ICT transformation through byod adoption in healthcare of pakistan

ISSN:2229-6093
Saima Nisar et al, International Journal of Computer Science & Communication Networks,Vol 7(3),58-65

ICT Transformation through Byod Adoption in Healthcare of Pakistan
Saima Nisara *, Wan Rozaini bt Sheik Osmana
a

School of Computing, College of Arts and Science, UUM, Universiti Utara Malaysia, 06010, Sintok,
Kedah, Malaysia
;


Abstract
Information and communication technology (ICT) is
intensely transforming our society and economy.
Organization’s demands a committed plan and a
digital agenda to go ahead effectively. Medical sectors
are progressively looking for portable solutions to meet
their Information and Communication Technology
(ICT) needs. BYOD gains growing recognition as a
working device to remotely examine patient's health.
But, the insufficient study has shed light on
practitioners’ adoption of ICT. This research strives to
fill this gap by investigating the influence of doctor's
perception on the adoption of BYOD in Pakistan by
extending the UTAUT2 model to incorporate with
security and privacy. This article proposes a
conceptual model of BYOD by identifying the factors
and then model development. Future work is to validate
the proposed model by expert review method.
Keywords: ICT, BYOD, Doctors, UTATU2,

Conceptual Model

1. Introduction
1.1

ICT Transformation

Information and Co mmunicat ion Technology (ICT)
consists of software, hardware, med ia, and networks for
the storage, collection, t ransmission, processing,
providing informat ion and related services [1] [2]. As
with mu ltip lex service industries like banking, airlines,
and insurance, the digital innovation needed cannot
transpire without notable investment in ICT. The dig ital
transformation of ICT has stimulated considerably, it
not only provides assistance also, empower the
progressive redevelopment [3]. ICT is the essential
enabler to a transformation which will fulfil the
necessities of the health system [4].
ICT has excellent potential in providing tremendous
advantages to the healthcare providers by increasing
access, with sufficient investment, delivering
performance, extending the range and decreasing the
expense [5]. Health data is the core of healthcare
system, doctors require the complete patient's record

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before taking decisions. However, creating and

emp loying information in the constantly changing and
data concentrated healthcare system needs numerous
expertises [6].
ICT is adopted in the health sector for communicat ion
of digital data, containing vital data collection, and can
be recovered electronically to assist healthcare
anywhere. ICT has improved efficiency in several areas
of the economy. Nevertheless, still the adoption of ICT
has been comparatively slow in the health sector [7].
The latest progress regarding mobile technologies has
facilitated mobile devices to perform functions
previously not possible with handheld devices [8].
ICT mediu m can be utilized to reach a broad variety of
technological
resolutions
for
communication,
containing collecting data, text messaging, retrieving
Electronic Health Records (EHR), and treatment at
distances [9].

1.2 Bring Your Own Device
Bring Your Own Device (BYOD) is closely associated
with IT consumerization [10], which various scholars
view as the dual use of IT for business and private
purpose [11][12] or as the adoption of employee’s
devices, applications, and tools in the workplace [13].
Mobility extends the internet providing and computing
more independence to employees and their personal life
and at work [14] allo wing for the “anything, anywhere,

anytime” scenario [15].
The word BYOD was first used by Ballagas et al., at
UBICOMP 2004 [16]. BYOD entered in 2009,
courtesy of Intel when it accepted an increasing
tendency among its employees to bring their own
devices to work and connect them to the corporate
network[17]. The adoption of BYOD addressed
different organizational needs; namely, the need for
mobility, the need to keep employees satisfactorily
engaged in every aspect of the business process, the
need to improve the business environment or
workp lace, the need to attract young talents and retain
skillfu l workforces, and so forth, and the need for
attaining business goals or profits, [18][19][20][21].
These needs generally resulted in major improvement
in terms of emp loyee mobility enhancement, retention,

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improved corporate-customers relationship through
various innovative ways, improved IT value to the
business, a more flexible work environ ment, improved
business continuity, the ability to access content from
any device anywhere and at any time, familiar
technologies and increased motivation, an agile
workforce, and greater flexibility in collaboration,

familiar technologies and increased motivation,
informat ion
sharing,
and
communicat ion
[22][23][24][25]. The mainly accepted BYOD devices
are smartphones, laptops, mobile, and tablets[15].
Nowadays, BYOD is sufficiently advanced to perform
better than the traditional devices provided to the
emp loyees by their organizations. The greater part is
that the employees want their own device as it is better
than what their organizations supplied in terms of
productivity. Employees desire devices that reflect
them and are not selected by the organization[26][27].
In the healthcare industry, BYOD was seen as a helpful
trend that conveyed a lot of benefits to healthcare
providers, hospital, and patients. BYOD-enabled HCP
to work in quick, smarter and professional way[28].
Some of them are in provided in Table 1.

