data on the response rate, demographics of the respondents as well as the responses on the various questions posed them. 4.2 Demographic profile of respondents This section discusses the demographic profile of the study’s respondents. The demographic of the respondents gathered was on the gender, age, marital status, highest educational level, monthly income earnings and frequency on use of the healthcare mobile application. The demographic response in this study are presented in sections 4.3.1 to 4.3.10. 4.3.1 Awareness of mobile application on health From the responses 100 respondents representing (87%) were aware of the use of mobile application on health . Whiles 15 respondents, representing (13%) said they were not aware of the use of mobile application on health. Hence, based on the focus of the study , only the responses on the 100 who were aware of the use of mobile application on health was used in the analysis of this study. 24 University of Ghana http://ugspace.ug.edu.gh Table 4. 1 : Awareness of mobile application on health Frequency(N) (VALID)Percentage(%) Yes 100 87 No 15 13 Total 115 100 4.3.2 Gender distribution of respondents Out of the 100 responses analysed, 57 representing (57%) were females and 43 representing (43%) were males. Gender of respondent was captured in order to provide a balance representation on both sexes. Table 4. 2: Gender distribution of respondents Frequency(N) Percentage(%) Male 43 43 Female 57 57 Total 100 100 4.3.3 Age distribution of respondents From the responses analysed, most of the respondents were within the ages of 30 to 39 years representing (42%) followed by the ages of 19 to 29 years representing (27%) and then by 40 to 49 years representing (21%) and then by 50 to 59 years representing(9%) and the least among the age of respondents being 60 years and above representing (1%). The age distribution is shown in table 4.3. 25 University of Ghana http://ugspace.ug.edu.gh Table 4. 3: Age of distribution of respondents Frequency(N) Percentage(%) 19-29 27 27 30-39 42 42 40-49 21 21 50-50 9 9 60 and above 1 1 Total 100 100 4.3.4 Marital Status of respondents The results of the study as shown Table 3 below indicates 54 persons, representing (54%) of the respondents were married. 42 persons, representing (42%) of respondents were single. 3 persons, representing (3%) of respondents were separated. Whiles 1 person, representing (1%) of the respondents was divorced. The marital status of respondent is shown in table 4.4. Table 4. 4: Marital Status of respondents Frequency(N) Percentage(%) Married 54 54 Single 42 42 Separated 3 3 Divorced 1 1 Total 100 100 4.3.5 Highest Educational Level Attained Regarding the highest educational level that respondents have attained, 44 of them representing (44%) have First degree (Bachelors) followed by 42 respondents representing (42%) with a master’s degree and then 7 people representing (7%) have a professional certificate, 6, representing (6%) had a high school certificate whiles 1 person representing (1%) had a doctoral degree. Table 4. 5: Highest Educational level of respondents 26 University of Ghana http://ugspace.ug.edu.gh Frequency(N) Percentage(%) High school certificate 6 6 Professional certificate 7 7 First degree 44 44 Master’s degree 42 42 Doctoral degree 1 1 Total 100 100 4.3.6 Monthly Earnings The responses on monthly income recorded 30 respondents presenting (30%) earning between 2001 - 3000 Ghana Cedis, followed by 17 respondents representing (17%) earning 1001 - 2000 Ghana Cedis, then by 15 respondents, representing (15%) earn 3,001 - 4000, 14 respondents representing (14%) earn above 5000 Ghana Cedis and finally 12 respondents each, representing (12%) earn 500 – 1000 Ghana Cedis and 4001 - 5000 Ghana Cedis respectively. Table 4. 6: Monthly Income earnings of respondents Monthly Income Frequency(N) Percentage(%) 500-1000 12 12 1001-2000 17 17 2001-3000 30 30 3001-4000 15 15 4001-5000 12 12 Above 5000 14 14 Total 100 100 27 University of Ghana http://ugspace.ug.edu.gh 4.3.7 Why respondents Use the Healthcare Mobile Application From the responses 37 respondents representing (37%) used the application for education and awareness purposes, 18 respondents representing (18%) used it for disease preventions, another 18, representing (18%) use it for emergency purposes, 9 respondents, representing(9%) use it for supply of drugs, 9 respondents representing(9%) use it for treatment support whiles 9 respondent representing (9%) use it for other purposes. Table 4. 