THE IMPACT OF TELEHEALTH ON CHRONIC DISEASE MANAGEMENT IN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

Chronic diseases are widespread health problems that impact a substantial proportion of the global population. According to Cash (2019) chronic illnesses like diabetes, cardiovascular disease, asthma, and arthritis necessitate continuous management to provide the best possible health outcomes for individuals and alleviate the strain on healthcare systems (Basil et al., 2017). Nevertheless, proficiently handling chronic diseases poses several obstacles that healthcare professionals and patients must both overcome. The intricacies of chronic illnesses are not solely rooted in their multifactorial aetiology, but also in their enduring effects on physical, mental, and social well-being (Eriksen, 2019). Chronic ailments necessitate ongoing surveillance, adaptations to therapy, and adjustments to one's lifestyle in order to sustain stability and enhance the overall quality of life. In addition, the high occurrence of comorbidities introduces an additional level of intricacy, as patients may encounter the difficulty of simultaneously managing various disorders (Stephen, 2023). Given these difficulties, it is crucial to investigate inventive methods that can improve the management of chronic conditions.

Evidently, telehealth has shown significant growth in recent years, enabling more effective management of chronic health conditions. Telehealth is the provision of healthcare services from a distance using mobile technologies such as smartphone apps and the internet (Justin et al., 2021). Telehealth has been extensively utilized in recent years. Telehealth serves as a tool for managing chronic diseases, promoting high-quality care, and enhancing engagement between healthcare providers and patients (Alex et al., 2020). Telehealth enhances the potential for patient surveillance, therapy, and instruction. Telehealth emerged as a primary method of delivering healthcare during the epidemic, when in-person services were restricted. Liu et al (2023) asserts that telehealth was facilitated by exceptional legislative and monetary assistance, aimed at safeguarding providers and patients from the spread of the infection. Consequently, there was a rise in the demand for telehealth services. However, the utilisation of telehealth varied among different populations worldwide (Chang et al., 2021).

Nigeria encounters substantial obstacles in healthcare provision, namely in the management of chronic illnesses. The burden of chronic diseases among the population is exacerbated by factors such as a lack of healthcare infrastructure, a shortage of healthcare experts, and an unbalanced distribution of resources (Bode et al., 2023). Chronic disorders, including diabetes, hypertension, cardiovascular diseases, and chronic respiratory conditions, pose a substantial and increasing health burden in Nigeria (Fadeyi, 2023). These illnesses are major contributors to illness and death, putting a heavy burden on the healthcare system and affecting the well-being of numerous Nigerians. As per the World Health Organisation (WHO, 2023), chronic diseases contribute to 29% of total fatalities in Nigeria, with a significant section of the population experiencing one or more chronic ailments.

Telehealth, when compared to community care without digitalized technologies, has been shown to substantially decrease the time and expenses associated with monitoring health status (Bart et al., 2022). Additionally, there are reduced labour and location needs, as the presence of care leaders and offline involvement is no longer necessary (Chang et al., 2021). Other advantages include reduced hospitalisation rates and decreased human errors in data entry, as mobile devices can regularly and remotely record medical data (Patrice, 2022). Telehealth played a role in reducing patients' depression and anxiety during the COVID-19 pandemic by offering remote treatment and consultation options when in-person hospital visits were not possible (Chang et al., 2021). Telehealth appears to have been both efficient and successful. According to a study on patients' assessment of telemonitoring, over 90% of patients expressed satisfaction with the care they received and reported an increase in their understanding of their disease (Liu et al., 2023). Telehealth presents a hopeful resolution to tackle these difficulties. Therefore, the necessity for this investigation arises.

1.2 Statement of the Problem

Chronic diseases, such as diabetes, hypertension, and HIV/AIDS, pose a significant health burden in Nigeria. Limited access to specialists, high healthcare costs, and geographical disparities often hinder effective management. Telehealth, the use of technology to deliver healthcare remotely, offers a promising solution. However, the impact of telehealth on chronic disease management in Nigeria remains under-explored. According to Ekarika (2023) chronic diseases like diabetes, heart disease, and lung conditions are a growing concern globally, and Nigeria is no exception. Traditional healthcare delivery models often struggle to meet the needs of these patients, particularly due to limited access to specialists, high costs, and geographical barriers.

Femi (2023) states while telehealth holds promise, its effectiveness in managing chronic diseases within the Nigerian context remains unclear. Studies are needed to assess whether telehealth can improve clinical outcomes, medication adherence, and patient self-management skills for chronic conditions in Nigeria's specific healthcare environment. Telemedicine, the use of technology for remote healthcare delivery, has emerged as a potential solution. However, its effectiveness in managing chronic diseases remains a subject of debate even as Raju et al., 2022) claimed that t uncertainties surround the true impact of telemedicine on chronic disease management. 