2.0 Theoretical Background
Pakistan is

the developing country and has a
population 191.75 million in 2015, healthcare facilit ies
are overburden, congested, incompetent and shortstaffed that cannot satisfy the necessities of the patients
[33][34]. Though, the rise in a nu mber o f patients plus
a shortage of emerg ing technology has the adverse
influence on the overall healthcare performance as the
available sources will drop inadequate to match the

required quality for healthcare performance [33] [35]
[36].
The health system of Pakistan is consisting of public
and private sectors. The process of a health system in
Pakistan depends on three layers. The layer of
healthcare is Basic Health Unit (BHU) and Rural
Health Centres (RHC), the second layer is Tehsil
Headquarter (THQ) and District Headquarter (DHQ)
hospital. Although the third layer is Tertiary Care
Facilit ies (TCF) which is consist of teaching hospitals
mainly established in urban areas [34]. The details are
given in Figure 1.

Table 1 Benefits of BYOD [23]
Benefits of
BYOD
Flexible

Description
BYOD allows for more flexibility in
working hours

Creativ e

Employees will be more creativ e

Effectiv e

Employees will use applications
that are familiar to them,

making
their
work
more
effectiv e
Employees
will
be
more
innovativ e because of the
ability to collaborate and share
ideas at any giv en moment and
from any place

Innovativ e

BYOD increased patient satisfaction, as it permitted
quick access to caretakers and assured real-time
responses [29]. BYOD brought changes to the medical
work process by increasing coordination through
communicat ion and cooperation, improving access to
data, imp lement interdisciplinary workforce processes
which were ext remely vital in today’s healthcare
environment, and increasing satisfaction with both
physicians and patients [30]. BYOD encourage the
adoption of evidence-based clinical practices [31]. In
healthcare, portables electronically help the memory of
HCP at the point of care delivery to increase patient
safety, to reduce medical errors, and to increase the
continuity of services provided to patients [32].

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Figure 1 Healthcare Delivery in Pakistan
Pakistan's healthcare system has gone by devolution
with the amend ment of the 18th constitution from
2011. The Ministry of Health (MoH) has now been
devolved to the provinces [37] [38].
The gathering and measuring of data is a challenge in
the developing countries because the shortage of new
technologies [39]. Many developing countries depend
on old methods of data collection. With these old data
collection becomes time-consuming and complex [40]
[41]. Due to the development of technology and huge
penetration of mobile devices, numerous studies focus
on utilizing mobile technology in the developing
countries [42][39]. According to [43] the seventy
percent of cellular mobile phones subscribers in the
world are liv ing in the developing world. Smartphones
are affordable data collect ion method because of their

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connectivity, long lasting battery, and great memory
[44].

The world now is undergoing an exceptional growth
in the area of co mmunication. Many developing nations
such as Pakistan have observed an incredible progress
of annual cellular mobile subscribers approximately
131,412,658 in 2016 [45] as given below in Table 2.
Table 2 Mobile Subscription in Pakistan
Date
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004

Value
70.1
67.1
61.8
57.3
55.5
52.7
38.3
21.4
8.1
3.2

2003

1.6

understanding of the factors affecting the use and
adoption of BYOD.

3.0 Methodology
In this study the research methodology carried out in
two phase activities which are factor’s identificat ion
and designing of conceptual model as given below in
Figure 2.

Change, %
4.57 %
8.49 %
7.91 %
3.28 %
5.24 %
37.45 %
78.80 %
165.26 %
149.72 %
105.23 %
39.03 %

Source [46]

Mobile phones have changed and will continue to
create an influence on most people's lives. Mobile

phones because of their great penetration levels provide
opportunities those never thought before and potential
in different areas such as education, communication,
emp loyment, and health. Furthermore, the area of
health has been facing delayed in using mobile
technologies for a regular p rocedure, and its selection
would great for both providers and patients.
The doctors are constantly using their personal
mobile devices at work because they give a bevy of
programs, also efficiency and convenience. Doctors in
hospital are encountering and treating an increasing
number of patients which increased pressures to be cost
efficient. Business vendors too have taken the chance to
show the advancement of mobile device technology
which can reduce official burdens and errors [8].
According to [47] doctors utilising their personal
devices for professional use react more quickly to
med ical results, have fewer errors in prescription, and
show improved data management and record keeping
practices.
This paper aims to build an integrated conceptual
model in o rder to understand what drives perceptions of
the doctors towards the adoption of BYOD. Th is
research will be impo rtant to enable the government
and healthcare policy makers in having a clear
understanding of the perception of doctors.
As mentioned earlier, many of the past researchers
suggested that BYOD is still suffering fro m lo wer
utilizat ion and adoption rate, so requires more