7: Why respondents use the healthcare mobile application Frequency(N) Percent(%) Education and Awareness 37 37 Disease Prevention 18 18 Emergency Service 18 18 Supply of Drug 9 9 Treatment support 9 9 Other 9 9 Total 100 100 4.3.8 Length of Use of the application From the responses 14 respondents representing (14%) have used the application for 0 - 2 years, 42 respondents, representing (42%) have used it for 3 - 5 years, 16 respondents representing (16%), have used it for 6 - 8 years whiles 28 respondents representing(28%) have used the application or 9 years and above. 28 University of Ghana http://ugspace.ug.edu.gh Table 4. 8: Length of Use of the Healthcare Mobile Application Frequency(N) Percentage(%) 0-2 years 14 14 3-5 years 42 42 6-8 years 16 16 9 years and above 28 28 Total 100 100 4.3.9 Frequency in the Use of the Application From the responses 32 respondents representing (32%) use the application daily, another 32 respondents representing (32%) use weekly, 19 respondents repressing (19%) use it monthly, and 17 respondents, representing (17%) use it yearly. Table 4. 9:Frequency in the Use of the Application Frequency(N) Percentage(%) Daily 32 32 Weekly 32 32 Monthly 19 19 Yearly 17 17 Total 100 100 4.3.10 Overall usage of the application(App) From the responses 40 respondents representing (40%) have a Very high usage, 27 respondents, representing (27%) very have a high usage, 9 respondents, representing ( 9%) use on the average, 12 respondents, representing(12%) have a low usage and another 12 respondents, representing(12%) have a very low usage. 29 University of Ghana http://ugspace.ug.edu.gh Table 4. 10: Overall usage of the application(App) Monthly Income Frequency(N) Percentage(%) Very High 27 27 High 40 20 Average 9 9 Low 12 12 Very low 12 12 Total 100 100 4.4 Findings based on the research Questions The sections below presents the findings according to the research questions pose in chapter 1 4.4.1 Research questions 1: Most Used Healthcare Mobile Application From the responses 45 respondents representing (45%) used Physical Exercise/Workout/Gym Apps, 27 respondents representing (27%) used Reproductive Health Apps, 14, representing (14%) used Updates/News on General Wellness Apps, 5 respondents, representing (5%) use Medical Insurance Apps, another 5 respondents representing (5%) use Medication Apps, 3 respondents representing (3%) use Medical Appointment App and finally, 1 respondent representing(1%) use other type app. 30 University of Ghana http://ugspace.ug.edu.gh Table 4. 11: Most Used Type of Healthcare Mobile Application Healthcare Mobile Application Frequency(N) Percent(%) Physical Exercise/Workout/Gym Apps 45 45 Reproductive Health Apps 27 27 Medication Apps 5 5 Medical Appointment App 3 3 Updates/News on General Wellness 14 14 Apps Medical Insurance App 5 5 Other 1 1 Total 100 100 4.4.2 Research question 2: Impact of Healthcare Mobile Application(App) on Health The impact in using healthcare mobile application was looked at based on a number of factors. These are; level of satisfaction that individuals have in using the application, the cost involved and the time involved. 4.4.2.1 Level of satisfaction in using the application Regarding the level of satisfaction individuals wo use healthcare mobile applications have with the improvement in their health, a Mean value of 3.71 and Standard deviation of 0.957 indicates that having used healthcare mobile application, individuals are not satisfied with the improvement in their health. 31 University of Ghana http://ugspace.ug.edu.gh Table 4. 12: Satisfaction with healthcare mobile application Number(N) Mean Std. Deviation With the use of healthcare mobile application I am 100 3.71 0.957 satisfied with improvement in my health 4.4.2.2 Time involved in using the application Regarding how individuals see healthcare mobile applications in reducing the time involved in seeking healthcare, a Mean value of 4.11 and Standard deviation of 0.984 indicates that having used healthcare mobile application individuals do not find the application as aiding them to reduce the time involved in seeking healthcare. Table 4. 13: Time involved in seeking healthcare Number(N) Mean Std. Deviation Using Mobile healthcare applications has 100 4.11 0.984 reduced time involved in seeking healthcare 32 University of Ghana http://ugspace.ug.edu.gh 4.4.2.3 Cost involved in using the application Regarding how individuals see healthcare mobile applications in reducing the cost involved in seeking healthcare, a Mean value of 3.62 and Standard deviation of 1.17 indicates that having used healthcare mobile application individuals do not find the application as aiding them to in reduce the cost involved in seeking healthcare. Table 4. 