An assessment of the level of awareness of e-health among Saudi medical students

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Alhassan, Sami Al-Nasser, Mostafa A. Abolfotouh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.9931/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Previous studies described the levels of awareness of patients and health care providers on e-health in general and on e-health for a certain condition/disease. However, none of these studies was conducted in Saudi Arabia. The aims of this study were 1)To determine the levels of knowledge, attitude and practice of medical students on e-health, and 2) To identify the predictors of e-health practice among medical students. Methods: A cross-sectional survey of 440 medical students at the college of medicine, King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, was conducted, during October/November 2019, using a previously validated questionnaire, to assess: (1) knowledge in three domains; e-health definition (13 statements), fields of application of e-health (8 statements), methods of using e-health (7 statements), (2) attitude toward using e-health (8 statements) and (3) reported practice of e-health in medical training (5 statements). A scoring system was used to calculate the total and percentage score of knowledge, attitude and practice for each student. Multiple regression analysis was applied to identify predictors of e-health practice. Significance was considered at p<0.05. Results: Of the 440 medical students surveyed, the majority were females (55.7%), of stream type1 (79.8%) and from families whose monthly income was more than 10,000SR (82.8%). Overall knowledge about e-health was unsatisfactory (PMS=71.62%), with only 43.6% of all students reporting satisfactory level. However, this level was satisfactory for fields of application (Percentage mean score-PMS=76.43%) and unsatisfactory for definition of e-health (PMS=70.69%) and methods of its use (PMS=65.69%) domains. Overall attitude towads e-health use was positive (PMS=82.32%), with nearly three-quarters of all students (73.4%) reporting positive attitude. Generally, good level of practice of e-health was reported by students (PMS=84.27%), with more than three-quarters of medical students (78.4%) reporting good practice. Adjusting for age, gender, stream, educational grade and family monthly income, good practice was significantly predicted with higher knowledge (t=2.219, p=0.027) and attidude (t=2.114, p=0.035) scores. Conclusion: This study provides basic information regarding medical students’ knowledge, attitude, and practice on e-health. More resources should be directed to elevate medical students’ knowledge and to motivate them to practice e-health using the available tools. Internal Medicine E-health Knowledge E-health perception E-health application E-health practice IT methods medical informatics Background Information technology (IT) methods in healthcare are well known to provide clinicians with health-related information and tools, such as clinical decision supportive systems. These softwares are expected to improve patient care and minimize medical errors.[1]. In other words, the rising demand to improve the healthcare processes via technical products and services has led to a tremendous development of wireless technologies worldwide [2]. E-health has been discussed widely in literature, workshops, scientific meetings, and the popular press. At the end of 2011, studies on e-health accounted for 659 research data in PubMed, 18,600 in Google scholar, 2,420,000 in Yahoo search and 29,500,000 in Google.com [3]. Globally, the functions of e-health services have been expanding rapidly, with the aim to improve health, reduce costs of healthcare, increase equity and quality of healthcare, and improve communication between healthcare providers and patients [4]. There are many definitions of e-health, however no universal agreement is there on any of them [3]. Moreover, there remains a lack of consistency in the use of the e-health research [4]. A broad range of digital technologies and interventions used by stakeholders in many diverse settings have been described by e-health[5,6]. The World Health Organization defines e-health as “the combined use of electronic communication and information technology in the health sector” [7]. E-health was also defined as internet-based health-related information seeking and developing to support health services locally, regionally, and globally [8]. E-health was recently defined by Shaw et al [9] as an emerging field in the intersection of medical informatics, public health, and business. The term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked global thinking, to improve healthcare locally, regionally, and worldwide by using information and communication technology. Previous studies described the levels of awareness of patients and health care providers on e-health in general and on e-health for a certain condition/disease [10,11]. All these studies revealed modest levels of awareness of e-health. However, none of these studies was conducted in Saudi Arabia. Thus, the aim of the present study is to determine e-health awareness among Saudi medical students at the college of medicine, King Saud bin-Abdulaziz University for Health Sciences (KSAU-HS).through the following objectives: 1)To determine the levels of knowledge of medical students about e-health, 2) To determine the level of attitude towards e-health use in medical practice, 3) To determine the field of practice of e-health among medical students, and 4) To identify the predictors of e-health practice among medical students. Methods Study Setting College of Medicine (COM-R), King Saud bin-Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. COM-R admits Saudi national mainly and awards a bachelor of medicine to two educational streams. Stream 1 has secondary school graduates and follows what is known as the conventional program. Stream 2 allows holders of Bachelor of Science degrees. These students follow what is known as the Graduate Entry Accelerated Program. This program is the first of its kind in the kingdom of Saudi Arabia and is designed to expedite the process of graduation by recognizing these students’ previous learning, thus, helping increase market supply of physicians faster [12]. Medical students of both sexes, in both steams, during the study period will make the target of this study. Study Subjects The study population is the students of College of Medicine (COM-R), King Saud bin-Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. Study Design A cross-sectional study to assess the levels of knowledge, attitude and practice of medical students on e-health in medical field. Students will be contacted once Sample size and sampling technique: Assuming a prevalence of 50% satisfactory level of knowledge of e-health among students, a confidence interval of 95%, and a margin of error of 5%, the estimated sample size was 384 students. To compensate for non-response of 20%, a total of 460 questionnaires were distributed to students of different educational grades, using an equal allocation method of sampling. Data Collection A previously validated self-administered questionnaire [11] was utilized to assess awareness of medical students on e-health. Based on test re-test reliability, correlations for overall knowledge score, attitude score and practice score were: r = 0.89, r = 0.80 and r= 0.46 respectively. Internal consistency was high [Average Cronbach’s α = 0.80]. Knowledge: Knowledge about e-health was assessed in terms of: what is e-health, where and when to apply e-health. Factual statements were responded by “yes”, “No” or “Do not know”. Knowledge score was calculated as follows: 1 point for correct answer and 0 point for don’t know & wrong answer. The total score for each student was calculated by summing scores for all responses, and then a percentage score was calculated. This percentage score was categorized into satisfactory (≥75%) and unsatisfactory (<75%). Attitude: Attitude towards e-health was assessed in terms of; interest in receiving e-health training, use of patient electronic medical records in health settings, use of internet in health service/research, does the use of computer by physician save time, should computer be used in all health centers, does the use of computer relieve pressure on hospital outpatients, how it is difficult to use the internet in the field of health. Attitudinal statements were responded to by “strongly agree”, “agree”, “not sure”, “disagree” or “strongly disagree”. Attitude score was calculated by using 5-point Likert scale ranging from 0 to 4 points; 4 points for strongly agree on positive attitude sentence, to 0 point for “strongly disagree”. The total score for each student was calculated by summing scores for all responses, and then a percentage score was calculated. This percentage score was categorized into positive (>75%), neutral (50-75%) and negative(<50%) attitudes. Practice of e-health: Practice of students was assessed as regards: participation in video conference, use of the internet for health related information, and use of patient electronic records, program, and. Statements related to practice will be responded to by “No” or “Yes”. Practice score was calculated by giving a score 1 for practicing and 0 for non-practicing. The total score for each student was calculated by summing scores for all responses, and then a percentage score was calculated. This percentage score was categorized into good (>75%), average (50-75%) and poor (<50%) levels. The questionnaire includes questions on personal characteristics and previous experience in computer use. The investigator distributed an anonymous self administered English based questionnaire inside an envelope, to ensure