Willingness to use eHealth and associated factors Among Disabled Students in Higher Education Institutions in Debre Markos city 2025
Original article
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GizawHailiyeTeferi1
ZegeyeRegasaHordofa1
AndualemFentahunSenishaw1
GetayeTizazuBiwota1
TemesgenFeyuDesalegn1
BinyamLakewTilahun4
AyenewSisayGebeyehu1
TesfayeShumetMekonnen2
LijalemMegibaruEneyew3
MaruMeseretTadele1
1Debre Markos University College of Medicine and Health science, Department of Health InformaticsDebre MarkosEthiopia
2Debre Markos University College of Medicine and Health science, Department of Public HealthDebre MarkosEthiopia
3Department of Software EngineeringDebre Markos University Institute of technologyDebre MarkosEthiopia
4Department of Internal MedicineCollege of Health Science Arsi UniversityAsellaEthiopia
Gizaw Hailiye Teferi1*, Zegeye Regasa Hordofa1, Andualem Fentahun Senishaw1, Getaye Tizazu Biwota1, Temesgen Feyu Desalegn1, Binyam Lakew Tilahun4, Ayenew Sisay Gebeyehu1, Tesfaye Shumet Mekonnen2, Lijalem Megibaru Eneyew3, Maru Meseret Tadele1.
1Debre Markos University College of Medicine and Health science Department of Health Informatics, Debre Markos, Ethiopia
2Debre Markos University College of Medicine and Health science Department of Public Health, Debre Markos, Ethiopia
3Debre Markos University Institute of technology, Department of Software Engineering, Debre Markos, Ethiopia
4Department of Internal Medicine, College of Health Science Arsi University, Asella, Ethiopia
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Abstract
Background
eHealth technologies offer a way to improve healthcare access for students with impairments at higher academic institutes particularly in low-income areas like Ethiopia. However the willingness of students in these to use eHealth and the factors that influence willingness of students to use the platforms has not yet been thoroughly investigated.
Objective
The aim of this study is examine the willingness of disabled students at higher academic institutes in Debre Markos city to use eHealth and the factors influencing their willingness.
Method
Institution based cross-sectional study was conducted from November 2024 to January 2025 among disabled students at higher academic institutes in Debre Markos city. Multi-stage stratified sampled technique was used. Data were collected using structured interviewers administered questionnaire and analyzed using SPSS version 26. Descriptive statistics were computed to represent the characteristics of study participants and binary and multivariable logistic regression analysis was conducted to identify factors associated with willingness of students to use eHealth.
Result
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Among the total study participants approached (168), 61.9% were willing to use eHealth service and mentioned mobile health and telemedicine as preferred platforms. Factors including but not limited to smartphone ownership (AOR = 3.1, 95% CI: 1.3–7.5, p = 0.01), previous knowledge about eHealth (AOR = 1.6, 95% CI: 1-3.6, p = 0.001), Favorable attitude (AOR = 2.6, 95% CI: 1.1–6.5, p = 0.002), Availability of internet (AOR = 2.5, 95% CI: 1.2–5.2, p = 0.015), and perceived ease of use (AOR = 4.2, 95% CI: 2.24–7.81, p < 0.001) were significantly associated with willingness.Conclusion
Despite most of the study participants were aware of eHealth; the willingness level was moderate.. Prior knowledge about eHealth, attitude, internet accessibility and perceived ease of use were the factors associated with willingness to use eHealth services. Academic institutions may improve willingness level by offering training courses that could boost awareness and knowledge about eHealth potentials in improving health service access, integrating eHealth with assistive technology, and designing disability friendly platforms.
Keywords:
eHealth
disability
higher education
willingness
use
Ethiopia
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Background
The world is home to an estimated 1.3 billion people with some form of disability, which represents 16% of the global population. Eighty percent of those with disabilities reside in low- and middle-income nations(1). The estimates of the proportion of disabled persons in Africa range from 10% of the continent's total population to 20% in the poorer regions, or 60–80 million individuals. However, this number may be greater in areas with extreme poverty. Ethiopia one of the second most populated country in Africa is a home for 15 million people with disability (2, 3).
