Nurses’ readiness for informatics competency in Afghanistan: A quantitative study

by Dr. Alaattin Parlakkilic
Management Information Systems, Faculty of Economics And Administrative Sciences, Ufuk University, Ankara, Turkey
aparlakklc@gmail.com

Dr. Volkan Saribas
Yildirim Bayezit University, Industrial Engineering Dept. Ankara, Turkey
saribasvolkan@gmail.com

Citation: Parlakkilic, A. & Saribas, V. (2021). Nurses’ readiness for informatics competency in Afghanistan: A quantitative study. Canadian Journal of Nursing Informatics, 16(3-4).  https://cjni.net/journal/?p=9390

Abstract

Background: The use of computers and technology has the power to improve qualifications in terms of nursing services. In Afghanistan, it is important to know the informatics competencies of nurses in the provision of healthcare services.

Aim: This study aims to determine the readiness of Afghan nurses’ informatics competency through computer literacy, information literacy, and information management.

Method: The focus of this study consists of nurses working at a hospital in Kabul-Afghanistan. A paper-based informatics competence readiness questionnaire was distributed to 70 nurses who worked in the hospital and 68 nurses completed the questionnaire.

Results: When nurses’ informatics competence level was evaluated, it was determined that they scored 47.2% (2.36) at the computer literacy level, 50% (2.51) at the information literacy level and 49.6 % (2.48) at the information management level. It was observed that nurses’ informatics competence did not differ according to age, gender, marital status and branches but differed for educational status and duration of work. As the nurses’ computer literacy, information literacy and information management scores increased, their informatics competencies increased with a positive correlation.

Conclusions:  As a result, nurses working in Afghanistan are competent at the level of 2.45 (49%) which is inadequate. Thus, nursing informatics application areas can help nurses improve their nursing competence, but informatics education and infrastructure need significant improvements.

Keywords: Informatics, readiness, competence, literacy, information, management, Afghan, nurse.

Introduction

Information technology (IT) significantly affects the health sector as well as many other sectors. Most of the information and information services, from the medical interventions to health personnel training have supported the emergence of health informatics as a science. In the definition made by the World Health Organization, health is expressed not only as the absence of an individual’s disability or illness but as complete well-being of the individual both mentally and physically. Based on this statement, the fact that information technologies can support the detection of all kinds of illnesses, can track mental and physical integrity of a person at an early stage, and can be used to record and decide on necessary measures to apply has played an important role in the development of health information systems (Oner, 2014).

 The most efficient and effective use of all the data obtained is possible with the correct understanding and transfer of health information. The efficient and rapid provision of healthcare services, the fact that the obtained quality data is organized in correct, complete, timely, appropriate, and correct usage conditions increases the effectiveness of health informatics (Oner, 2014).  Due to the potential for uninterrupted continuity of health services, a simple and rapidly accessible health system should be established with high service quality and efficiency rates. Institutions and organizations that provide health care services increase efficiency and effectiveness with system evaluation, information evaluation, system establishment, and system analysis (Barut, 2015).

Informatics competence is a prerequisite for people to take part in professions and workplaces. It is equally vital for Afghans to improve their skills in using Information Technology (IT). Afghanistan has been subjected to civil war and political and social instability for over four decades. Now is the time to renew and rebuild the economic and social structure. The use of IT is a critical factor in ensuring that the country’s workforce is capable and ready to deal with the challenges posed by such a reform. Nevertheless, technically talented people are unfortunately lacking in health, government, military, public, and private sectors (Parlakkilic, 2015).

    In this context, the aim of our study is to evaluate the nursing informatics competencies of nurses at a hospital in Afghanistan. Clinical nurses may have inadequacies due to their lack of training, skills, competence, and support (Ball et al., 2011). In order to help address these needs and difficulties, a questionnaire used to determine the competence of nurses in computer skills, informatics literacy, and information management can be used to assess levels. For this purpose, the following objectives for Afghan nurses are important:

• To determine the effect of the demographics on informatics competence,
• To determine the computer literacy of nurses,
• To determine the informatics literacy of nurses,
• To determine the information management of nurses,
• To determine the relationship between nurses’ computer literacy, information literacy, and information management,
• To determine the informatics competence of nurses.

Informatics Competence

Readiness

Ongoing technological developments require that workers such as nurses should have the necessary informatics skills to use it. Hence, it is important to test participant technical capacity and especially their perceptions towards technology to ascertain levels of informatics competence readiness (Broadley, 2012).