confidencialy, with a cover letter. Each envelope was handed to the student in his/her classroom. Students were expected to fill the questionnaire and return it in the envelope sealed with no identifiers. The cover letter served as the front page that explained the purpose of the study and invited the student to particpate voluntarily. Agreement to fill the questionnaire was considered as a consent. Data analysis SPSS software Ver. 25 was used for data entry and analysis. Descriptive statistics such as mean score and standard deviation, as well as frequency and percentages of all independent variables (age, gender, educational grade, etc…) were used. Responses were scored by frequency and percentage then converted to percentage mean scores, then transformed to qualitative data as mentioned previously. Analytic statistics were applied to test associations of the student’s practice, attitude and knowledge with the personal characteristics. Chi-square test will be used for qualitative data and student t-test, ANOVA for quantitative data. To predict the significant predictors of student’s practice, multiple regression analysis was be applied Significance will be considered at p-value <0.05. Ethical Considerations The survey was introduced to the students in an envelope, with a cover letter, explaining the aims of the study. Participation in the study was voluntary. The envelope was not recognized by the instructors. The cover letter assured the students that their feedback would not affect their academic evaluation. Agreement to participate was considered as a consent. The collection of data sheets was framed with confidentiality in a matter where the student’s name, contact information, or badge number would not be identified or traced by anyone. This study was approved by the IRB of the Ministry of National Guard-Health Affairs [Ref. #SP18/488/R]. Results A total of 440 medical students were surveyed for their levels of awareness of e-health, the majority were females (55.7%), of stream 1 (79.8%) and of families whose monthly income was more than 10,000 SR (82.8%). Those students were distributed nearly equally on the four educational grades. Table 1 shows the distribution of students according to their responses to factual statements on knowledge about e-health. With regard to the definition of e-health, the majority of students responded correctly to 11 statements, and incorrectly to 2 statements; they incorrectly agreed that e-health is “patient examination through the use of internet” (65%) and “organization of health care for patients, including surgical operations, via the internet” ( 58.6%). With regard to the fields of application of e-health, the majority of students correctly agreed on the follwing applications; clinical (80.5%), educational (89.5%), administrative (74.5%), policy-making ( 57.8%) and research (83.6%). However, the majority incorrectly agreed that video games and watching entertainment movies are applications of e-health (74.5%) & 73.9% respectively). Regarding the methods of using e-health, the majority of the students correctly agreed that visual communication (74.7%), internet (91.3%) and e-mail (81.1%) were methods of e-health, while around one-half of them incorrectly agrred on paper-post (44.7%), fax (51.4%) and landline telephone (50.2%) as methods of using e-health. The percentage mean scores for the three domains of knowledge about e-health, namely e-heath definition (70.69%, unsatisfactory level of knowledge), fields of its application (76.43%, satisfactory level of knowledge) and methods of its use (65.69%, unsatisfactory level of knowledge). The percentage mean score of overall knowledge about e-health was 71.62% ( unsatisfactory level). Only 43.6% of all students reported satisfactory level of overall knowledge about e-health,Table 1. Table 2 shows the responses of medical students to 8 attitudinal statements on using e-health. Generally speeaking, the majority of students responded positively to the statements. However, less than two-thirds of them agreed or strongly agreed that “doctor use of computer during patient interview saves time” (64.9%), and less than two-thirds disagreed that “the use of internet in the field of health is difficult”(63.2%). The percentage mean score of attitude towards the use of e-health was 82.32% (positive attitude). Nearly three-quarters of all students reported positive attitude to e-health use (73.4%), with only 2% of them who reported a negative attitude. Table 3 shows the forms of practice of e-health during medical training as reported by the medical students.Using electronic medical records and searching for health information ranked first (92.6% & 91.7% respectively), followed by using e-health in medical training (85.2%), while attending e-health traing programs and participation in visual communication came last (77.5% & 74.1% respectively). The percentage mean score of overall practice was 84.27% (good level of practice). More than three-quarters of medical students (78.4%) reported good practice, only 9.1% of them reported poor practice. Table 4 shows the results of a multiple regression analysis of e-health practice among medical students and the independent variables; gender, age, educational grade, stream type, monthly income attitude score and knowledge score. It shows that higher e-health practice score was significantly predicted by higher knowledge (t=2.219, p=0.027) and attitude (t=2.114, p=0.035) scores, after adjusting for other variables in the regression model. Discussion It is believed that the use of information and communication technologies (ICT) can be a potential alternative to address some of the daunting problems in healthcare sector in developing countries. Knowledge, skills and acceptance of e- health by health professionals are essential attributes of a successful integration of this new tool. In a study on medical students in Sri Lanka [13], fifty one percent rated their knowledge of e-health applications as minimal, and 43% were familiar with the term e-health. This finding was comparable with the findings of our study, where only 43.6% of all students reported satisfactory level of overall knowledge about e-health. This lack of knowledge on e-health could be attributed to the absence of formalized e-health educational components in the medical curriculum. On the other hand, nearly three-quarters of all students reported positive attitude to e-health use, in our study. This finding was in agreement with the finding of a study in Sri Lanka [13], where over 80% believed that e-health had an important role to play in the current and future health sector, and another study in Bangladesh, where the majority of students believed the internet was useful for helping to make health decisions [14]. Medical educators recognize that electronic health record (EHR) proficiency is a skill required for students to succeed after medical school [15]. Medical students need hands-on experience documenting clinical encounters as well as entering orders to prepare for residency and become competent physicians. A 2012 survey of clerkship directors by the Alliance for Clinical Education and the University of Michigan Medical School also showed the limited scope of EHR use by students [16]. In the study of Sri Lanka, respondents had very poor access to computers and internet use was rare. In Bangladesh study of e-health literacy among university students [14], the majority of students used the internet to find health information, although a little over half of students were competent in computer. However, in the present study, using electronic medical records and searching for health information, and using e-health in medical training were reported by almost all students, and attending e-health traing programs and participation in visual communication were reported by three-quarters of students, with an overall good level of practice. It has been reported that some factors such as; level of education [14,17-20], electronic device use[14,19], advanced age [14,19] and gender [19] influenced the use of internet for health-related information [19]. In Bangladesh study [14], e-health literacy was found to be influenced by age, education and marital status, computer knowledge used to search for health information. In the present study, e-health practice score was significantly predicted by both the knowledge and attitude scores, after adjusting for age, gender , stream type, educational grade and family monthly income. This finding reflect the need for an educational e-health program for medical students. This stdy has some limitations. Conduction of this survey on the medical students of one university would not allow for generalizing its conclusion. However, this study may open the door for investigating the challenges for upgrading the knowledge on e-health and the use of its applications by medical students in Saudi Arabia. The cross sectional design of the study would not guarantee the causal association between the practice of e-health and the predictors of this practice among students. Longtudinal studies are recommended in the future to control for this limitation. Conclusion Overall knowledge of students about e-health was less than satisfactory, while their attitudes were satisfactory and their practices were good. Students’ practice of e-health was significantly predicted by their levels of knowledge and attitude on e-health. This study could provide basic information regarding medical students’ knowledge, attitude, and practice on e-health. More resources should be directed to elevate medical students’ knowledge and to motivate them to practice e-health using the available tools. It would help policy makers and education planners in developing appropriate evidence-based strategies and curriculum in medical and