The rapid integration of technology into healthcare has paved the way for eHealth, which encompasses electronic health services, tools, and applications designed to enhance the delivery and management of healthcare(4).
Telemedicine services, mobile health apps, and health information systems are valuable tools for overcoming major healthcare access challenges faced by people with disabilities. These technologies can greatly improve the way individuals with disabilities receive care. In colleges and universities, eHealth platforms are particularly beneficial for students with disabilities(5). These platforms can provide essential support that helps disabled students manage chronic health conditions, access mental health resources, and maintain their general well-being. By using these platforms, students can better handle their health needs while focusing on their studies (6).
The Role of eHealth in Supporting Disabled Students
It is more difficult for students with disabilities access conventional health care service often encounter significant challenges in accessing traditional healthcare services(7). The ability of these individuals to seek prompt medical assistance may be hampered by physical restrictions, transportation issues, and time restraints related to academic commitments(8). These challenges may also be made worse by stigmatization and misunderstandings of their particular needs for healthcare. In order to solve the healthcare issues that impaired students in higher education institutions experience, eHealth technologies have become revolutionary tools(9). By utilizing digital platforms, eHealth solutions offer remote access to medical services, allowing students with chronic illnesses or mobility impairments or other forms disability to receive prompt care without physically visiting a medical institution(10). The potential of eHealth to enable tele-consultations, which let students communicate with medical professionals via video chats, is one of its many noteworthy advantages (11, 12).
Factors influencing willingness to use eHealth
The willingness of disabled students to use eHealth services is influenced by several factors, including technological accessibility, digital literacy, perceived usefulness, and privacy concerns(13). Ownership of a smartphone or digital device is a key technology determinant for access to eHealth platforms. Familiarity with different smartphone platforms like social media and more recent devices make it easier for students to use services(14), and students with access to up-to-date devices are more likely to engage with them, because of compatibility and user experience issues that also depend on the connection overall(15). When students perceive these platforms as useful for their health management and easy to use, their intention to use eHealth tools grows(16). Experiences with similar technological systems and robust digital literacy skills greatly boost individuals' capacity to navigate, comprehend, and utilize digital health platforms effectively. The development of expertise in digital tools builds user confidence for eHealth service utilization while simultaneously shortening the technological use learning curve. The integration of technical skill enhancement with critical assessment capabilities enables users to independently resolve digital issues while fully exploiting the advantages provided by advanced healthcare systems(17).
Even though digital health technology has become increasingly ubiquitous in Higher academic institutions, students with disabilities may face unique challenges in navigating digital tools due to sensory, cognitive, or physical impairments(18). Moreover, the perceived reliability of eHealth platforms, along with concerns about data security and confidentiality, plays a pivotal role in shaping their attitudes toward eHealth use(19).
eHealth utilization in higher educational institutes
The universities are trying to grant disabled students accessibility to eHealth through support structures such as accessible eHealth platforms and training geared toward helping them improve their digital literacy skills. Assistive Technology provides services such as supplying various specialized resources and advanced technologies to allow students with disabilities to gain increased independence concerning the self-management of their health and well-being. They may include screen readers, voice recognition software, and adaptable input devices-all of which highly improve the accessibility of digital health services. Apart from improving such technological methods, structured training programs would enable such students to attain key digital skills, which in turn make them feel confident and even competent in navigating eHealth systems (20). Higher education institutions usually play the function of setting up innovative methods and at the same time linkers of healthcare providers and students(21). Thus, the significance of these programs mostly lies in the ability to comprehend the exact requirements, choices, and readiness of the disabled students to make use of eHealth technologies(22).
