eHealth still underappreciated among diabetics, general public

Patients and the general public still seem to harbour generally unfavourable attitudes towards eHealth, especially in the context of diabetes care, according to a recent Singapore study.

“A strong preference for face-to-face sessions was observed with a larger proportion of participants with diabetes, citing the reason that eHealth might not be suitable for their health condition. The lack of clinician-patient rapport, requirement of computer skills, and privacy were highlighted by most of the participants, which needs to be addressed through awareness programs to improve acceptance,” the researchers said.

The cross-sectional epidemiological study included 2,895 participants (aged >18 years), of whom 436 had diabetes while 2,459 did not. An eHealth questionnaire, administered in one of four local languages, found that there was a general unpreparedness for eHealth, with 47.3 percent of respondents saying that they were not ready for such an intervention. [J Med Internet Res 2021;23:e26881]

Notably, the degree of readiness for eHealth interventions was significantly lower among diabetic participants vs controls (24 percent vs 54.9 percent; p<0.001).

Acceptance rate was even worse, with only 28 percent of the overall sample saying that they would definitely or possibly seek treatment over the Internet. Among diabetics, 81.8 percent said that they would not. As with readiness, acceptance was significantly poorer among diabetics than controls (p<0.001).

Analysis according to individual eHealth services showed that diabetic participants predominantly preferred face-to-face transactions for booking appointments (55.7 percent), getting prescriptions (79.3 percent), consultations (92.6 percent), health information (63.4 percent), and referrals to other doctors (72.2 percent).

In the overall sample, using eHealth to book appointments was the most acceptable service (33.3 percent), followed by obtaining health information (23 percent). All other services were similarly poorly accepted.

The most common barrier to eHealth that participants cited was the requirement of computer literacy to use such services (90.8 percent). This was followed by the perception that eHealth could not build rapport between the clinician and the patient, especially as compared with face-to-face sessions (77.8 percent).

Other challenges included the lack of confidence about the credibility of eHealth (57.5 percent) and the perception that eHealth may be inappropriate for their medical condition (48.7 percent).     

In terms of advantages, participants responded that eHealth could help save time (79.8 percent), that it was more convenient (62.5 percent), and could help cut costs (61.8 percent). In general, diabetics had a significantly lower perception of the advantages of eHealth than healthy controls.

“This study showed a negative attitude toward eHealth, with the majority unwilling to use eHealth for their diabetes care,” the researchers said. “Participants were aware that eHealth saves time and is convenient; nonetheless, the lower perception of the benefits in patients with diabetes and higher perception of disadvantages is a challenge in accepting the technology for diabetes care.”