health institutes for successful implementation and use of e-health systems. Implementation of formalized e-health educational copmponents in the medical curiculum is necessary, to provide knowledge about the fundamentals of e-health, basic concepts and various applications . Such education must also include a practical component to provide medical students with necessary hands-on skills. Educational simulations without prior EHR training help students develop EHR competence [21]. List of abbreviations PMS__ percentage mean score, KAMC—King Abdulaziz Medical city, MNG-HA—Ministry of National Guard-Health Affairs, IRB---Institutional Review Board. Declarations Ethics approval and consent to participate This study was approved by the institutional review board of the Ministry of National Guard-Health Affairs in Riyadh, Saudi Arabia [Ref# SP18/488/R]. Consent to publish Not applicable Availability of data and materials Most of the data supporting our findings is contained within the manuscript, and all others, excluding identifying/confidential respondent data should, will be shared upon request. Competing interest The authors declare that they have no competing interests. Funding None Author contributions MAA and BD contributed to concept development, manuscript preparation and final writing, BD and AIA and SN contributed to concept development, research proposal writing and data collection, analysis and interpretation, and manuscript drafting. All authors read and approved the final manuscript. Acknowledgement This study was supported by King Abdullah International Medical Research Center, under the supervision of Department of Medical Education, College of Medicine, King Saud bin-Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia. References 1. Putzer, G., & Park, Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspectives in Health Information Management 2010 Jan 1;7:1b. 2. Wan Ismail, W., Hong Kit, P., Buhari, N., & Muzaini, A. Acceptance of Smartphone in Enhancing Patient-Caregivers Relationship. J. Technol. Manag. Innov. 2012, Volume 7, Issue 3, pp71-9. 3. Showell C, Nohr C. How should we define eHealth, and does the definition matter? Stud Health Technol Inform 2012; 180:881-4. 4. Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, et al. The impact of eHealth on the quality and safety of health care: A systematic overview. PLoS Med 2011; 8(1):e1000387. https://doi.org/10.1371/journal.pmed.1000387 5. Cunningham S, Wake D, Waller A, Morris A. Definitions of eHealth. In: Gaddi A, Capello F, Manca M (eds). eHealth, Care and Quality of Life. Milan: Springer 2014:15-30. 6. Gaddi A, Capello F. The debate over eHealth. In: Gaddi A, Capello F, Manca M (eds). eHealth, Care and Quality of Life. Milan, Springer, 2014:1-13. 7. WHO. Building Foundation for eHealth, Geneva,2006. http://www.who.int/goe/publications/bf_FINAL.pdf 8. Ilic D. The role of the internet on patient knowledge management, education, and decision-making. Telemed J E-Health 2010; 16(6):664-9. 9. Shaw T, McGregor D, Brunner M, Keep M, Janssen A, Barnet S. What is e-Health (6)? Development of a conceptual model for e-Health: qualitative study with key informants. J Med Internet Res. 2017 Oct 24;19(10):e324. doi: 10.2196/jmir.8106. 10. Hofstede J, de Bie J, van Wijngaarden B, Heijmans M. Knowledge, use and attitude toward eHealth among patients with chronic lung diseases. Int J Med Inform 2014; 83(12): 967-74. 11. Alkhatlan H, Almutairi B, El-Shazly M. Knowledge, attitude and practice of primary health care providers regarding e-health: A validation study. Greener J Med SCIENCES (GJMS) 2016; 6(1): 18-24. 12. Abolfotouh MA, Al Saleh SA, Mahfouz AA, Abolfotouh SM, Al Fozan HM. Attitudes of Saudi nursing students on AIDS and predictors of willingness to provide care for patients in central Saudi Arabia. SAGE Open 2013 . DOI: 10.1177/2158244013499163 13. Edirippulige S1, Marasinghe RB, Smith AC, Fujisawa Y, Herath WB, Jiffry MT, Wootton R. Medical students' knowledge and perceptions of e-health: results of a study in Sri Lanka. Stud Health Technol Inform. 2007;129(Pt 2):1406-9. 14. Islam MM, Touray M, Yang HC, Poly TN, Nguyen PA, Li YJ, Syed Abdul S. E-Health Literacy and Health Information Seeking Behavior Among University Students in Bangladesh. Stud Health Technol Inform. 2017;245:122-125. 15. Hersh WR, Gorman PN, Biagioli FE, Mohan V, Gold JA, Mejicano GC. Beyond information retrieval and electronic health record use: Competencies in clinical informatics for medical education. Adv Med Educ Pract. 2014;5:205–212. 16. Hammoud MM, Margo K, Christner JG, Fisher J, Fischer SH, Pangaro LN. Opportunities and challenges in integrating electronic health records into undergraduate medical education: A national survey of clerkship directors. Teach Learn Med. 2012;24:219–224. 17. Neter E, Brainin E. eHealth literacy: extending the digital divide to the realm of health information. Journal of medical Internet research. 2012 Jan;14(1). 18. Brown CA, Dickson R. Healthcare students'e-literacy skills. Journal of allied health. 2010 Sep 1;39(3):179-84. 19. Tennant B, Stellefson M, Dodd V, Chaney B, Chaney D, Paige S, Alber J. eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults. Journal of medical Internet research. 2015 Mar;17(3). 20. Powell J, Inglis N, Ronnie J, Large S. The characteristics and motivations of online health information seekers: cross-sectional survey and qualitative interview study. Journal of medical Internet research. 2011 Jan;13(1). 21. March CA, Steiger D, Scholl G, Mohan V, Hersh WR, Gold JA. Use of simulation to assess electronic health record safety in the intensive care unit: A pilot study. BMJ Open. 2013;3:e002549. Tables Table 1. Response of medical students to factual statements on e-health What is e-health? Wrong (%) Correct (%) 1. Health Care Online 25.4 74.6 2. Use of the Internet and other technology to improve health 9.1 90.9 3. Entertainment between working hours* 27.8 72.2 4. Shopping* 26.0 74.0 5. Social communication between friends* 28.9 71.1 6. Control of medicine supply for patients through electronic software 29.4 70.6 7. Provide medical advice to the patient through the use of the Internet 23.3 76.7 8. Patient examination through the use of the Internet 65.0 35.0 9. Organization of health care for patients, including surgical operations via the Internet 58.6 41.4 10. Provide electronic patient records 19.6 80.4 11. Monitor the health of the patient through electronic technologies 22.1 77.9 12. Education of doctors through the use of electronic sources 27.9 72.1 13. Exchange of medical information and medical communication between doctors 25.5 74.5 Percentage mean score 70.69 [unsatisfactory] Fields of applications of e-health No (%) Yes (%) 1. Clinical 19.5 80.5 2. Educational 10.5 89.5 3. Administrative 25.5 74.5 4. Policy maker 42.2 57.8 5. Research 16.4 83.6 6. Video games 25.5 74.5 7. Watching entertainment movies 26.1 73.9 Percentage mean score (%) 76.43 [satisfactory] Methods of using e-health No (%) Yes (%) 1. Visual communication 25.3 74.7 2. Paper post 55.3 44.7 3. Fax 48.6 51.4 4. Internet 8.7 91.3 5. Land line telephone 49.8 50.2 6. E-mail 18.9 81.1 Percentage mean score (%) 65.69 [unsatisfactory] Overall Knowledge (%) Satisfactory 43.6 Unsatisfactory 56.4 Overall percentage mean score (%) 71.62 [unsatisfactory] Table 2. Response of medical students on attitudinal statements on using e-health Statements SA (%) AG (%) NS (%) DA (%) SD (%) 1. I think that the use of the Internet is useful in the field of health 85.1 12.0 2.5 0.2 0.2 2. I think that the use of the Internet in the field of health is difficult 5.8 7.1 24.0 36.9 26.3 3. I think that doctor use of computer during patient interview saves time 37.2 27.7 22.4 8.3 4.4 4. I think doctor use of computer must be applied at all health centers 56.4 26.8 12.9 3.7 .2 5. I think that the use of computer relieves pressure on hospital outpatient 46.8 30.3 18.1 2.8 2.1 6. I think that patient's electronic file must be applied in all centers and hospitals 73.9 16.9 7.9 1.2 0.1 7. I think e-Health can be used to increase awareness and control of communicable diseases 61.6 25.5 11.5 1.4 0.0 8. I am interested in receiving training for the use of electronic health 57.0 26.4 12.2 3.0 1.4 Overall attitude levels (%): Positive Neutral Negative 73.4 24.6 2% SA---strongly agree, AG----agree, NS---not sure, DA---disagree, SD---strongly disagree. Table 3. Practice of e-health during medical training among medical students Practice No (%) Yes (%) Searching for health information 8.3 91.7 Using electronic medical records during medical training 7.4 92.6 Attending e-health training programs 22.5 77.5 Using e-health in medical training 14.8 85.2 Participating in visual communication during medical training 25.9 74.1 Overall practice levels (%): Good 78.4 Average 12.5 Poor 9.1 Overall percentage mean score (%) 84.27 [Good] Table 4. Predictors of good e-health practice among medical students Independent variables B SE t-value p-value Constant 80.278 29.109 2.758 0.006 Gender 0.628 2.582 0.243 0.808 Age -1.578 1.166 -1.353 0.177 Educational grade 1.491 1.542 0.967 0.334 Stream -8.002 5.367 -1.491 0.137 Monthly income 3.722 2.251 1.654 0.099 Attitude score 0.229 0.108 2.114 0.035** Knowledge score 0.176 0.079 2.219 0.027** **---statistical significance. Supplementary Files supplement1.doc Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1088","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":90947,"identity":"e317555d-fed9-4473-ae43-2f68aa1aa216","order_by":1,"name":"Bader Aldebasi","email":"","orcid":"","institution":"King Abdullah International Medical Research Center/King Saud bin-Abdulaziz University for Health Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bader","middleName":"","lastName":"Aldebasi","suffix":""},{"id":90948,"identity":"5dfcf631-b01e-4baa-ab90-e7434dcef3d5","order_by":2,"name":"Abdulaziz