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Figure 2 Methodology Activities

3.1 Phase I: User-Centered Design
This study extends the ideas of the existing
technology acceptance model. The UTAUT2 model is
used as a base model in constructing the proposed
model as it is the most widespread one to exp lain
technology acceptance among doctors. However, it has
to be remember that the content of user centered design
is different with the existing models because doctor’s
acceptance is not only dependent on their perceived
benefits, but is also impacted by their perceived
concerns, like concerns about privacy and security to
adopt BYOD [48]. The summary of PMT research is
given in Table 3. The summary of PMT research is
given below in Table 3. The assessment of concern in
the circu mstance of BYOD has been viewed litt le in the
Information System (IS) research literature [22].

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Table 3 Su mmary of PMT in Security Research

STUDY

Crossler
et al.,
2014
[49]

Theoretical
background
PMT

Target
behavior
and context
Comply with
BYOD
policies;
organization

Dependent
variable

Purpose of study and key findings related to UTATU
variable

Intentions
Actual
complianc
e (selfreported
coded as

1/0 binary)

Purpose: Investigate factors that influence
employees’ decisions to comply with BYOD policies
Findings: Only self-efficacy and response efficacy
had a significant impact on intentions.

Sample
(Valid)
250,
accounting
and nonaccounting
college
students and
white colla r
employees
Purpose:

Jenkins,
Grimes,
Proudfo
ot &
Lowry,
2013
[50]

PMT Fear
Appeals

Vance,

Siponen,
&
Pahnila ,
2012
[51]

PMT

Posey,
Roberts
& Lowry,
2011
[52]

Johnsto
n&
Warkent
in, 2010
[53]

Create
Unique
passwords;
online web
accounts

Actual
Behavior
(actual
uniq ue

passwords)

Purpose: Investigate ways to discourage password
reuse

135 univ ersity
students

Strategy: Used Fear Appeals to manip ula te all PMT
variables except self-efficacy

2 study
group

Findings: Their data revealed that 88% of those who
receiv ed fear appeals created unique passwords,
compared with only 4.5% of those who did not
Comply with
security
policies
related to
locking PCs,
sharing
passwords,
etc;
organization
al

Intentions

PMT

Protect
organization'
s information
assets using
measures
such as
protecting;
sensitiv e
information,
computer;
organization
al

Intentions
Actual
behavior
(selfreported)

Purpose: Investigate factors that motiv ate insiders
(employees) to protect their organization's
information assets. Also, proposes fear as a predictor
of protection motiv ation in an organizational setting.
Findings: Intrinsic rewards and coping appraisals
significantly influence insiders’ protection motiv ation.
Response efficacy is the strongest predictor. A
coping appraisal is a better predictor than threat
appraisals. Fear is a function of perceiv ed severity
and perceiv ed vulnerability but has no significant

influence on employees' decision to protect their
organization's information assets.

380 insiders
from v arious
organizations
and
industries in
the US

PMT Fear
appeals

Use antispyware
software;
personal
computer

Intentions

Purpose: Investigate if fear appeals do influence user
intentions to comply with recommended security
measures Strategy: Used Fear Appeals to manip ula te
perceiv ed severity and vulnerability, self-efficacy,
response efficacy Findings: Fear appeals successfully

275 univ ersity
staff and
students 3
study groups

TH

Create

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Purpose: Examine factors that influence IS security
compliance and the role of habit in shaping these
factors. Habit is based on PMT's assumption that prior
experience is an antecedent to threat and coping
appraisals

210
participants
from one
municip al in
Finland

Findings: Prior habit was found to influence all threat
and coping appraisal factors. All hypothesized
relationships were supported with the exception of
perceiv ed vulnerability and intentions

Purpose:

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environment

Herath
& Rao,
2009
[54]

PMT

LaRose,
Rifon, &
Enbody,
2008
[55]

PMT

Woon,
Tan &
Low,
2005
[56]

PMT

DT

ELM
Persuasiv e
messages
(SCT)

elicited change in perceptions that ultimately
influenced intentions to apply anti-spyware security
measures

Compliance
with security
policies;
organization

Intentions,
mediated
by attitude
towards
security
policy

Purpose: Conduct a field study of employee
intentions to comply with security policies. Simila r to
Woon et al. (2005), proposes no direct link between
threat severity and threat probability to intentions.
Proposes that attitudes mediate the effects of threat
concern, self-efficacy, Response efficacy and
response cost on intentions Findings: Threat concern is
a function of threat severity and threat probability.
Although threat concern, self-efficacy, response

efficacy and response cost all had a significant
impact on attitudes towards organizational security
policy, the attitude has no direct impact on
intentions.

