Background Information
In 2022, Saudi Arabia’s Ministry of Health launched the Seha Virtual Hospital in Riyadh to modernize the country’s healthcare industry. The main objective was to meet Saudi Arabia’s Vision 2030 initiative for the modern healthcare industry (Ministry of Health, 2023). The Hospital offers access to primary and specialized care through virtual medicine, utilizing advanced technologies such as the Internet of Things (IoT), artificial intelligence, and augmented reality (Ministry of Health, 2023). The country’s citizens no longer have to travel to various regional hospitals to consult with medical specialties, thus facilitating the accessibility of healthcare services to all populations. They also are not confined to regular hours of traditional physical clinics and can access healthcare specialties 24/7. They can share their vital signs, conduct tests, and take medical imagery through the virtual Hospital. The patients can also access various services, including emergency and critical consultations, medical support services, home care services, and specialized clinics. They can also access multidisciplinary committees for experts’ opinions and remotely monitor their conditions. Today, SVH is the largest virtual Hospital providing care in over 170 hospitals across Saudi Arabia (Ministry of Health, 2023). It also offers a wide range of services, over 23 specialties and 52 subspecialties (Ministry of Health, 2023). Therefore, SVH uses innovative approaches to deliver accessible and comprehensive healthcare services.
Problem Identification
Despite its innovative approach, SVH faces significant challenges. One core issue is low utilization due to public skepticism about digital healthcare and limited awareness of the SVH. A recent study of factors affecting utilization found that more than half, about 88.5 percent, of Saudi Arabians did not use the Seha application, the leading platform used to access services in Seha Virtual Hospital (Al-Kahtani et al., 2022, p.1610). Only 11.46 percent used the app (Al-Kahtani et al., 2022, p. 1610). The study further found a need for more awareness about the app as the most significant barrier among those who did not use it (Al-Kahtani et al., 2022, p. 1614). Tzeng et al. (2022) confirm that although the use of virtual health facilities increased 300 times during COVID-19, the majority (94.2 percent) of outpatient visits are still in person (p. 4). Therefore, the research confirms that virtual hospitals face significantly low utilization of their services. Low awareness and skepticism about the technology are two main factors for low utilization.
The low utilization of SVH can significantly affect Riyadh’s healthcare system and overall national healthcare goals. First, it directly challenges the aim of SVH to ensure healthcare accessibility and innovativeness. Therefore, it hinders realizing a modernized healthcare industry’s ambitious Vision 2030 goal. As many Saudi Arabians choose not to use SVH, Hospital’s efforts to increase efficiency and promote digital health solutions face significant barriers. Furthermore, patients using SVH have reported major benefits, including reduced waiting times, more accessible and better patient–physician communication, and access to accredited and professional doctors (Al-Kahtani et al., 2022, p. 1610). They also can contact a general practitioner at any time, save traveling time, and have the opportunity to ask for the cost and payment of treatment beforehand (Al-Kahtani et al., 2022, p. 1610). Users of the Seha App also have better experience with the healthcare system and fewer doctor visits than users of traditional services (Alharbi et al., 2021, p. 9). Non-users of the SVH miss out on all these benefits derived from the Hospital. Accordingly, the low utilization of SVH by the Saudi population undermines the country’s healthcare goals and prevents patients from accessing high-quality healthcare services provided by the Hospital.
Research Questions
This study will be guided by one primary research question broken down into two sub-research questions.
Primary Research Question
What educational information should Seha Virtual Hospital share with the public to increase knowledge and reduce skepticism about the platform, thus improving utilization of the Hospital among the Saudi population?
Sub-research Questions
- What does the Saudi Arabian population know and do not know about Seha Virtual Hospital?
- What are the components of targeted and effective educational campaigns to bridge knowledge gaps and misconceptions about Seha Virtual Hospital that increase user utilization?
Methodology
Study Design
This study will focus on Saudi Arabia’s residents’ knowledge gaps and misunderstandings surrounding Seha Virtual Hospital. Accordingly, a qualitative research methodology will be used to answer the primary and sub-research questions. The decision to use qualitative research is rooted in its ability to investigate individual experiences, viewpoints, attitudes, and beliefs about phenomena. Busetto et al. (2020) argue that qualitative methods help explain what, when, and why something occurs. The current research will have a qualitative design enveloping a framework within a response as to why the use of SVH is not highly used; it will also enhance the raising knowledge of the numerous misconceptions and knowledge-related variables that are attributed to the causing of low uptake of SVH. It is also intended to target the development of Seha Virtual Hospital (SVH) by analyzing the factors that can be used to build successful educational programs that will help solve the gaps and misunderstandings in the Hospital.
Data Collection Method
The leading tool for this research is an online form of a qualitative survey, with questions to be sent to several people, recorded in various parts of the country, using email lists, social networking mediums, healthcare forums, and other online options. It will aim to elicit the respondents’ detailed perceptions and misconceptions of SOGV. It shall contain both open-ended and closed-ended to get demographic and qualitative data. Age and gender – The age group participating and the gender will be recorded in the study. Open-ended questions are relied upon for in-depth responses from the participants, who will further comment on their viewpoints on SVH. The specific questions will cover why the participants have or have not used SVH until now, gaps in knowledge about the experiences they had, or the barriers/difficulties faced while using SVH. Online surveys have been selected due to their convenience. The study targets a large population, so it is convenient to send them online surveys. It can reach a wide range of participants in Saudi Arabia.