Readiness is required before any training can succeed and includes the ability of the health system to adapt to technology, collaborative educational processes, synchronous and asynchronous training. It also includes an individual’s ability to adapt to technological processes, collaborative training processes, asynchronous and asynchronous education. Readiness includes infrastructure, training objectives, teacher support, guidance and novel leadership. Therefore, readiness requires successful engagement (Nyoni, 2014).

Competence

Nursing informatics competence has the potential to improve care for patients, collect data, provide communication, improve, and support public health. In addition, nursing informatics makes the contribution of nursing to medical records visible and acts as a support for nurses’ decision-making processes (Iraz, 2004).

Nursing informatics competence work first started in 1974, and was further spurred by the International Medical Informatics Association (IMIA) ‘s establishment in 1983, coupled with their Nursing Informatics working group which responded to the needs of nurses in the informatics field and shows that nursing informatics has been accepted as an integral part of the IMIA, along with medical informatics (Saba, 2001).

 Information management is a discipline that affects nursing practice. Nurses can take advantage of computers to provide more personalized care to their patients, making it easier to track patient progress, provide patient education and share resources with patients in a timely way (Clendon, 2020).

It is widely thought that informatics competence has very important advantages in nursing practices and education, as well as some disadvantages. These disadvantages are the violation of the privacy of the individual as a result of the inability to store the personal information of the patient or healthy individual, the risk of reducing communication, or the lack of skills and knowledge of nurses, which prevent the efficient and effective use of computers (Koc, 2006).

Patient care documentation can be done through the use of patient care modules in hospital information systems to convey the required information to appropriate sections in patient records. This element of informatics allows the gathering of information in a form that can be used for multiple departments such as accounting, inventory control, research, scheduling, and planning. Nurses use patient care modules for the purpose of evaluating patient conditions, organizing appropriate care plans, determining necessary interventions for patients, documenting care, tracking results and quality control (Koc, 2006).

Computer literacy

Literacy means more than just reading and writing skills. The rapid development of communication and computer technologies has enabled people to easily access a lot of information. Being computer literate does not mean knowing every aspect of the computer, but rather being able to use the computer to facilitate daily life, having basic computer hardware knowledge, knowing the types of software, and being able to use e-mail productively. 

The content and focus of computer literacy may change over time. Skills such as using e-mail and using the internet in daily life are also evaluated within the concept of internet literacy. Computer literacy continues throughout life because the field of computers is in a state of constant change and this change needs to be followed to continue to evolve along with the technology (Hunter, McGonigle, & Hebda, 2013).

Information literacy

This current age is often defined as the Information age which is reflected by a corresponding “Information society” where the interaction between technological materials and human factors affect perception factors and life practices of individuals in general, and create cultural and pedagogical differences in a special sense (Goodova et al., 2015).

 Avci (2015) said that information literacy transforms people’s lives with awareness of and comfort with new digital materials. With digitalization, information literacy has gained value such as the interaction of the media, virtuality, modularity, and their usability to people (Akarcay 2015). The traditional understanding of communication and activities has started to occur on virtual platforms and in this context, people have provided both the production and consumption of information (Yegen, 2015, p.85). Media consumers are growing, and social networks have become critical factors in the internet environment where users actively play a role (Akarcay, 2015).

Information management

Nursing practices are an important component of patient care since nurses are the people who determine the needs of the patient and plan and implement patient care accordingly. By focusing on the individual needs of patients, nurses not only provide basic care to deal with the consequences of illnesses and make necessary adjustments but also care for patients as people, meeting their psychological, physical, and spiritual needs. Nursing’s need for information systems has increased in order to focus on this holistic care and at the same time make many dimensions of patient care visible (Molina-Mula & Gallo-Estrada, 2020).

Thus, principles regarding the development of nurse support systems gradually emerged. The first definition of the concept of nursing informatics by Scoles and Barber (1980) that Nursing informatics is the use of computer technology and information systems in all fields of nursing has evolved over time (Thede, 2012). Computer-aided recording systems that provide the management of nursing informatics and their features are generally discussed as problem-centered medical information systems; computer-aided patient care records, nursing minimum data sets; and preoperative nursing data sets are examples of this continued evolution with a focus on nursing practice and how to record it effectively (Kleinbeck & Dopp, 2005).

Methods

Participants

The population of this study consists of nurses working at Kabul Hospital in Afghanistan with the permission of hospital authorities. The Nursing Informatics Competency Readiness Questionnaire was distributed to 70 nurses who took part in the hospital of which 68 nurses participated in the survey.