312
participants
from 78
organizations
in the
western
areas of New
York, USA

Adopt
security
measures
such as
firewalls,
anti- virus,
antispyware;
home
Internet use

Intentions

Purpose: Investigate ways to motiv ate internet users
to take personal responsibility and take the internet
safety measures Strategy: Used persuasiv e messages
to manipulate personal responsib ility Findings:

Personal responsib ility, response efficacy, and selfefficacy were found to be the best predictors of
online security behavior

206 students

Adoption of
wireless
security
measures;
home
network

Actual
Behavior
(selfreported
using
yes/no
binary
measure)

Purpose: Use PMT to examine factors that predict
adoption of wireless security measures on home
computers Findings: Their study found support for all
hypothesized direct rela tionships except for the
relationship between perceiv ed vulnerability and
adoption of recommended behavior.

189 home
computer
users who

own a
wireless
network at
their home
recruited
from a large
univ ersity

4study
groups

PMT = Protection Motiv ation Theory; TTAT = Technology Threat Av oidance Theory; TAM = Technology Acceptance Model; SCT =
Social Cognitiv e Theory ; ELM = Elaboration Likelihood Model; TPB = Theory of Pla nned Behavior; CET = Cognitiv e Evaluation
Theory; GDT = General Deterrence Theory; IDF = Innovation Diffusion Theory; DT = Deterrence Theory; TH = Theory of Habit;

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So, based on the existing guidelines, and theories,
this study has identified the factors which can affect the
perception of doctors to adopt BYOD. Those factors
were essential to identified fo r developing the
conceptual model through systematic review and
comparative analysis. Earlier to designing the model, a

comparative analysis of the literature was carried out.
After user-centered approach and comparative analysis
the designing of the conceptual model has been
conducted.

3.2 Phase II: Model Development
A theoretical model is a collection of interrelated
concepts that leads to this study, determining what
things will be measured and what relationships will be
required fro m the data [57]. A theoretical framework is
described as how one theorized or makes logical sense
of the relationships among several factors that have
been identified as important to the problems [58].
Sekaran (2003) emphasised that the research
framework is the basic foundation upon which other
research structures extend the frontier of knowledge.
Furthermore, a theoretical framework is a presentation
of reality, it explains in greater detail those variables of
the real world the scientist considers to be relevant to
the problem investigated, and clarifies the significant
relationship between them.
Thus, to comprehensively understand doctor’s
adoption of BYOD, the researchers propose an insight
into the determinants of doctor’s decision to take part
in BYOD, and impact of security and privacy on
doctor’s intention to use BYOD. To the best of the
researcher’s knowledge, this study will be first to
comprehensively examine the intention to adopt BYOD
among doctors of Pakistan not only fro m a
technological perspective as well as fro m behavioral

perspective. The researchers proposed a conceptual
model by integrating Unified Theory of Acceptance
and Use of Technology 2 (UTAUT2), and Protection
Motivation Theory (PMT) theories as the theoretical
foundations for proposed model.
Considering the specific attributes of BYOD, the
researcher proposes their conceptual research model as
shown in Figure 3.

Figure 3 Proposed Conceptual Model
The basic objective of the present study is to
investigate the intention to adopt BYOD, and to unveil
those factors which influence the BYOD intention and
privacy concerns related to HCP in Pakistan.
Unfortunately, Pakistan faces short-staffed of different
groups of HCP [35]. The scope of this study is given in
Figure 4

Figure 4 Scope of the Study
In this respect, the point of importance is whether
the HCP intent to adopt BYOD or not, their decision
would largely depend upon the security and privacy
concerns.

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4.0 Conclusion and Future Work
This article presents the ongoing research regarding the
identification of factors which can affect the intention
to adopt BYOD. In this study BYOD, user-centered
approach and literature analysis have been conducted in
identifying the factors and designing the conceptual
model. Future work of this study is to validate the
proposed model through expert review process.

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