title: Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers.
abstract: BACKGROUND
  Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging 'post-conflict' contexts. However, analyses on the adoption of technology for health (that is, 'e-health') and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations.
  
  
  METHODS
  This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger's diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis.
  
  
  RESULTS
  All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination.
  
  
  CONCLUSIONS
  Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users.
authors.affiliation: King's International Development Institute, King's College London, Strand, London, UK. aniek.woodward@kcl.ac.uk.
authors.forename: Aniek
authors.initials: A
authors.lastname: Woodward
authors.forename: Molly
authors.initials: M
authors.lastname: Fyfe
authors.forename: Jibril
authors.initials: J
authors.lastname: Handuleh
authors.forename: Preeti
authors.initials: P
authors.lastname: Patel
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.forename: Andrew
authors.initials: A
authors.lastname: Leather
authors.forename: Alexander
authors.initials: A
authors.lastname: Finlayson
mesh_terms: D001291:Attitude of Health Personnel; D032882:Comprehension; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D004059:Diffusion of Innovation; D015730:Djibouti; D034742:Electronic Mail; D005260:Female; D006801:Humans; D020407:Internet; D007407:Interviews as Topic; D007988:Liberia; D008297:Male; D008877:Middle East; D036301:Qualitative Research; D012807:Sierra Leone; D014857:Warfare
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