14: Cost involved in seeking healthcare Number(N) Mean Std. Deviation Using Mobile healthcare applications has 100 3.62 1.17 reduced cost involved in seeking healthcare The impact on the use of healthcare mobile applications was in improving healthcare of individuals was measured through the summations of the level of satisfaction, cost involved and time involved, Table 4.15 shows that the impact of Healthcare Mobile application of users was low. The cumulative Mean value of 3.83 and Standard deviation of 0.842 indicates that having used healthcare mobile application users are not satisfaction with the improvement in their health. Table 4. 15: Impact of Healthcare Mobile Application(App) on Health Number(N) Mean Std. Deviation My healthcare has improved with the use of mobile healthcare 100 3.83 0.842 applications 33 University of Ghana http://ugspace.ug.edu.gh 4.4.3 Research question 3: Challenges in Using Healthcare Mobile Application(Apps) From the responses, 79 respondents, representing 35.6% found that the challenges associated with the use of healthcare mobile application to be bad network or connectivity. 68 respondents, representing 30.6% found the challenges to use the healthcare mobile application to be high cost in using the application. 29 respondents representing 13.1% had found challenges as a result of Lack of technical support. Further, 17 respondents, representing 7.7% had challenges with knowledge on the app. 15 respondents, representing 6.8% had breach of security and privacy challenges whiles 14 respondents, representing 6.3% had Usability challenges. Table 4. 16: Challenges in Using Healthcare Mobile Application(Apps) Responses Percent of cases Number Percent Usability and 14 6.3 14.3 handling of Mobile App Knowledge on the 17 7.7 17.3 app Bad Network or 79 35.6 80.6 connectivity High cost in using 68 30.6 69.4 the application Breach of Security 15 6.8 15.3 and Privacy Lack of Technical 29 13.1 29.6 support Total 222 100 226.5 34 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE DISCUSSION, CONCLUSION AND RECOMMENDATIONS 5.1 Introduction This chapter present a discussion, conclusion and presents the implications of the study for policy and practice as well as its limitations and future research directions. This chapter infers from the primary data that was collected and analysed based on the objectives of the study which was to explore the impact that healthcare mobile applications have on residents in Accra who have adopted it to manage their health in Ghana. 5.2 Discussion of Findings The study seeks to provide descriptive insights into what respondents’ use of healthcare mobile applications, its impact on their health and the challenges they face in using the applications. The sections below discusses the findings of the study based on the responses received. 5.2.1 Most Used Healthcare Mobile Application Based on the findings, the most used healthcare application was application that aided respondents to engage in Physical Exercise or to workout. Following this is Reproductive Health Apps which is used generally by female to track their periods and to monitor their reproductive cycles. Then applications that provided users with new updates on general wellness. The rest that followed were Medical Insurance Apps which enables user insure their health and then medication app which user use to track and monitor when they should take their next medication of to find out details about how and when to take a particular medication. This was followed by medical appointment apps which allows individuals to make appointment with a physician or to alert them on their hospital appointment. 35 University of Ghana http://ugspace.ug.edu.gh This findings identified in this study regarding the most used healthcare mobile applications are seen in line with Elsevier Clinical Solutions, (2015), where they identify health and wellness consumer applications which offer patients a number of ways to help them manage their health. Additionally, Handler, Boyce, Ligons, Perera, Nace, and Hochheiser, (2013), foe eample were kept aware of the harmful drug reaction through the use of a healthcare mobile application by looking up prescription information on their mobile devices. 