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A mixed methods study of factors influencing health managers acceptance of eHealth services in the Kingdom of Saudi Arabia.

Alshahrani, Abdullah Mohammed


Abdullah Mohammed Alshahrani


Katie MacLure

Derek Stewart


The Kingdom of Saudi Arabia (KSA) is a country with one of the largest land masses and most difficult geographical terrain in the Middle East. The accessibility of advanced health services, especially for people in rural areas, has been considered one of the main health challenges. Health services across the country are accessible through three categories of providers. The Ministry of Health (MOH), which is the dominant health provider, is responsible for 60% of all health services and facilities. The private health sector and other government-run health authorities are the providers for the remaining 40%. Many initiatives to embrace technology in healthcare were launched by the MOH to advance the level of acceptance. One of the initiatives was the ambitious National eHealth Strategy, which was launched in 2011 to govern eHealth projects across the country, and to set consistent standards, policies, and procedures for the practice activities. This study was sponsored by the MOH as part of a bigger plan to involve stakeholders in the digital transformation. The overall aim of this doctoral research was to explore the factors that influence health managers' acceptance of eHealth services in KSA. The 1st phase was a systematic review (SR): based on a PRISMA-P guided protocol published with CRD Prospero, five databases were searched for studies published between 1993 and 2017. One reviewer performed the search; two reviewers screened the titles and abstracts. Exclusions were recorded with reasons. Tools appropriate to study design were applied independently by two reviewers to assess the quality of included studies. After duplicates were removed, 110 papers were screened and 15 studies met the inclusion criteria. From these 15 papers, 39 factors were identified as influencing varying levels of eHealth adoption and acceptance in KSA. Lack of studies on the views of health managers and limited studies from only a few geographical settings were also identified as knowledge gaps. The 2nd phase was a survey: an online questionnaire in both Arabic and English language was designed around the Unified Theory of Acceptance and Use of Technology (UTAUT) model determinants. Professionals with a health managerial role from multiple disciplines - such as health professions, administration, and health IT - were invited to take part in the study. Ethical approval had been gained. Participation links were distributed across a range of social media platforms. SPSS v25 was used for data analysis. Findings from the 2nd phase survey showed the significance (p < 0.05) of Performance Expectancy and Social Influence moderated by age to the Behavioural Intention of health managers as well as the Performance Expectancy and Facilitating Conditions to the actual Use Behaviour. Some ambiguous results need further investigations. The 3rd phase consisted of a mixture of face-to-face and telephone in-depth interviews with 21 health managers from Aseer province, KSA. Four umbrella domains were derived from the UTAUT model. The pre-defined themes from phases 1 and 2 were explored and mapped against the domains. Ethical approval had been gained. Microsoft Excel and NVivo were used for the data analysis. Through the interviews, ambiguity in the previous phase was clarified and the most influential factors based on the views of health managers in Aseer province, KSA, were identified. Three domains out of four showed significance: Performance Expectancy, Social Influence, and Facilitating Conditions. This mixed methods research design presented across three phases was adopted with the findings from each phase informing the next. Overall, the research confirmed the influence of the same factors on health managers' acceptance of eHealth services in KSA and generated original findings. First, by providing evidence that this area has not been previously studied through registering a protocol and publishing a systematic review. Second, by using social media platforms to support a novel recruitment approach for the study. Third, by employing UTAUT as a theoretical framework in both quantitative and qualitative phases. Finally, exploring eHealth practice in Aseer province, a part of KSA that has not previously been explored in the published literature. These original findings draw a clearer picture of the potential challenges faced by health managers in KSA in accepting and using eHealth services. The findings may also work as a foundational basis from which to better prepare other stakeholder groups for accepting eHealth services. By doing so, staff can more effectively utilise health technology interventions as key concepts in making successful and positive transformational and sustainable change to the delivery of healthcare.


ALSHAHRANI, A.M. 2021. A mixed methods study of factors influencing health managers acceptance of eHealth services in the Kingdom of Saudi Arabia. Robert Gordon University, PhD thesis. Hosted on OpenAIR [online]. Available from:

Thesis Type Thesis
Deposit Date Sep 6, 2021
Publicly Available Date Sep 6, 2021
Keywords Healthcare provision; Digtial healthcare; eHealth; Technology adoption; Saudia Arabia
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