Research gap and importance
Despite the fact that eHealth is becoming more and more popular, the willingness of the disabled students in the higher education sector to use these technologies and the factors affecting their willingness are not yet fully exploited(23). The most part of the previous work concentrates on general groups or healthcare surroundings, which in turn creates a space of awareness for the unique situations of disabled students at academic institutions (24). On the one hand, the recognition of whether the students find eHealth technology effective and the influence of their attitudes toward it in their own academic performance can be achieved only if the students are the ones responsible for recognizing the problem and solving it(25).
Hence the aim of this research is assess the willingness of disabled students in higher education institutions to use eHealth service, and factors associated with willingness.
Method and material
Study period and setting.
A cross-sectional study was conducted among disabled students at higher academic institution students at Debre Markos city from November 05, 2024 to January 25, 2025. Debre Markos city is situated in the Amhara Regional State in northwestern Ethiopia. Serving as the capital of the East Gojjam Zone, the city was established around 1852. It is located approximately 300 kilometers from Addis Ababa, the capital of Ethiopia, and 265 kilometers from Bahir Dar, the regional capital. The city spans a geographic area of 6,160 square meters and encompasses 17,000 hectares divided into four sub-cities and 20 kebeles.
Sampling procedure
A multi-stage sampling technique was used. Initially, the institutions were divided into four different strata—private colleges, a university, a polytechnic college, and a preparatory school—using a stratified sampling technique. From 9 private colleges three colleges were chosen by simple random sampling among the private college stratum. For the remaining three institutions—Debre Markos University, Debre Markos Polytechnic College, and Debre Markos Preparatory School—purposive sampling was used. In order to ensure that all eligible participants were included in the study, a census method was finally used to include all students with impairments in the chosen institutions. The selection of this sampling technique was made in order to strike a balance between the requirements for inclusivity, pragmatism, and representativeness. The study included forty-four students from a preparatory school, sixteen from Debre Markos Polytechnic, twenty-two students from private colleges, and the remaining(93) students from Debre Markos University
Source population and study population
All students with disability in higher academic institutions in Debre Markos city
Study population
All students with disability from three private colleges, Debre Markos University, Debre Markos Polytechnic, and Debre Markos preparatory school were the study population for this study.
Study variables and operational definitions
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Outcome variableThe study's dependent variable was the participants' willingness to use eHealth (Yes/No). Five Likert-scale questions were utilized to measure disabled students' willingness to use eHealth platforms, and the results were converted to a binary response (Yes/No).
Independent variables
The independent variables were socio-demographic factors (age, sex, department, year of study, smartphone type, and health app availability), system-related factors (perceived ease of use, perceived usefulness, innovativeness, optimism, discomfort), organizational factors (infrastructure), and behavioral factors (technical skill, trust).
Operational definition
Disability: Refers to a physical, sensory, mental, or intellectual condition that significantly restricts a person's ability to perform everyday activities or participate fully in society on an equal basis with others(26).
Willingness to use eHealth: Willingness of students with disability to use eHealth was measured using five willingness likert-scale questions(27). The students with a score of 3 or higher were labeled as willing to use, while students who score less than a score of 3 labeled as not willing(28).
Data collection procedure and quality control
The data were collected using a structured, interviewer-administered questionnaire adapted from a previous study and adjusted to fit to our context. The tool comprises 42 questions covering socio-demographic characteristics, prior knowledge, affordability, and willingness, perceived ease of use, perceived usefulness, and overall attitude. Sign language interpreters facilitated data collection from students with hearing impairments. Prior to the main data collection, a pilot study was conducted with 15 students from Injibara University. The tool's validity was assessed by panel of expert and factor analysis. Internal consistency were assessed using Cronbach’s alpha (0.78). Based on the pretest findings, adjustments were made to the questionnaire.
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Participants included students were from three private owned colleges (Gabist, Ghion, Brana), Debre Markos polytechnic college and Debre Markos University. They were invited to participate during their first morning class, with the process lasting 45 minutes. Data collectors received two days of training on the study’s objectives, participants’ rights, and data collection procedures. Supervisors closely monitored adherence to participants’ rights and ensured the quality of the data collected.This cross-sectional study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines(29). The STROBE framework was utilized to ensure accurate reporting of the study design, methodology, and findings.
