Determinants of cloud computing adoption for health service delivery by public health facilities in Kisumu county, Kenya

Abstract

Cloud computing has emerged as a technological paradigm to reduce Information Technology (IT) costs, foster collaboration while increasing productivity. Cloud computing if adopted would offer economic benefits (less capital expenditure, lower maintenance costs, reduced IT labor costs and energy savings), operational advantages (enhanced collaboration, improved security, unlimited computing resources and 24- hour platform) and functional benefits (easy integration because it uses standard protocols) and these would improve health service delivery. The healthcare sector has been slower to adopt cloud computing compared to other industries. Furthermore, it has been established that cloud computing adoption is sector specific due to the different features and security levels they need and as such, cloud adoption studies should be sector specific. Locally, there is limited literature concerning the adoption and benefits of cloud computing in Kenyan healthcare sector. The study was done in Kisumu County and it focused on 57 public health facilities in the county. This study was based on a conceptual framework integrated from the Technological Acceptance Model, Theory of Planned Behaviour and Technology-Organization-Environment model. The objectives of the study were to assess the extent of cloud computing adoption, determine the influence of technological factors, establish the influence of organisational factors and evaluate the influence of behavioural factors in cloud computing adoption for health service delivery. The target population was 114 healthcare personnel (facility in-charges and health records officers). The sample size was 88 healthcare personnel and it was computed using Yamane formula (1967) and

sample was drawn using stratified random sampling. The study employed a cross- sectional study using questionnaires to collect data from respondents. Data analysis

was done using Stata 14.0 software; logistic regression was used to establish the association of health service delivery and determinants of cloud computing adoption. The findings showed that cloud computing prevalence was at 53% and these cloud implementations were deployed as hybrid clouds with Software-as-a-Service (100%) being the most common implementation. Cloud computing adoption influenced health service delivery (Odds Ratio [OR]=7.14, p=0.016).The study found out the following factors to be predictors of cloud computing adoption for health service delivery: Technological factors (technological infrastructure OR=10.29, p<0.0001; technical competency OR=12.27, p<0.0001; security OR=7.40, p=0.0010; privacy OR=11.70, p<0.0001; expert scarcity OR=4.83, p=0.001), organisational factors (Budgetary allocation for IT OR=2.96, p=0.048; firm size OR=21.79 p<0.0001) and behavioural factors (Perceived usefulness OR=10.29, p<0.0001, perceived ease of use OR=8.48 , p=0.002; social influence OR=3.44 p=0.016). From the study findings, I recommend increased adoption of cloud computing to improve health service delivery: bottom-up systems that are unique to facility needs. On technological factors, I recommend, improvement of technological infrastructure in all facilities. On organisational factors, I recommend increased budgetary allocation for IT in health facilities. On behavioural factors, I recommend building the capacity of healthcare personnel in cloud paradigm, related skills and its benefits. I also suggest that future studies can improve on this work by diversifying the target population to include other healthcare workers to better understand use and acceptance of cloud computing for health service delivery.