Data collection

The informatics competence questionnaire was used to collect quantitative data in the study. The questionnaire consisted of two parts. In the first part, there were five questions created to determine the demographic information of the participants. The second part was used to determine the informatics competence with 30 questions consisting of computer literacy, informatics literacy, and information management dimensions.

The Nursing Informatics Competency Readiness Questionnaire, which was used in the study by Rahman (2015) and is free to access and use, was used as a data collection tool in this research study. The questionnaire was translated into the Afghan Dari language for use in this setting. The questionnaire consists of a five- point Likert type scale using (1 = Strongly Disagree, 2 = Disagree, 3 = Undecided , 4 = Agree, 5 = Strongly Agree).

Analysis of Data

The SPSS 25.0 Statistics package program was used for statistical analysis . While evaluating the study data, descriptive statistical methods (Frequency, Percentage, Mean, Standard deviation) were used. In the case of two groups in the comparison of quantitative data, Independent samples t tests were used to compare the parameters with normal distribution between groups. In the case of more than two groups in the comparison of the quantitative data, One-way Anova tests were used in the comparison of the parameters with normal distribution between groups, and the Tukey ad hoc test was used. The results were evaluated at the 95% confidence interval, at the p<0.05 significance level.

Ethical considerations

Participants were informed about the purpose of the study, the protection of anonymity, and the free will of the individuals to participate or withdraw from the study. The participants participated in the survey with their free will and without any pressure. This study was also approved by the hospital where the participants worked.

Measures

Reliability analysis of the informatics competence survey was found to have generally high consistency (Cronbach’s alpha = 0.742) as shown in Table 1. When informatics competence dimensions were examined independently, the Information literacy had the highest consistency subscale (Cronbach’s alpha = 0.842) and the information management had the lowest consistency subscale (Cronbach’s alpha = 0. 652).    

Table 1. Reliability analysis of the survey

Informatics competence dimensions	Cronbach Alpha
Computer literacy	0.733
Information literacy	0.842
Information management	0.652
General (Informatics competence)	0.742

Results

The demographic characteristics of the nurses participating in the study were determined first  (see Table 2), and then the results and levels of the informatics competence questionnaire were evaluated in the order described below.

 Table 2. Demographic information

Demographics	Number (n)	Percent (%)
GENDER
Female	36	52.9
Male	32	47.1
AGE
18-29 years old	30	44.1
30-39 years old	13	19.1
40-49 years old	16	23.5
50 years and older	9	13.2
EDUCATION STATUS
High school	15	22.1
Associate Degree	47	69.1
Undergraduate Degree	6	8.8
MARITAL STATUS
Single	22	32.4
Married	46	67.6
YEARS OF EXPERIENCE
0-5 years	28	41.2
6-10 years	10	14.7
11-15 years	5	7.4
16-20 years	5	7.4
21-25 years	4	5.9
More than 25 years	16	23.5
BRANCH
Intensive care	31	45.6
Obstetrics	3	4.4
Nursery	6	8.8
Orthopedics	13	19.1
Surgery	8	11.8
Medicine	7	10.3

Demographics and informatics competence

GENDER: Comparison of the informatics competence levels and sub-dimensions of the participants included in the study was made with a T-test. As a result of the analysis, it was determined that the informatics competence levels were similar for both genders and there was no statistically significant difference (p> 0.05). Similarly, it was found that the average scores of men and women were similar in computer literacy (p> 0.05), information literacy (p> 0.05) and information management sub-dimensions (p> 0.05).

AGE: The scores of informatics competence and its sub-dimensions according to the age groups of the participants were evaluated with a One-Way ANOVA test. According to the results of the analysis, the scores of the informatics competence [F (3, 64) = 1.088, p> 0.05] and its sub-dimensions of the participants do not differ according to age groups.

EDUCATION STATUS: As a result of the analysis, it was observed that there was a positive correlation between the educational status and the participants’ mean scores in informatics competence and sub-dimensions. The scores of informatics competence and its sub-dimensions were evaluated with a One-Way ANOVA test which looked at the educational background of the participants in the study. According to the results of the analysis, the participants’ Informatics Competence [F (2.65) = 9.227, p <0.05] and computer literacy [F (2.65) = 6.825, p <0.05], information literacy [F (2.65) ) = 8.470, p <0.05] and information management [F (2, 65) = 8.059, p <0.05] sub-dimensions showed a statistically significant difference according to educational status. Tukey multiple comparison analysis was conducted to determine the source of the difference between groups. It was determined that the mean scores of the high school graduates in informatics competence and three sub-dimensions were significantly lower than those with associate and undergraduate degrees, and this difference was statistically significant (p <0.05). There was no significant difference between the undergraduate and associate degree graduate groups.