5.2.2 Why they use the Healthcare Mobile Application The findings point to a number or users using healthcare mobile application for education and awareness purposes. This suggest that for many who use the application it sensitises, educated or make them aware of how to keep a healthy lifestyle. So for example, for user who use the physical exercise or workout apps, the app serves as a means through which they can be informed on the proper way to workout in order to yield result that will enable them keep healthy. Following the reason of education and awareness is the reason of disease preventions, where app are used as a means to prevent the occurrence of diseases where users a kept proactive instead of reactive in order to ensure they don’t contract diseases rather than fight disease. Next in reason the use of the apps for emergency purposes where users use the app in emergence situation like requesting for ambulances. Then the next in line of reasons is for the supply of drugs where such apps are used especially to request from pharmacies to supply users with a particular needed drug. The next reason for use of apps is for treatment support where apps enable users to who are under treatment to get well by enabling through processes such as monitoring their blood pressure or heartbeat. 36 University of Ghana http://ugspace.ug.edu.gh These finding are in line with that of Qiang, Yamamichi, Hausman, Altman, and Unit, (2011) who identify that number of ways in which mobile health application are used in health care management include, health financing, emergency services, disease prevention as well as providing education and awareness on diseases. 5.2.3 How often they use the Healthcare Mobile Application Overall, the use of the application daily topped the frequency of use users of healthcare mobile applications. Following this it its weekly use and then monthly use. The least in frequency of use was use was on a yearly basis. The recorded daily use of the application for example can be attributed to the high use of application that are used for physical exercise or workout which usually occurs on a daily basis. 5.2.4 Impact of Healthcare Mobile Application(App) on Health Generally, user of healthcare mobile applications did so see the application to be impacting on their health. There was low satisfaction with the improvement in their health. Also, users did not find a significant impact regarding healthcare mobile application in aiding them to reduce the time involved in seeking healthcare. Also, having used healthcare mobile application, users do not find the application as aiding them to reduce the cost involved in seeking healthcare. 5.2.5 Challenges in Using Healthcare Mobile Application(Apps) The major challenges as noted from the findings point to challenges to Bad network connectivity. This cannot be far fetch as most of these application rely on internet connectivity to remain functional and updated. The next challenge found by most users had to with high cost in using the application. 37 University of Ghana http://ugspace.ug.edu.gh This is also not far fetch as one need to buy data for internet connection in order to fully make use of a mobile application. Other challenges that followed included the lack of technical support in using the application when there are issues. This can either be issues regarding bugs or updates of the application. The next challenge is the general knowhow in using the application. Quite a number of user also had challenges as they indicate security and privacy challenges as part of the issue they encounter in using the application. Finally is Usability and handling of the app challenges which could either be as a result of the app being designed with small fonts etc. A similar assertion is made by Nielsen (2009), that most mobile devices, their screens are smaller than a normal desktop computer, thereby limiting the type of information that the user can see, especially for users who have problems with their vision. Further, the findings regarding challenges identified in this study are similar to the assertion by Shieh, Tsai, Anavim, Shieh, Lin (2008) as cited in Bhutkar, Karande, and Dhore, (2009) that some of the major challenges in using mobile application based healthcare systems includes cost of using the applications well as usability, mobile network connectivity issues. 5.3 Summary of the Study The study sought to explore user perception of impact that healthcare mobile applications have on persons who have adopted it to manage their health in Accra, Ghana. In this regard, the following research objectives were formulated, 1. To identify the healthcare mobile applications that individuals use the most 2. To identify the impact of healthcare mobile applications in managing health of those who have adopted it in Ghana. 3. To identify the challenges that users face in using healthcare mobile applications in Ghana. 38 University of Ghana http://ugspace.ug.edu.gh In order to meet the objectives of this study the following questions were posed; 1. What are the healthcare mobile applications that individuals use the most? 2. What is the impact of healthcare mobile applications in managing health of those who have adopted it in Ghana? 