Cultural issues will be crucial in designing the surveys. Saudi Arabia is predominantly an Arabic country, with most residents practicing the Islamic religion. Cultural factors, including language, communication, and cultural attitudes toward technology, affect the level of experience in digital health programs (Alodhayani et al., 2021). Pelzang and Hutchinson (2018) point out that to ensure that the research approach is accurate and reliable, research methods have to be designed and refined in a way that fits the cultural setting (p.1). Thus, the survey will be in line with the cultural aspects of Saudi Arabia. For instance, the questions will be translatable to the Arab, the official language of Saudi Arabia, and respectful of Islamic principles.
Target Population
The target population will be individuals from all regions of Saudi Arabia. Using Saudi Arabian residents as the study population offers many benefits. For instance, they are the primary users of Seha Virtual Hospital and understand the motivations for using the Hospital and the drawbacks and knowledge gaps that prevent them from using it. Therefore, it aligns with the Hospital’s target population, ensuring that the research findings are relevant to the intended users. The population also has distinctive cultural and socio-economic contexts. These cultural factors influence healthcare-seeking behaviors and the utilization of virtual healthcare programs, and cultural-related factors such as language, communication, and cultural views on technology influence the experiences of digital health program interventions (Alodhayani et al., 2021).
Furthermore, the utilization of virtual healthcare services is influenced by demographic factors. In their investigation of patient views and preferences about telemedicine, Moulaei et al. (2023) discovered that demographic variables such as residency, sex, age, and educational attainment impacted the preference towards telemedicine (p.6). The study thus focuses on people from a variety of demographic backgrounds, taking into account variables like age, gender, geography, and educational attainment to provide a representative sample of the whole Saudi population
The participants will range in age from eighteen to sixty-five years old. Including a wide age range might provide crucial information on how different demographic groups use the Hospital, what knowledge gaps exist, and usage trends. According to research, people of various ages are only somewhat comfortable and familiar with virtual healthcare services. For example, telemedicine hospital visits are preferred by those between the ages of 18 and 27 more than by those 57 and older (Moulaei et al., 2023, p. 6). Adoption barriers specific to each age group include digital literacy, accessibility, usability, and privacy (Moulaei et al., 2023, p. 9).
Factors like educational attainment and geographic location may impact telemedicine initiatives like SVH adoption. Urban dwellers are much more expected to use telemedicine services than rural or far-dwelling counterparts (Moulaei et al., 2023, p. 6). Besides, areas around the world can limit technology and the internet, thus forming a ‘digital gap.’ In so doing, the present study will position itself in urban and rural areas to identify any ‘knowledge gap’ that may exist across different contexts. Another demographic factor is the level of education, which one anticipated would be associated with health literacy, albeit also related to technological literacy. The research will discuss the perceived ease of use of technology among participants from the entire educational level spectrum, from just having a high school certificate to having a Ph.D. Studies have shown that highly educated people, compared to the lower educated who are low technology skill bearers, tend to know more about the technology and are endowed with competencies and experiences in the operation of telemedicine platforms (Lee et al., 2022). It will ensure that people with varied educations are involved; hence, opinions are diverse.
Sampling Technique
Purposive enrolment and sampling of the research participants will be administered. This means that this approach typically characterizes participants with attributes interrelated to features and demands for the respective set goals of the study, of the researchers, and the targeted audience (Busetto et al., 2020, p. 7). The purposive sampling design assures that inclusion and selection to participate in the process incorporate only those meeting the set criteria of being inclusive of the defined demographic population. The strategy guarantees an exhaustive representation of the target population in terms of geography, gender, age, and education to indicate the Saudi population. It will ensure that the study’s findings can be applied to the entire population.
Sample Size and Recruitment Process
The online survey for the study will have a participant size of around 100–200. The sample size was chosen to represent the Saudi population as a whole, with just enough numbers to cater to the time and other constraints related to the investigation of a large population. It, however, does not amount to a meaningful fraction of the whole population in Saudi Arabia; instead, purposive sampling will ensure representation from so many demographic groups in the country. This would increase the general validity and generalization of the study. It sends out invitations as part of the recruitment process from forums like social media, neighborhood associations, and medical forums. The other half of the selection process is that willingness drives the selection of the participants. The other part of the selection process is to see that the factors relating to the demographics are balanced in the selection. The selected would then be provided with the link to the online survey.
Data Analysis
Data collected will be analyzed using appropriate qualitative data analysis methods. After the data collection, a phlegmatic analysis will be performed. The nature of the entered data will be highlighted from the themes; the patterns and highlights represent the data streaming from the respondents’ answers (Busetto et al., 2020, p. 5). Wayne Thematic analysis gracefully emanates the need to identify all narratives and the various perspectives from the given dataset coupled with the potential for conducting a high volume of responses through online surveys. This encompasses responses from each participant, understood in successive order, from one to the other, what they are replying to, and discern the trends and themes.