MARITAL STATUS: To compare differences according to the marital status of the participants in the study, the scores of informatics competence and its sub-dimensions were evaluated with a One-Way ANOVA test. According to the results of the analysis, the participants’ informatics competence [F (2, 65) = 1.629, p> 0.05] and sub-dimensions scores did not show a statistically significant difference according to the marital status of the participants.

YEARS OF EXPERIENCE: According to the duration of working in the profession of the participants, the scores of informatics competence and its sub-dimensions were evaluated with a One-Way ANOVA test. According to the results of the analysis, the participants’ Informatics Competence [F (5, 62) = 1.785, p> 0.05] and their sub-dimensions scores did not show a statistically significant difference according to the years of experience of the participants.

BRANCHES: The scores of informatics competence and its sub-dimensions according to the branches of the participants in the study were evaluated with a One-Way ANOVA test. According to the results of the analysis, the participants’ ?nformatics Competence [F (5, 62) = 0.221, p> 0.05] and sub-dimensions scores did not show a statistically significant difference according to the area of work of the participants.

Informatics competence levels

The assessment of nurses’ informatics competence levels in this study was evaluated based on a process used by Aydin and Tasci (2005). A five-point Likert scale in which each answer was coded into 1, 2, 3, 4, and 5 therefore the critical level was 0.8 (4 intervals divided by 5 categories) resulting in 66.64 (3.4) as the expected level of informatics competence. Table 3 presents the percentages of informatics competence of the Afghan nurses who participated.

Table 3. Informatics competence level

Competence Dimension	Mean	Percent (%)
Computer literacy	2.36	47.2
Information literacy	2.51	50.0
Information management	2.48	49.6
Informatics Competence	2.45	49.0

The level of informatics competence in each dimension was evaluated individually. It was determined  that computer literacy level was 47.2% (2.36); information literacy level was 50% (2.51); information management level was 49.6% (2.48); and informatics competence level was 49% (2.45), thus all levels showed the participants are not ready, and need some work to work effectively with informatics.

Competence correlations

The relationships between the mean scores of the informatics competencies, shown as computer literacy, information literacy, and information management by using the Pearson Correlation test. As in Table 4.  As a result of the analysis, it was determined that there was a statistically significant and positive correlation between the scores of the informatics competence and its three sub-dimensions. Similarly, there is a statistically significant positive correlation between the scores obtained from computer literacy, information literacy, and information management sub-dimensions (p<0.05).

Table 4. Correlation analysis of informatics competence dimensions

COMPARISON	Computer literacy	Information literacy	Information  management	Informatics  competence
Computer literacy	1	0.827	0.740	0.926
Information literacy		1	0.835	0.948
Information  management			1	0.918
Informatics  competence				1

As the computer literacy, information literacy, and information management subscale scores of the healthcare professionals increased, the informatics competence scale scores increased; or on the contrary, as the scores obtained from computer literacy, information literacy, and information management sub-scales decreased, the scores obtained from the informatics competence scale also decreased.

As the scores obtained from the computer literacy subscale increased, the scores obtained from the information literacy and information management subscales increased; as the computer literacy subscale decreased, the scores obtained from the information literacy and information management subscales also decreased.

Likewise, as the scores obtained from the information literacy subscale increased, the scores obtained from the computer literacy and information management subscales increased; as the scores obtained from the information literacy scale decreased, the scores obtained from the computer literacy and information management subscales decreased.

Finally, as the scores obtained from the information management subscale increased, the scores obtained from the computer literacy and information literacy subscales increased; as the scores on the information management subscale decreased, the scores on the computer literacy and information literacy subscales decreased.

Discussion

When demographic characteristics were evaluated, the majority of the nurses in this sample were male participants with 52.9%. Most of the participants were in the 18-29 age range. Participants aged 50 and over constituted the minority group with a rate of 13.2%. When the participants were evaluated according to the marital status variable within the scope of the study, it was seen that 67.6% of the participants were married. According to the length of stay in the profession, it was concluded that the majority of the participants had less than 5 years of experience and a significant portion (45.6%) of their employees were working in intensive care units. In addition, the distribution frequency was evaluated, and it was determined that approximately half of the participants were at a “sufficient” level. The rate of participants at the “expert” level was determined to be 8.8%.