Data management and analysis
After the collection the data were exported from Kobo tool to excel and preprocessed to remove missing values and invalid entries and then analyzed with SPSS version 26. Descriptive analyses were performed to summarize the socio-demographic characteristics of disabled students and assess their willingness to use eHealth services presented using frequency and cross tabulation. Binary logistic regression was performed to examine the effect of each independent variable on willingness to use eHealth at a 95% confidence level. Variables with a p-value of 0.02 were considered for inclusion in the multivariable logistic regression. Multivariable analysis was then conducted to identify key factors influencing the willingness of disabled students to use eHealth. Adjusted odds ratios, along with 95% confidence intervals and p-values, were calculated to determine the strength and significance of associations between dependent and independent variables.
Model fitness was tested using the Hosmer-Lemeshow goodness-of-fit test. Multi-collinearity among variables for the final model was assessed using variance inflation factors and no significant multicollinearity was detected among the variables included in the multivariable analysis.
Result
Socio-demographic characteristics of the respondents
Out of 175 disabled students surveyed, 168 valid responses were received, yielding a response rate of 96%. The majority of participants 120(71.4%) were male, with 56% of the students were from Debre Markos University. Over half (62.5%) the study participants reported being a visual impaired, followed by physical disability (31%) and most of the students are enrolled in social science studies 120(76.2%). (Table 1).
Variable | Category | Frequency | Percentage |
|---|---|---|---|
Gender | Male | 120 | 71.4% |
Female | 48 | 28.6% | |
Age | Under 20 years | 20 | 11.9% |
20–25 years | 88 | 52.4% | |
Above 25 years | 60 | 35.7% | |
Institution | Debre Markos University | 94 | 56% |
Debre Markos Poly technic | 16 | 9.5% | |
Private colleges | 35 | 20.8% | |
Debre Markos preparatory school | 23 | 13.7% | |
Disability type | Visual impairment | 105 | 62.5% |
Hearing impairment | 4 | 2.4% | |
Mobility impairment | 59 | 35.1% | |
Marital status | Single | 120 | 71.4% |
Married | 36 | 21.4% | |
Divorced | 12 | 7.1% | |
Parental income | > 5000 ETB | 96 | 57.1% |
5000–10000 ETB | 60 | 35.7% | |
10000–15000 ETB | 8 | 4.8% | |
> 15000 ETB | 4 | 2.4% | |
Place residence | Rural | 96 | 57.1% |
Urban | 72 | 42.9% | |
Device ownership | Feature phone | 112 | 66.7% |
Smartphone | 56 | 33.3% |
Access to technology and Awareness of eHealth among disable students
Only 56(33.3%) of the respondents owned smartphones or devices enabling internet access and have internet access. Students were inquired about social media usage and 38.1% of the students use social media platform of which 33% used telegram followed by tiktok (31%) Fig. 1.
Fig. 1
Social media usage pattern among disabled students at higher education institute in Debre Markos city.
Among the study participants, 90% had heard of eHealth, with mobile health (50%) and Telemedicine (40.5%) being the most recognized services Fig. 2. Beside the students were asked to select the types of communication media they prefer in relation to access information through eHealth platform and all of them preferred information in the form of Audio followed by video and picture.
Fig. 2
eHealth platform mentioned (Note: students can choose more than 1 option)
Willingness to Use eHealth and Preferences
Among participants, 61.9% expressed willingness to use eHealth services if accessible. Preferred platforms included mobile apps (54.9%) and university-hosted portals (36.2%). Students were asked the preferred communication way of eHealth service most of the students preferred audio transmit service 128(76%) followed by video channels 13% while 11% of the students choose both video and picture.