While studies suggest potential benefits like improved medication adherence and patient self-management, a clear picture for the Nigerian context is lacking. We need research to assess whether telemedicine can effectively translate to improved clinical outcomes for chronic conditions within the realities of the Nigerian healthcare system. Remilekun (2023) states that patient acceptance and digital literacy pose further challenges to the adoption of telehealth in Nigeria. Remilekun (2023) states that the success of telehealth depends on both the readiness of healthcare professionals and the willingness and technological competence of patients. A considerable portion of the Nigerian population may face limited access to digital technologies, which poses a challenge to the widespread use of telehealth. Against this backdrop, the study evaluate the influence of telehealth on the management of chronic diseases in Nigeria.

Objectives of the study

The primary objective of this study is to critically evaluate the impact of telehealth on chronic disease management in Nigeria. Specific objectives of this study are to:

To assess the extent of Nigerians' knowledge on telehealth.

To assess the impact of telehealth on chronic disease management in Nigeria.

To identify the factors hindering telehealth adoption in management of chronic disease Nigeria 

To provide the strategies to promote effective telehealth adoption in management of chronic disease.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the extent of Nigerians' knowledge on telehealth?

What is the impact of telehealth on chronic disease management in Nigeria?

What are the factors hindering telehealth adoption in management of chronic disease Nigeria?

What are the strategies to promote effective telehealth adoption in management of chronic disease  Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The extent of Nigerians' knowledge on telehealth is low

Ha: The extent of Nigerians' knowledge on telehealth is high.

1.6 Significance of the study

In Nigeria, the care of chronic diseases such as diabetes, hypertension, and HIV/AIDS presents considerable difficulties due to the high prevalence of these conditions among a major section of the population. Telehealth, a method of providing healthcare services remotely using digital technologies, has the potential to revolutionise the management of chronic diseases by enabling faster interventions, increasing access to specialised care, and improving patient outcomes. This study will function as a key source of information for the general public, lawmakers, healthcare professionals, students, and academics.

The research of the influence of telehealth on chronic disease management in Nigeria holds multiple dimensions of importance. Chronic diseases are a primary reason for illness and death in the country, resulting in a substantial burden of sickness and healthcare expenses. This study has the potential to promote the overall well-being of individuals living with chronic diseases by investigating how telehealth interventions can support their treatment. It aims to improve the quality of care and reduce complications associated with these ailments.

Furthermore, the implementation of telehealth in the management of chronic diseases has the potential to overcome obstacles to healthcare access in Nigeria, specifically in distant or neglected regions where specialised medical attention may be scarce. Telehealth facilitates remote consultations, continuous monitoring, access to educational resources, and self-management options for patients with chronic illnesses, all within the convenience of their own homes.

Moreover, examining the influence of telehealth on the management of chronic diseases in Nigeria has wider ramifications for healthcare provision in the nation. This research showcases the efficacy of telehealth interventions in enhancing health outcomes and minimising healthcare disparities among individuals with chronic illnesses. Consequently, it can provide valuable insights for policy makers, healthcare investors, and capacity-building initiatives that aim to integrate telehealth into Nigeria's mainstream healthcare system.

Furthermore, this study is important because it has the potential to enhance our understanding of the role of telehealth in managing chronic diseases, provide evidence-based insights for healthcare practices, and inform future initiatives aimed at improving care delivery for individuals with chronic diseases in Nigeria. This research aims to examine the effects of telehealth on the management of chronic diseases. It has the potential to bring about beneficial transformations in healthcare provision, advance fairness in health outcomes, and enhance the overall well-being of individuals with chronic disorders in the country.

Moreover, future academics will employ it as a comprehensive analysis of the existing literature. As a result, other students who are interested in studying this subject will have the chance to use this work as existent information that may be subjected to critical examination. This study contributes to the academic discourse surrounding the impact of telehealth on chronic disease management in Nigeria. 

1.7 Scope of the study

Broadly, this study focuses to critically evaluate the impact of telehealth on chronic disease management in Nigeria. Specifically, this study seeks to assess the extent of Nigerians' knowledge on telehealth, the impact of telehealth on chronic disease management in Nigeria and assess the effect of telehealth on clinical outcomes. 

Further, this study will focus on identifying the factors hindering telehealth adoption in Nigeria and it also seeks to provide recommendations to overcome barriers and promote effective telehealth adoption in Nigeria’s primary healthcare system.

1.8 Limitations of the study

As is typical in any human endeavour, the researchers faced minor limitations during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data for impact of telehealth on chronic disease management in Nigeria. Hence, a significant investment of time and effort was necessary to locate appropriate materials, publications, or information and gather data.

 Moreover, this study is constrained by its small sample size and narrow geographic scope, namely focusing solely on Nigeria. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation. 

Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities.

1.9 Definition of terms

Telehealth: Telehealth involves the delivery of healthcare services using digital technologies and telecommunications.

Chronic disease: Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.

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