I. Alhassan","email":"","orcid":"","institution":"Department of Medical Education, College of Medicine, King Saud bin-Abdulaziz University for Health Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abdulaziz","middleName":"I.","lastName":"Alhassan","suffix":""},{"id":90949,"identity":"703d03a9-1d9a-44e8-b758-0d64f5b0f3a5","order_by":3,"name":"Sami Al-Nasser","email":"","orcid":"","institution":"Department of Medical Education, College of Medicine, KIng Saud bin-Abdulaziz University of Health Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sami","middleName":"","lastName":"Al-Nasser","suffix":""},{"id":90950,"identity":"a19c6921-defb-4ab1-96ad-20ca35cf5bf9","order_by":4,"name":"Mostafa A. Abolfotouh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYFACHgaGBzZgBuMDEMlHlJaENAYJIIPZAMRlI0ULmwSIT1CLbvvZgw8SEmzq+CVyj1V+zbGTYWNgfvjoBh4tZmfykg0SEtIkJGfkpd2W3ZYMdBibsXEOPi0HcswkEn8cljC4kWN2W3IbM1ALD5s0Xi3n35hJJCRAtBRLbqsnQgtQJVwL48dth4nR8g7sF8mZPW+MpRm3HedhYybkl/O5Bx98SLDh52fPMfz4c1u1PT9788PH+LSgAGYeMEmschBg/EGK6lEwCkbBKBgxAAD7O0Q05ZVT/QAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-3787-429X","institution":"King Abdullah International Medical Research CEnter/ King Saud bin-Abdulaziz University for Health Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mostafa","middleName":"A.","lastName":"Abolfotouh","suffix":""}],"badges":[],"createdAt":"2019-05-28 14:17:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.2.9931/v1","doiUrl":"https://doi.org/10.21203/rs.2.9931/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13467620,"identity":"f12e1565-accb-4098-ab82-21a9a2b473bd","added_by":"auto","created_at":"2021-09-16 20:55:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":404097,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1088/v1/c8ec153a-7059-45c3-aa00-7d125d71c109.pdf"},{"id":2613271,"identity":"bce5ce9e-3d3c-4ce1-8f65-512641431b7e","added_by":"b0e95e7b-bbe0-4bfd-bf12-a325b7db0c3e","created_at":"2020-09-25 20:53:30","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":80896,"visible":true,"origin":"","legend":"","description":"","filename":"supplement1.doc","url":"https://assets-eu.researchsquare.com/files/rs-1088/v1/supplement_1.doc"}],"financialInterests":"","formattedTitle":"An assessment of the level of awareness of e-health among Saudi medical students","fulltext":[{"header":"Background","content":"\u003cp\u003eInformation technology (IT) methods in healthcare are well known to provide clinicians\n with health-related information and tools, such as clinical decision supportive systems.\n These softwares are expected to improve patient care and minimize medical errors.[1].\n In other words, the rising demand to improve the healthcare processes via technical\n products and services has led to a tremendous development of wireless technologies\n worldwide [2].\u003c/p\u003e\n \n\n \n\u003cp\u003eE-health has been discussed widely in literature, workshops, scientific meetings,\n and the popular press. At the end of 2011, studies on e-health accounted for 659 research\n data in PubMed, 18,600 in Google scholar, 2,420,000 in Yahoo search and 29,500,000\n in \u003ca href=\"http://Google.com\"\u003eGoogle.com\u003c/a\u003e [3]. Globally, the functions of e-health services have been expanding rapidly, with\n the aim to improve health, reduce costs of healthcare, increase equity and quality\n of healthcare, and improve communication between healthcare providers and patients\n [4].\u003c/p\u003e\n \n\n \n\u003cp\u003eThere are many definitions of e-health, however no universal agreement is there on\n any of them [3]. Moreover, there remains a lack of consistency in the use of the e-health\n research [4]. A broad range of digital technologies and interventions used by stakeholders\n in many diverse settings have been described by e-health[5,6]. The World Health Organization\n defines e-health as “the combined use of electronic communication and information\n technology in the health sector” [7]. E-health was also defined as internet-based\n health-related information seeking and developing to support health services locally,\n regionally, and globally [8].\u003c/p\u003e\n \n\u003cp\u003eE-health was recently defined by Shaw et al [9] as an emerging field in the intersection\n of medical informatics, public health, and business. The term characterizes not only\n a technical development, but also a state-of-mind, a way of thinking, an attitude,\n and a commitment for networked global thinking, to improve healthcare locally, regionally,\n and worldwide by using information and communication technology. \u003c/p\u003e\n \n\n \n\u003cp\u003ePrevious studies described the levels of awareness of patients and health care providers\n on e-health in general and on e-health for a certain condition/disease [10,11]. All\n these studies revealed modest levels of awareness of e-health. However, none of these\n studies was conducted in Saudi Arabia. Thus, the aim of the present study is to determine\n e-health awareness among Saudi medical students at the college of medicine, King Saud\n bin-Abdulaziz University for Health Sciences (KSAU-HS).through the following objectives:\n 1)To determine the levels of knowledge of medical students about e-health, 2) To determine\n the level of attitude towards e-health use in medical practice, 3) To determine the\n field of practice of e-health among medical students, and 4) To identify the predictors\n of e-health practice among medical students.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch4\u003eStudy Setting\u003c/h4\u003e\n \n\u003cp\u003eCollege of Medicine (COM-R), King Saud bin-Abdulaziz University for Health Sciences,\n Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. COM-R admits Saudi\n national mainly and awards a bachelor of medicine to two educational streams. Stream\n 1 has secondary school graduates and follows what is known as the conventional program.\n Stream 2 allows holders of Bachelor of Science degrees. These students follow what\n is known as the Graduate Entry Accelerated Program. This program is the first of its\n kind in the kingdom of Saudi Arabia and is designed to expedite the process of graduation\n by recognizing these students’ previous learning, thus, helping increase market supply\n of physicians faster [12]. Medical students of both sexes, in both steams, during\n the study period will make the target of this study.\u003c/p\u003e\n \n\n \n\u003ch4\u003eStudy Subjects\u003c/h4\u003e\n \n\u003cp\u003eThe study population is the students of College of Medicine (COM-R), King Saud bin-Abdulaziz\n University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh,\n Saudi Arabia. \u003c/p\u003e\n \n\n \n\u003ch4\u003eStudy Design \u003c/h4\u003e\n \n\u003cp\u003eA cross-sectional study to assess the levels of knowledge, attitude and practice of\n medical students on e-health in medical field. Students will be contacted once\u003c/p\u003e\n \n\n \n\u003ch4\u003eSample size and sampling technique:\u003c/h4\u003e\n \n\u003cp\u003eAssuming a prevalence of 50% satisfactory level of knowledge of e-health among students,\n a confidence interval of 95%, and a margin of error of 5%, the estimated sample size\n was 384 students. To compensate for non-response of 20%, a total of 460 questionnaires\n were distributed to students of different educational grades, using an equal allocation\n method of sampling. \u003c/p\u003e\n \n\n \n\u003ch4\u003e Data Collection \u003c/h4\u003e\n \n\u003cp\u003eA previously validated self-administered questionnaire [11] was utilized to assess\n awareness of medical students on e-health. Based on test re-test reliability, correlations\n for overall knowledge score, attitude score and practice score were: r = 0.89, r =\n 0.80 and r= 0.46 respectively. Internal consistency was high [Average Cronbach’s α = 0.80]. \u003c/p\u003e\n \n\n \n\u003cp\u003eKnowledge: Knowledge about e-health was assessed in terms of: what is e-health, where\n and when to apply e-health. Factual statements were responded by “yes”, “No” or “Do\n not know”. Knowledge score was calculated as follows: 1 point for correct answer and\n 0 point for don’t know \u0026amp; wrong answer. The total score for each student was calculated\n by summing scores for all responses, and then a percentage score was calculated. This\n percentage score was categorized into satisfactory (≥75%) and unsatisfactory (\u0026lt;75%).\n \u003c/p\u003e\n \n\n \n\u003cp\u003eAttitude: Attitude towards e-health was assessed in terms of; interest in receiving\n e-health training, use of patient electronic medical records in health settings,\n use of internet in health service/research, does the use of computer by physician\n save time, should computer be used in all health centers, does the use of computer\n relieve pressure on hospital outpatients, how it is difficult to use the internet\n in the field of health. Attitudinal statements were responded to by “strongly agree”,\n “agree”, “not sure”, “disagree” or “strongly disagree”. Attitude score was calculated\n by using 5-point Likert scale ranging from 0 to 4 points; 4 points for strongly agree\n on positive attitude sentence, to 0 point for “strongly disagree”. The total score\n for each student was calculated by summing scores for all responses, and then a percentage\n score was calculated. This percentage score was categorized into positive (\u0026gt;75%),\n neutral (50-75%) and negative(\u0026lt;50%) attitudes. \u003c/p\u003e\n \n\n \n\u003cp\u003ePractice of e-health: Practice of students was assessed as regards: participation\n in video conference, use of the internet for health related information, and use\n of patient electronic records, program, and. Statements related to practice will be\n responded to by “No” or “Yes”. Practice score was calculated by giving a score 1 for\n practicing and 0 for non-practicing. The total score for each student was calculated\n by summing scores for all responses, and then a percentage score was calculated. This\n percentage score was categorized into good (\u0026gt;75%), average (50-75%) and poor (\u0026lt;50%)\n levels. \u003c/p\u003e\n \n\n \n\u003cp\u003eThe questionnaire includes questions on personal characteristics and previous experience\n in computer use. The investigator distributed an anonymous self administered English\n based questionnaire inside an envelope, to ensure confidencialy, with a cover letter.