Determinants of eHealth Willingness
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The results of the bivariate analyses showed that age, place of residence, family monthly income, internet availability, ownership of a mobile device, attitude, perceived easiness, prior social media usage and perceived usefulness were associated with willingness to use eHealth services among students with disabilities at p < 0.2 Table2. All these factors were included in the multivariable logistic regression analysis model to control for potential confounders.Variable | Category | Willingness | OR(95% CI) | AOR(95% CI) | P value | |
|---|---|---|---|---|---|---|
Yes | No | |||||
Age | Under 20 years | 12 | 8 | 1 | 1 | |
20–25 years | 64 | 24 | 1.78[1.5-6] | 1.5[1.2–8.3] | .003 | |
Above 25 years | 28 | 32 | .58[.41-.74] | .52[.2-2.01] | .4 | |
Place of residence | Urban | 44 | 20 | 1.32[.57 − 3.7] | 1.22[.61 − 2.4] | .56 |
Rural | 60 | 36 | 1 | 1 | ||
Smartphone ownership | Yes | 46 | 10 | 4.35[2-9.6] | 3.1[1.3–7.5] | .01 |
No | 57 | 54 | 1 | 1 | ||
Internet availability | Yes | 44 | 14 | 2.6[1.2–5.3] | 2.5[1.2–5.2] | .015 |
No | 60 | 50 | 1 | 1 | ||
Knowledge | Yes | 88 | 45 | 2.3[1-4.9] | 1.6[1-3.6] | .001 |
No | 16 | 19 | ||||
Attitude | Favorable | 92 | 40 | 4.6[2.8–20] | 2.6[1.1–6.5] | .002 |
Unfavorable | 12 | 24 | 1 | 1 | ||
Perceived easiness | Yes | 88 | 12 | 5.5[.21 − 14] | 4.2[1.3–13.6] | .014 |
No | 16 | 12 | 1 | |||
Perceived usefulness | Yes | 96 | 44 | 5.4[2.2–13.3] | 2.9[1.04–8.1] | .012 |
No | 8 | 20 | 1 | 1 | ||
| Note: The stated p-values correspond to the adjusted odds ratio | ||||||
The study revealed several key factors influencing the willingness of disabled students to use eHealth services. Age of the of the students was of the factors that associate with willingness, students with age group 20 to 25 was 1.5 times more likely to express willingness to use eHealth platforms compared to under 20 age groups (AOR: 1.5, CI: 1.2–8.3, p = 0.003).
Owning smartphone is strongly linked to willingness, with smartphone users being over three times more likely to be willing (AOR 3.1 95% CI: 1.3–7.5, p = 0.01). Likewise, having internet access increases the likelihood of willingness by 2.5 times, supported by confidence levels (95% CI: 1.2–5.2, p = 0.015).
Previous knowledge about eHealth platform and favorable attitude were significant associated factors to willingness, Students who had prior knowledge were 1.6 times more likely willing to use eHealth platform compared to their counterpart’s. Furthermore, perceived easiness of the eHealth platform was a powerful determinant of willingness to use eHealth. Platforms with use friendly interface and easy to navigate were 4.2 times more likely to be used (AOR: 4.18, CI: 2.24–7.81, p < 0.001), underscoring the critical consideration in the designing user specific platforms.
Meanwhile, where someone lives doesn't have a big impact on their willingness. These findings emphasize that having technology, prior knowledge, good attitudes, and seeing benefits are crucial in affecting whether someone is willing or not.
Discussion
Unintended barriers to healthcare access, such as physical inaccessibility, communication challenges, and stigma, could be mitigated through the use of eHealth technologies, which offer remote consultations, digital health monitoring, and accessible health information. This study aimed to assess the willingness of disabled students at higher institutions in Debre Markos Town to use eHealth and identify factors influencing their willingness.