As a result of the comparison of the computing competence levels and sub-dimensions of the participants included in the study, it was determined that the computing competence levels for both genders were similar, and there was no statistically significant difference. Similarly, it has been determined that the average scores of men and women in computer literacy, information literacy, and information management sub-dimensions are similar. In the study conducted by Takak (2019), when evaluating the gender and information technology competence of the participants, the information technology competencies of the female participants were found to be higher than the male participants. In the study by Berkant (2016) who evaluated nurse self-efficacy, no significant relationship was found between the gender variable and information technology self-efficacy. In a study conducted by Ozdemir (2017), the information technology competencies of male participants were found to be higher than female participants.

 In addition, the scores of informatics competence and its sub-dimensions according to the age groups of the participants were evaluated. According to the results of the analysis, it was observed that the scores of the informatics competence and sub-dimensions of the participants did not differ according to age groups. As in our study, it was concluded in the research conducted by Topkaya (2010) that information technology self-efficacy does not differ according to age. In the study of Takak (2019), it was observed that, contrary to our study, the informatics competencies of the participants between the ages of 36-40 were higher than the participants in the 41-45 age group. Adalier (2012) observed that informatics competence increased with the increase of age.

 As a result of the descriptive analysis, it was observed that there was a positive relationship between the educational status and the mean scores of the participants in informatics competence and sub-dimensions. According to the results, computer literacy, information literacy, and information management sub-dimensions show a statistically significant difference according to their educational status. High school graduate participants’ average scores in the three sub-dimensions were significantly lower than the participants with an undergraduate degree: the difference was statistically significant. There was no significant difference between undergraduate and associate degree graduates. When the literature was examined, it was observed in the study conducted by Bas (2011) that the information technology competence of the participants with a postgraduate education level was higher than the participants with undergraduate and graduate education. Bayrak and Hirca (2016) stated in their study that there was no significant relationship between educational status and information technology competence. Likewise, Gunes and Buluc (2017) found that there was no significant relationship between educational status of participants in their study.

According to the results of the analysis, the scores of the IT Competence and sub-dimensions of the participants do not show a statistically significant difference according to the marital status of the participants. According to the duration of employment, the scores of the IT Competence and sub-dimensions of the participants do not show a statistically significant difference. In the studies conducted by Kucuk (2006), and Ulas and Ozan (2010), it was concluded that the information technology self – efficacy decreased as the working time in the profession increased. In Kocak’s study (2013), the participants with less time in the profession had higher information technology self – efficacy compared to the participants with a long time in the profession. 

The relationship between the mean scores of the Afghan nurses participating in the study from the informatics competence scale and the scores of the computer literacy, informatics literacy, and informatics competence sub-dimensions was evaluated with a Pearson Correlation test. It was determined that there is a statistically significant, positive correlation between the scores of the informatics competence scale and all three sub-dimensions of the scale. As a result, Afghan nurses’ informatics competence level was 49 % and this shows they are not ready and need some work to improve their competence levels.

Conclusion

Through this work, computer literacy, information literacy, and information management awareness of the Afghan nurses’ readiness was evaluated. It was observed that the informatics competencies of the participants did not differ according to their age, gender, marital status and branches. On the other hand, it has been observed that there is a positive relationship between the educational status and duration of working in the profession and the computing proficiency averages of the participants. As the nurses’ computer literacy, information literacy and information management scores increased, their informatics competencies increased, and a significant positive correlation was determined. When we looked at the sub-dimensions that constitute the informatics proficiency level of nurses, it was concluded that they are not ready at the level of computer literacy 47.2% (2.36), information literacy level 50% (2.51), and information management level 49.6% (2.48) and it is necessary to work for better preparation of our nurses in these areas. It was concluded that the level of competence in informatics was not at a sufficient level with 49% (2.45), and training, material, infrastructural and financial support to improve informatics competence should be actively and continuously provided during the education and working processes. As a result, nurses in Afghanistan are inadequately prepared at this time, and the nursing informatics application areas can provide nurses an advantage in their nursing competence, but informatics education and infrastructure need significant improvements.

Conflict Of Interest: The author declared no conflict of interest.

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AUTHOR INFO

Dr. Alaattin Parlakkilic 

Management Information Systems

Faculty of Economics and Administrative Sciences

Ufuk University,

Incek Sehit Savci Mehmet Selim Kiraz Bulvari

No: 129 (06836)  Ankara/Turkey

Email: aparlakklc@gmail.com

ORCID: 0000-0002-6834-6839

Dr. Volkan Saribas

Yildirim Bayezit University, Industrial Engineering Dept. Ankara, Turkey

Email: saribasvolkan@gmail.com

ORCID: 0000-0002-4819-2123