3. What are the challenges that users face in using healthcare mobile applications in Ghana? 5.4 Conclusion The purpose of the study was to explore user perception of impact that healthcare residents in Accra who have adopted it to manage their health in Ghana. More specifically and, based on the objectives of this study, the researcher explored the what healthcare mobile applications respondents used, how it impacts of on their health and the challenges the encounter in using the healthcare mobile application(App). Overall, in was indicative that the first 3 most used healthcare mobile applications by respondents was healthcare mobile applications that enables a person to perform physical exercises or to workout. Followed by reproductive health apps which are generally use by women to track their reproductive cycles, and then application that provided users with Updates or news on their general wellness and wellbeing. For example, the first of the most used application was expected as most of the respondents were females and so one would expect that having an application to monitor their reproductive cycle in not farfetched. The impact that the healthcare mobile application had on their lives was first identified not be significant. Users are not satisfaction with application in the improvement in their health. Users did not also application as aiding them to reduce the time involved in seeking healthcare. They also did not find the application as aiding them to in reduce the cost involved in seeking healthcare. 39 University of Ghana http://ugspace.ug.edu.gh On the whole, user of healthcare mobile applications did so see the application to be impacting on their health. Regarding challenges, the study found out that the first three most challenges that respondents were faced with was Bad network connectivity, followed by high cost in using the application and then the lack of technical support in using the application. It is expected that the findings presented in this study would trigger more stakeholders’ discussions on how to make healthcare mobile applications apart of the healthcare delivery system beginning with citizens and further up to healthcare policy implementers and practitioners. 5.5 Implications of the Study for Policy and Practice The implications of this study can be observed from a research and practice perspective. Regarding the implication to practice, Mobile application developers Healthcare mobile applications can therefore look in the direction of developing healthcare applications that can bring health awareness, monitoring and delivery to the doorstep many. Regarding, this study policy can inform regulatory authorises especially in the healthcare sector to push for the more stringent measures that ensure healthcare mobile applications used in the country meet the needed healthcare standards. 5.6 Limitations of the Study As it is in many research studies that are undertaken, there are bound to be some limitations and this study is no exception. Some of the limitation of this researched included; Constraints in getting respondents on the questionnaire especially when data was to be collected from certain category of persons. The researcher had to put a lot of pressure by sending countless reminders to 40 University of Ghana http://ugspace.ug.edu.gh respondents in order to gather data for the study. This constraint had a rippling effect on the time it took in conducting the study since responses were not forth coming. Finally, time and financial constraints did not permit the researcher to explore the study beyond residents in Accra, Ghana. 5.7 Suggestions for Future Research The purpose of the study was to explore user perception of impact that healthcare mobile applications have on residents in Accra who have adopted it to manage their health in Ghana. Having conducted this study, the researcher suggests that study should be done in other regions of the country in order to have a broader perspective the impact that healthcare mobile applications have on individuals users. The study can also be looked as a qualitatively where interviews will be used in order to lend in-depth understanding and to help to generate rich insights. 41 University of Ghana http://ugspace.ug.edu.gh REFERENCES Abu-Dalbouh, H. M. (2013). A questionnaire approach based on the technology acceptance model for mobile tracking on patient progress applications. Journal of Computer Science, 9(6), 763-770. Afrin, L. 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