\n Each envelope was handed to the student in his/her classroom. Students were expected\n to fill the questionnaire and return it in the envelope sealed with no identifiers.\n The cover letter served as the front page that explained the purpose of the study\n and invited the student to particpate voluntarily. Agreement to fill the questionnaire\n was considered as a consent. \u003c/p\u003e\n \n\n \n\u003ch4\u003eData analysis\u003c/h4\u003e\n \n\u003cp\u003eSPSS software Ver. 25 was used for data entry and analysis. Descriptive statistics\n such as mean score and standard deviation, as well as frequency and percentages of\n all independent variables (age, gender, educational grade, etc…) were used. Responses\n were scored by frequency and percentage then converted to percentage mean scores,\n then transformed to qualitative data as mentioned previously. Analytic statistics\n were applied to test associations of the student’s practice, attitude and knowledge\n with the personal characteristics. Chi-square test will be used for qualitative data\n and student t-test, ANOVA for quantitative data. To predict the significant predictors\n of student’s practice, multiple regression analysis was be applied Significance will\n be considered at p-value \u0026lt;0.05. \u003c/p\u003e\n \n\n \n\u003ch4\u003eEthical Considerations\u003c/h4\u003e\n \n\u003cp\u003eThe survey was introduced to the students in an envelope, with a cover letter, explaining\n the aims of the study. Participation in the study was voluntary. The envelope was\n not recognized by the instructors. The cover letter assured the students that their\n feedback would not affect their academic evaluation. Agreement to participate was\n considered as a consent. The collection of data sheets was framed with confidentiality\n in a matter where the student’s name, contact information, or badge number would not\n be identified or traced by anyone. This study was approved by the IRB of the Ministry\n of National Guard-Health Affairs [Ref. #SP18/488/R].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 440 medical students were surveyed for their levels of awareness of e-health,\n the majority were females (55.7%), of stream 1 (79.8%) and of families whose monthly\n income was more than 10,000 SR (82.8%). Those students were distributed nearly equally\n on the four educational grades. \u003c/p\u003e\n \n\u003cp\u003eTable 1 shows the distribution of students according to their responses to factual\n statements on knowledge about e-health. With regard to the definition of e-health,\n the majority of students responded correctly to 11 statements, and incorrectly to\n 2 statements; they incorrectly agreed that e-health is “patient examination through\n the use of internet” (65%) and “organization of health care for patients, including\n surgical operations, via the internet” ( 58.6%). With regard to the fields of application\n of e-health, the majority of students correctly agreed on the follwing applications;\n clinical (80.5%), educational (89.5%), administrative (74.5%), policy-making ( 57.8%)\n and research (83.6%). However, the majority incorrectly agreed that video games and\n watching entertainment movies are applications of e-health (74.5%) \u0026amp; 73.9% respectively).\n Regarding the methods of using e-health, the majority of the students correctly agreed\n that visual communication (74.7%), internet (91.3%) and e-mail (81.1%) were methods\n of e-health, while around one-half of them incorrectly agrred on paper-post (44.7%),\n fax (51.4%) and landline telephone (50.2%) as methods of using e-health. \u003c/p\u003e\n \n\n \n\u003cp\u003eThe percentage mean scores for the three domains of knowledge about e-health, namely\n e-heath definition (70.69%, unsatisfactory level of knowledge), fields of its application\n (76.43%, satisfactory level of knowledge) and methods of its use (65.69%, unsatisfactory\n level of knowledge). The percentage mean score of overall knowledge about e-health\n was 71.62% ( unsatisfactory level). Only 43.6% of all students reported satisfactory\n level of overall knowledge about e-health,Table 1.\u003c/p\u003e\n \n\n \n\u003cp\u003eTable 2 shows the responses of medical students to 8 attitudinal statements on using\n e-health. Generally speeaking, the majority of students responded positively to the\n statements. However, less than two-thirds of them agreed or strongly agreed that “doctor\n use of computer during patient interview saves time” (64.9%), and less than two-thirds\n disagreed that “the use of internet in the field of health is difficult”(63.2%). The\n percentage mean score of attitude towards the use of e-health was 82.32% (positive\n attitude). Nearly three-quarters of all students reported positive attitude to e-health\n use (73.4%), with only 2% of them who reported a negative attitude.\u003c/p\u003e\n \n\n \n\u003cp\u003eTable 3 shows the forms of practice of e-health during medical training as reported\n by the medical students.Using electronic medical records and searching for health\n information ranked first (92.6% \u0026amp; 91.7% respectively), followed by using e-health\n in medical training (85.2%), while attending e-health traing programs and participation\n in visual communication came last (77.5% \u0026amp; 74.1% respectively). The percentage mean\n score of overall practice was 84.27% (good level of practice). More than three-quarters\n of medical students (78.4%) reported good practice, only 9.1% of them reported poor\n practice.\u003c/p\u003e\n \n\n \n\u003cp\u003eTable 4 shows the results of a multiple regression analysis of e-health practice among\n medical students and the independent variables; gender, age, educational grade,\n stream type, monthly income attitude score and knowledge score. It shows that higher\n e-health practice score was significantly predicted by higher knowledge (t=2.219,\n p=0.027) and attitude (t=2.114, p=0.035) scores, after adjusting for other variables\n in the regression model.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIt is believed that the use of information and communication technologies (ICT) can\n be a potential alternative to address some of the daunting problems in healthcare\n sector in developing countries. Knowledge, skills and acceptance of e- health by health\n professionals are essential attributes of a successful integration of this new tool.\n In a study on medical students in Sri Lanka [13], fifty one percent rated their knowledge\n of e-health applications as minimal, and 43% were familiar with the term e-health.\n This finding was comparable with the findings of our study, where only 43.6% of all students reported satisfactory level of overall knowledge about\n e-health. This lack of knowledge on e-health could be attributed to the absence of\n formalized e-health educational components in the medical curriculum. On the other\n hand, nearly three-quarters of all students reported positive attitude to e-health\n use, in our study. This finding was in agreement with the finding of a study in Sri\n Lanka [13], where over 80% believed that e-health had an important role to play\n in the current and future health sector, and another study in Bangladesh, where the\n majority of students believed the internet was useful for helping to make health decisions\n [14]. \u003c/p\u003e\n \n\n \n\u003cp\u003eMedical educators recognize that electronic health record (EHR) proficiency is a skill\n required for students to succeed after medical school [15]. Medical students need\n hands-on experience documenting clinical encounters as well as entering orders to\n prepare for residency and become competent physicians. A 2012 survey of clerkship\n directors by the Alliance for Clinical Education and the University of Michigan Medical\n School also showed the limited scope of EHR use by students [16]. In the study of\n Sri Lanka, respondents had very poor access to computers and internet use was rare.\n In Bangladesh study of e-health literacy among university students [14], the majority\n of students used the internet to find health information, although a little over half\n of students were competent in computer. However, in the present study, using electronic\n medical records and searching for health information, and using e-health in medical\n training were reported by almost all students, and attending e-health traing programs\n and participation in visual communication were reported by three-quarters of students,\n with an overall good level of practice. \u003c/p\u003e\n \n\n \n\u003cp\u003eIt has been reported that some factors such as; level of education [14,17-20], electronic\n device use[14,19], advanced age [14,19] and gender [19] influenced the use of internet\n for health-related information [19]. In Bangladesh study [14], e-health literacy was\n found to be influenced by age, education and marital status, computer knowledge used\n to search for health information. In the present study, e-health practice score was\n significantly predicted by both the knowledge and attitude scores, after adjusting\n for age, gender , stream type, educational grade and family monthly income. This finding\n reflect the need for an educational e-health program for medical students.