In the current study, nearly all participants (90%) were aware of eHealth platforms. This, awareness level is higher compared to study in Gondar Ethiopia (73.7%)(30). The disparity may reflect greater internet penetration, institutional promotion of digital tools, and targeted disability-inclusive initiatives in urban academic settings. Despite high awareness, only 61.9% of respondents expressed strong willingness to use eHealth. This gap may stem from inadequate digital literacy, concerns about privacy, or lack of tailored eHealth solutions for diverse disabilities. A study evaluating nursing students' confidence and willingness to use eHealth showed similar results, despite differences in the study population(31).Among participants aware of eHealth, 50% identified m-Health as a primary service, while 16.7% recognized both telemedicine and mobile health apps.
Key factors significantly associated with the willingness to use eHealth among disabled students included age, device ownership, knowledge, attitude and internet access among others. In this study middle age groups (20–25) were two times more likely to be willing to use eHealth compared to the age groups 15 to 20, while age groups above 25 were not associated with willingness of students to use eHealth. Ownership of electronic device (smartphone) which enables to use eHealth and accessibility of the internet where the students live were significant associated with willingness. Those who had internet access were 2.5 times more likely willing, while those with smartphone were more than three times more likely to be willing than those without. This result is comparable with previous researches indicating that access to digital device increase tendency to use eHealth (32–34).
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Additionally, participants tended to be willing to use eHealth when they had prior knowledge, demonstrating the importance of awareness in decision-making. This result aligns with Bandura's Social Cognitive Theory, which holds that learning affects behavior through the concepts of perceived control and self-efficacy (35). In particular, people who had a favorable attitude were more likely to be willing than those who had unfavorable attitude. This is in line with Theory of Planned Behavior, which holds that attitude plays a significant role in determining one's intention to carry out a particular behavior(36).The perceived easiness of eHealth platform interfaces and perceived usefulness of the eHealth service were other factors strongly associated with willingness, which is in line with technology acceptance model assumptions (33, 37). The perception of ease of use and usefulness is vital factor that influence behavioral intentions (38, 39). These confirm that user-friendly design may boost student’s willingness to use. A study examining the digital divide between students with and without disabilities supports this finding. It revealed that students with disabilities had more difficulty using eHealth platforms compared to their non-disabled peers. This highlights the need for eHealth platform design to incorporate accessible features—such as voice recognition and Braille—to accommodate various types of disabilities(40).
However research was focused on Debre Markos Town, which may limit the generalizability of the findings to rural areas or non-academic populations. Furthermore, the study may have some bias in how visual impairment status and phone user status all varied among the participants. It is possible that the students with some visual impairment may have had difficulty interacting with the websites or digital platforms used in the study and the study process. Students' responses to the survey measures and ultimately, their experiences using eHealth tools may have been affected.
Conclusion
while awareness of eHealth is high among disabled students in Debre Markos, willingness to use these tools is moderate and influenced by age, smartphone ownership, and attitude and internet access. Intervention like improved internet access around disabled student dormitory, user interface tailored to disability type such as screen integration may enhance willingness of students to use eHealth. Future research should employ mixed methods to capture nuanced barriers and include populations outside academic institution to inform national disability-inclusive health policies.
Declarations
Ethics approval and consent to participate
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This study adhered to all ethical standards for conducting research. A
Ethical approval was obtained from the Debre Markos University Ethical Review Board, and permission to involve participants was secured from the respective college deans and admins. A
Furthermore, written informed consent was gained from all participants. Participation was entirely voluntary, and no incentives were offered to the participants.Consent for publication
Not applicable
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Data Availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Competing interests
Authors declare conflict of interest.
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Funding
No funding received to conduct this study.
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Author Contribution
GHT conceptualized the research idea, conducted the statistical analyses, and prepared the original draft of the manuscript. MMT, AFS, TFD, ZRH and GTB were responsible for data entry and cleaning. ASG, LME, BLT, and TSM contributed to data analysis. All authors reviewed and approved the final version of the manuscript.
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Acknowledgement
The researcher expresses sincere gratitude to Debre Markos University for its support and collaboration in conducting this study. Deep appreciation is extended to the data collectors for their commitment to data collection, and the research participants, the disabled students in higher educational institutions of Debre Markos City for their willingness to give their time.
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