This is closely followed by the data coding, in which many drawn conclusions must be classified. In most cases, nearly every response would be labeled and used in more than one label as a short sentence or paragraph with a description (Busetto et al., 2020, para. 4). The NVivo software will be used to help in managing the qualitative analysis using it, which has been seen to be very handy in the sectioning of code (Busetto et al., 2020, para. 4). Coding will involve the use of coding software like the NVivo for the selection of the phrases extracted in addition to the sentences and paragraphs answering to the study questions. There will be a table representing the codes and what they represent in a manner that will give a clear understanding of the type of data used in the study. The following step will involve the searching for themes, which includes searching for patterns in addition to relationships in all parts. The following steps will involve bringing all the themes, including master, primary, and sub-themes, together to refine the data set (Dawadi et al., 2020, p. 67). The data will then be interpreted within each theme to answer the research questions. The final step is reporting the findings. Qualitative data is often presented using illustrative quotes and examples from the data (Busetto et al., 2020, p. 5).
Ethical Considerations
The study involves human subjects that require ethical considerations within the course of the study. Three ethical standards guide research involving human subjects: respect for persons, beneficence, and justice (White, 2020, p. 21). According to White (2020, 21), beneficence dictates that the study minimize potential damage and maximize benefits to participants, while the respect for persons principle calls for treating study participants as autonomous agents. According to the fairness principle, each research participant must receive an equitable share of the study’s risks and rewards (White, 2020, p. 21). This study will put these ethical principles into practice by obtaining participants’ informed agreement. Comprehensive details on the goals, methodology, and advantages and disadvantages of research participation will all be included in the consent form. Besides, it will be communicated that the participants, in the eventuality that they will participate in the research, will be participating in it voluntarily and are free to withdraw anytime. The ultimate goal is to make the participants start with informed and voluntary decisions when participating in the research.
Due to its online nature, there is a significant risk of hacking and data breaches. Some of the strategies will be used in the study to ensure that the privacy and confidentiality of the participants in information generation are observed to minimize the risks. The research will encourage the participants to use codes or even pseudonyms, and all the information collected will be presented using pseudonyms to ensure that the same are anonymous. All collected data will be held in privacy and guarded and only be used for this study.
Justification of the Methodology
The research design used in this study embodies a qualitative rather than a quantitative methodology because it aims to come out with an understanding of the different attitudes, opinions, and standpoints of Seha Virtual Hospital. The comparison of the two research approaches, either qualitative or quantitative, shows that a qualitative inquiry in such a research is strongly preferable. Busetto et al. (2020) argue that responsiveness, transparency, and adaptability are hallmarks of qualitative research, enabling participants to verbally communicate their viewpoints or experiences on a research issue instead of quantitatively (p.1, 2). Qualitative study ensures that the depth and complexity of people’s experiences and perspectives are noticed, which can happen with quantitative approaches. The perspectives and experiences of the people of Saudi Arabia are at the core of understanding the diverse utilization of SVH.
On the contrary, while quantitative studies have strengths in providing trends, patterns, and generalizing findings, they fail to capture the elements and complexities of human experience (Mohajan, 2021, p. 69). It is based on numerical data and statistical analysis that has the potential to disregard an individual’s experiences and viewpoints, including the depth and diversity of these experiences and opinions (Mohajan, 2021, p. 69). More importantly, quantitative research methods rely on standardized techniques and closed-ended questions that can fail to capture the full range of human experience and perspectives, in this case with Seha Virtual Hospital.
At the same time, there are various reasons qualitative surveys with open-ended questions were preferable over other qualitative data collection methods such as observation, interviews, and focus groups. One of the benefits of online surveys during research is their efficiency and cost-effectiveness compared to one-on-one interviews and focus groups (Braun et al., 2020, p. 649). A survey can reach many people using readily available and accessible online platforms such as social media. On the contrary, it is costly and time-consuming to interview a large population, such as the 100-200 participants targeted in this study.
Conclusion
In conclusion, low utilization is a significant problem that affects Seha Virtual Hospital. Lack of knowledge and skepticism about SVH by the public are the root causes of the low utilization. This study aims to eliminate these underlying causes to ensure high utilization of the SVH. It specifically aims to investigate educational information that can be shared with the public to increase their knowledge about SVH and ultimately promote the utilization of the Hospital. The study will explore the knowledge gaps and misconceptions surrounding SVH and how this information can be used to develop targeted and effective educational campaigns that bridge knowledge gaps and misconceptions about Seha Virtual Hospital and increase user utilization of the Hospital. The study targets the primary users of the Hospital, the Saudi Arabian residents, who will provide information about what they know and do not know about SVH. Qualitative methods will be used with online qualitative surveys as the data collection tool due to their ability to obtain individual’s perspectives on what they know and do not know about SVH. Ultimately, identifying and addressing the knowledge gaps will eliminate the low utilization of SVH, promoting SVH as a critical healthcare delivery platform.
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