\u003c/p\u003e\n \n\n \n\u003cp\u003eThis stdy has some limitations. Conduction of this survey on the medical students\n of one university would not allow for generalizing its conclusion. However, this study\n may open the door for investigating the challenges for upgrading the knowledge on\n e-health and the use of its applications by medical students in Saudi Arabia. The\n cross sectional design of the study would not guarantee the causal association between\n the practice of e-health and the predictors of this practice among students. Longtudinal\n studies are recommended in the future to control for this limitation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall knowledge of students about e-health was less than satisfactory, while their\n attitudes were satisfactory and their practices were good. Students’ practice of e-health\n was significantly predicted by their levels of knowledge and attitude on e-health.\n This study could provide basic information regarding medical students’ knowledge,\n attitude, and practice on e-health. \u003c/p\u003e\n \n\n \n\u003cp\u003eMore resources should be directed to elevate medical students’ knowledge and to motivate\n them to practice e-health using the available tools. It would help policy makers and\n education planners in developing appropriate evidence-based strategies and curriculum\n in medical and health institutes for successful implementation and use of e-health\n systems. Implementation of formalized e-health educational copmponents in the medical\n curiculum is necessary, to provide knowledge about the fundamentals of e-health, basic\n concepts and various applications . Such education must also include a practical component\n to provide medical students with necessary hands-on skills. Educational simulations without prior EHR training help students develop EHR competence\n [21].\u003c/p\u003e"},{"header":"List of abbreviations","content":"\u003cp\u003ePMS__ percentage mean score, KAMC—King Abdulaziz Medical city, MNG-HA—Ministry of\n National Guard-Health Affairs, IRB---Institutional Review Board. \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch4\u003eEthics approval and consent to participate\u003c/h4\u003e\n \n\u003cp\u003eThis study was approved by the institutional review board of the Ministry of National\n Guard-Health Affairs in Riyadh, Saudi Arabia [Ref# SP18/488/R].\u003c/p\u003e\n \n\n \n\u003ch4\u003eConsent to publish\u003c/h4\u003e\n \n\u003cp\u003eNot applicable\u003c/p\u003e\n \n\n \n\u003ch4\u003eAvailability of data and materials\u003c/h4\u003e\n \n\u003cp\u003eMost of the data supporting our findings is contained within the manuscript, and all\n others, excluding identifying/confidential respondent data should, will be shared\n upon request.\u003c/p\u003e\n \n\u003ch4\u003eCompeting interest\u003c/h4\u003e\n \n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n \n\n \n\u003ch4\u003eFunding\u003c/h4\u003e\n \n\u003cp\u003eNone\u003c/p\u003e\n \n\n \n\u003ch4\u003eAuthor contributions\u003c/h4\u003e\n \n\u003cp\u003eMAA and BD contributed to concept development, manuscript preparation and final writing,\n BD and AIA and SN contributed to concept development, research proposal writing and\n data collection, analysis and interpretation, and manuscript drafting. All authors\n read and approved the final manuscript.\u003c/p\u003e\n \n\n \n\u003ch4\u003eAcknowledgement\u003c/h4\u003e\n \n\u003cp\u003eThis study was supported by King Abdullah International Medical Research Center, under\n the supervision of Department of Medical Education, College of Medicine, King Saud\n bin-Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1. Putzer, G., \u0026amp; Park, Y. The effects of innovation factors on smartphone adoption among nurses in community hospitals. Perspectives in Health Information Management 2010 Jan 1;7:1b.\u003c/p\u003e\n\u003cp\u003e2. Wan Ismail, W., Hong Kit, P., Buhari, N., \u0026amp; Muzaini, A. Acceptance of Smartphone in Enhancing Patient-Caregivers Relationship. J. Technol. Manag. Innov. 2012, Volume 7, Issue 3, pp71-9. \u003c/p\u003e\n\u003cp\u003e3. Showell C, Nohr C. How should we define eHealth, and does the definition matter? Stud Health Technol Inform 2012; 180:881-4. \u003c/p\u003e\n\u003cp\u003e4. Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, et al. The impact of eHealth on the quality and safety of health care: A systematic overview. PLoS Med 2011; 8(1):e1000387. https://doi.org/10.1371/journal.pmed.1000387\u003c/p\u003e\n\u003cp\u003e5. Cunningham S, Wake D, Waller A, Morris A. Definitions of eHealth. In: Gaddi A, Capello F, Manca M (eds). eHealth, Care and Quality of Life. Milan: Springer 2014:15-30. \u003c/p\u003e\n\u003cp\u003e6. Gaddi A, Capello F. The debate over eHealth. In: Gaddi A, Capello F, Manca M (eds). eHealth, Care and Quality of Life. Milan, Springer, 2014:1-13. \u003c/p\u003e\n\u003cp\u003e7. WHO. Building Foundation for eHealth, Geneva,2006. http://www.who.int/goe/publications/bf_FINAL.pdf \u003c/p\u003e\n\u003cp\u003e8. Ilic D. The role of the internet on patient knowledge management, education, and decision-making. Telemed J E-Health 2010; 16(6):664-9. \u003c/p\u003e\n\u003cp\u003e9. Shaw T, McGregor D, Brunner M, Keep M, Janssen A, Barnet S. What is e-Health (6)? Development of a conceptual model for e-Health: qualitative study with key informants. J Med Internet Res. 2017 Oct 24;19(10):e324. doi: 10.2196/jmir.8106.\u003c/p\u003e\n\u003cp\u003e10. Hofstede J, de Bie J, van Wijngaarden B, Heijmans M. Knowledge, use and attitude toward eHealth among patients with chronic lung diseases. Int J Med Inform 2014; 83(12): 967-74. \u003c/p\u003e\n\u003cp\u003e11. Alkhatlan H, Almutairi B, El-Shazly M. Knowledge, attitude and practice of primary health care providers regarding e-health: A validation study. Greener J Med SCIENCES (GJMS) 2016; 6(1): 18-24. \u003c/p\u003e\n\u003cp\u003e12. Abolfotouh MA, Al Saleh SA, Mahfouz AA, Abolfotouh SM, Al Fozan HM. Attitudes of Saudi nursing students on AIDS and predictors of willingness to provide care for patients in central Saudi Arabia. SAGE Open 2013 . DOI: 10.1177/2158244013499163\u003c/p\u003e\n\u003cp\u003e13. Edirippulige S1, Marasinghe RB, Smith AC, Fujisawa Y, Herath WB, Jiffry MT, Wootton R. Medical students' knowledge and perceptions of e-health: results of a study in Sri Lanka. Stud Health Technol Inform. 2007;129(Pt 2):1406-9.\u003c/p\u003e\n\u003cp\u003e14. Islam MM, Touray M, Yang HC, Poly TN, Nguyen PA, Li YJ, Syed Abdul S. E-Health Literacy and Health Information Seeking Behavior Among University Students in Bangladesh. Stud Health Technol Inform. 2017;245:122-125.\u003c/p\u003e\n\u003cp\u003e15. Hersh WR, Gorman PN, Biagioli FE, Mohan V, Gold JA, Mejicano GC. Beyond information retrieval and electronic health record use: Competencies in clinical informatics for medical education. Adv Med Educ Pract. 2014;5:205–212.\u003c/p\u003e\n\u003cp\u003e16. Hammoud MM, Margo K, Christner JG, Fisher J, Fischer SH, Pangaro LN. Opportunities and challenges in integrating electronic health records into undergraduate medical education: A national survey of clerkship directors. Teach Learn Med. 2012;24:219–224.\u003c/p\u003e\n\u003cp\u003e17. Neter E, Brainin E. eHealth literacy: extending the digital divide to the realm of health information. Journal of medical Internet research. 2012 Jan;14(1).\u003c/p\u003e\n\u003cp\u003e18. Brown CA, Dickson R. Healthcare students'e-literacy skills. Journal of allied health. 2010 Sep 1;39(3):179-84.\u003c/p\u003e\n\u003cp\u003e19. Tennant B, Stellefson M, Dodd V, Chaney B, Chaney D, Paige S, Alber J. eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults. Journal of medical Internet research. 2015 Mar;17(3).\u003c/p\u003e\n\u003cp\u003e20. Powell J, Inglis N, Ronnie J, Large S. The characteristics and motivations of online health information seekers: cross-sectional survey and qualitative interview study. Journal of medical Internet research. 2011 Jan;13(1).\u003c/p\u003e\n\u003cp\u003e21. March CA, Steiger D, Scholl G, Mohan V, Hersh WR, Gold JA. Use of simulation to assess electronic health record safety in the intensive care unit: A pilot study. BMJ Open. 2013;3:e002549.\u003c/p\u003e"},{"header":"Tables","content":"\u003cbody\u003e\u003cp\u003e\u003cb\u003eTable 1. Response of medical students to factual statements on e-health\u003c/b\u003e\u003c/p\u003e\n\u003cp/\u003e\n\u003ctable class=table\u003e\u003ctbody\u003e\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eWhat is e-health?\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eWrong\u003c/b\u003e\u003c/p\u003e\n\u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eCorrect\u003c/b\u003e\u003c/p\u003e\n\u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e1. Health Care Online \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e25.4\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e74.6\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e2. Use of the Internet and other technology to improve health \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e9.1\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e90.9\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e3. Entertainment between working hours* \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e27.8\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e72.2\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e4. Shopping* \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e26.0\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e74.0\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e5. Social communication between friends* \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e28.9\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e71.1\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e6. Control of medicine supply for patients through electronic software \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e29.4\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e70.6\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e7. Provide medical advice to the patient through the use of the Internet \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e23.3\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e76.7\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e8. Patient examination through the use of the Internet \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e65.0\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e35.0\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e9. Organization of health care for patients, including surgical operations via the Internet\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e58.6\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e41.4\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e10. Provide electronic patient records \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e19.6\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e80.4\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e11. Monitor the health of the patient through electronic technologies \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e22.1\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e77.9\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e12. Education of doctors through the use of electronic sources \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e27.9\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e72.1\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e13. Exchange of medical information and medical communication between doctors\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e25.5\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e74.5\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003ePercentage mean score \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e70.69 [unsatisfactory]\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003c/tbody\u003e\u003c/table\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003ctable class=table\u003e\u003ctbody\u003e\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e\u003cb\u003eFields of applications of e-health\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003e No (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eYes (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e1. Clinical \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e19.5\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e80.5\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e2. Educational \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e10.5\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e89.5\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e3. Administrative \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e25.5\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e74.5\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e4. Policy maker \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e42.2\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e57.8\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e5. Research \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e16.4\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e83.6\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e6. Video games\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e25.5\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e74.5\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e7. Watching entertainment movies \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e26.1\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e73.9\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003ePercentage mean score (%)\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e76.43\u003c/p\u003e\n\u003cp\u003e [satisfactory]\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e\u003cb\u003eMethods of using e-health\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eNo (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eYes (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e1. Visual communication \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e25.3\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e74.7\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e2. Paper post\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e55.3\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e44.7\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e3. Fax\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e48.6\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e51.4\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e4. Internet \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e8.7\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e91.3\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e5. Land line telephone \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e49.8\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e50.2\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e6. E-mail \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e18.9\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e81.1\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003ePercentage mean score (%)\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e65.69\u003c/p\u003e\n\u003cp\u003e[unsatisfactory]\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e\u003cb\u003eOverall Knowledge (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp/\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003eSatisfactory \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e43.6\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003eUnsatisfactory \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e56.4\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003eOverall percentage mean score (%)\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e71.62 [unsatisfactory]\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003cp\u003e\u003cb\u003eTable 2. Response of medical students on attitudinal statements on using e-health\u003c/b\u003e\u003c/p\u003e\n\u003cp/\u003e\n\u003ctable class=table\u003e\u003ctbody\u003e\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eStatements\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eSA (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eAG (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eNS (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eDA (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eSD (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e1. I think that the use of the Internet is useful in the field of health\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e85.1\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e12.0\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e2.5\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.2\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.2\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e2. I think that the use of the Internet in the field of health is difficult\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e5.8\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e7.1\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e24.0\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e36.9\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e26.3\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e3. I think that doctor use of computer during patient interview saves time\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e37.2\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e27.7\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e22.4\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e8.3\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e4.4\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e4. I think doctor use of computer must be applied at all health centers\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e56.4\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e26.8\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e12.9\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e3.7\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e.2\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e5. I think that the use of computer relieves pressure on hospital outpatient\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e46.8\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e30.3\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e18.1\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e2.8\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e2.1\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e6. I think that patient's electronic file must be applied in all centers and hospitals\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e73.9\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e16.9\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e7.9\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e1.2\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.1\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e7. I think e-Health can be used to increase awareness and control of communicable diseases\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e61.6\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e25.5\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e11.5\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e1.4\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.0\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003e8. I am interested in receiving training for the use of electronic health\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e57.0\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e26.4\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e12.2\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e3.0\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e1.4\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003c/tbody\u003e\u003c/table\u003e\n\u003cp/\u003e\n\u003ctable class=table\u003e\u003ctbody\u003e\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"\u003eOverall attitude levels (%):\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003ePositive\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eNeutral\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eNegative\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp class=\"list_Paragraph\"/\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e73.4\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e24.6\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e2%\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003eSA---strongly agree, AG----agree, NS---not sure, DA---disagree, SD---strongly disagree.\u003c/p\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp\u003e\u003cb\u003e \u003c/b\u003e\u003c/p\u003e\n\u003cp\u003e\u003cb\u003eTable 3. Practice of e-health during medical training among medical students\u003c/b\u003e\u003c/p\u003e\n\u003ctable class=table\u003e\u003ctbody\u003e\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003ePractice\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eNo (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eYes (%)\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eSearching for health information \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e8.3\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e91.7\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eUsing electronic medical records during medical training\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e7.4\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e92.6\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eAttending e-health training programs \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e22.5\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e77.5\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eUsing e-health in medical training\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e14.8\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e85.2\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eParticipating in visual communication during medical training \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e25.9\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e74.1\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp/\u003e\n\u003cp\u003eOverall practice levels (%):\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp/\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp/\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eGood \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e78.4\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eAverage \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e12.5\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003ePoor \u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e9.1\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eOverall percentage mean score (%)\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e84.27 [Good]\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003c/tbody\u003e\u003c/table\u003e\n\u003cp/\u003e\n\u003cp\u003e \u003c/p\u003e\n\u003cp\u003eTable 4. \u003cb\u003ePredictors of good e-health practice among medical students\u003c/b\u003e\u003c/p\u003e\n\u003ctable class=table\u003e\u003ctbody\u003e\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eIndependent variables\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eB\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003eSE\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003et-value\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eConstant\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e80.278\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e29.109\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e2.758\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.628\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e2.582\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.243\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.808\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e-1.578\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e1.166\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e-1.353\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.177\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eEducational grade\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e1.491\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e1.542\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.967\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.334\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eStream\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e-8.002\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e5.367\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e-1.491\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.137\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eMonthly income\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e3.722\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e2.251\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e1.654\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.099\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eAttitude score\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.229\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.108\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e2.114\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.035**\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003ctr\u003e\t\u003ctd\u003e\u003cp\u003eKnowledge score\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.176\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.079\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e2.219\u003c/p\u003e\n\u003c/td\u003e\t\u003ctd\u003e\u003cp\u003e0.027**\u003c/p\u003e\n\u003c/td\u003e\u003c/tr\u003e\n\u003c/tbody\u003e\u003c/table\u003e\n\u003cp/\u003e\n\u003cp/\u003e\n\u003cp\u003e**---statistical significance.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"E-health Knowledge, E-health perception, E-health application, E-health practice, IT methods, medical informatics","lastPublishedDoi":"10.21203/rs.2.9931/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.9931/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Previous studies described the levels of awareness of patients and health care providers on e-health in general and on e-health for a certain condition/disease. However, none of these studies was conducted in Saudi Arabia. The aims of this study were 1)To determine the levels of knowledge, attitude and practice of medical students on e-health, and 2) To identify the predictors of e-health practice among medical students. \u003c/p\u003e\u003cp\u003eMethods: A cross-sectional survey of 440 medical students at the college of medicine, King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, was conducted, during October/November 2019, using a previously validated questionnaire, to assess: (1) knowledge in three domains; e-health definition (13 statements), fields of application of e-health (8 statements), methods of using e-health (7 statements), (2) attitude toward using e-health (8 statements) and (3) reported practice of e-health in medical training (5 statements). A scoring system was used to calculate the total and percentage score of knowledge, attitude and practice for each student. Multiple regression analysis was applied to identify predictors of e-health practice. Significance was considered at p\u0026lt;0.05. \u003c/p\u003e\u003cp\u003eResults: Of the 440 medical students surveyed, the majority were females (55.7%), of stream type1 (79.8%) and from families whose monthly income was more than 10,000SR (82.8%). Overall knowledge about e-health was unsatisfactory (PMS=71.62%), with only 43.6% of all students reporting satisfactory level. However, this level was satisfactory for fields of application (Percentage mean score-PMS=76.43%) and unsatisfactory for definition of e-health (PMS=70.69%) and methods of its use (PMS=65.69%) domains. Overall attitude towads e-health use was positive (PMS=82.32%), with nearly three-quarters of all students (73.4%) reporting positive attitude. Generally, good level of practice of e-health was reported by students (PMS=84.27%), with more than three-quarters of medical students (78.4%) reporting good practice. Adjusting for age, gender, stream, educational grade and family monthly income, good practice was significantly predicted with higher knowledge (t=2.219, p=0.027) and attidude (t=2.114, p=0.035) scores. \u003c/p\u003e\u003cp\u003eConclusion: This study provides basic information regarding medical students’ knowledge, attitude, and practice on e-health. More resources should be directed to elevate medical students’ knowledge and to motivate them to practice e-health using the available tools.\u003c/p\u003e","manuscriptTitle":"An assessment of the level of awareness of e-health among Saudi medical students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2019-05-29 11:37:01","doi":"10.21203/rs.2.9931/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4cac938c-141a-42e7-ba7f-cdaf46eecd99","owner":[],"postedDate":"May 29th, 2019","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":12815,"name":"Internal Medicine"}],"tags":[],"updatedAt":"","versionOfRecord":[],"versionCreatedAt":"2019-05-29 11:37:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1088","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-1088","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}