Date of Award

May 2016

Degree Type


Degree Name

Doctor of Philosophy


Biomedical and Health Informatics

First Advisor

Timothy B. Patrick

Committee Members

Casper G. Bendixsen, Kelsey M. Schwei, Priya Nambisan, Jake Luo, Jennifer Fink


Healthcare, Informatics, mHealth, Mobile, Physician, Rural


Introduction: Technology is as much rural as it is urban, but mobile health (mHealth) could have a unique impact on health and quality of life for rural populations. The adoption of mobile technologies has soared in recent decades leading to new possibilities for mHealth use. This project considers the impact of these technologies on rural populations. Specifically, it is focused on assessing the barriers of physicians and healthcare organizations to adopt mHealth into their care plans. Gaps in knowledge exist in assessing organizational readiness for mHealth adoption, the use of patient-reported data, and the impact on rural healthcare. This project seeks to address those gaps.

Methods: Utilizing semi-structured, open-ended interviews as the primary instrument of inquiry, clinicians’ current practices, motivators, and barriers to the use of mHealth technologies were identified. Thematic analysis revealed code-category linkages that identify the complex nature of a rural healthcare organization’s current climate from a physician perspective. A thematic map was developed to visualize the flow from category to code. Those linkages were then utilized to construct a refined mHealth readiness model.

Results: Thirteen Wisconsin-based clinicians from the Marshfield Clinic Health System participated in interviews and consults. The interviews uncovered current practices, with 53.8% of participants reporting that they do encourage the use of mHealth apps or wearable devices with patients. Perceived barriers to adoption were categorized into three primary pillars – personal (clinician), patient, and organizational. Organizational was the most prominent category, with codes such as time, uniformity, and policy/direction.

Conclusion: Clinicians, particularly physicians have tight schedules with very limited time for continuing education, research, or exploration into new technologies. Limited clinician time can lead to a lack of familiarity with new and emerging technologies. Clinicians are interested and motivated to learn more, but also need assistance with screening and quality reviews. Organizationally-led directives and suggestions, such as a menu of technologies, would be used.

There are some risks that would need to be mitigated, but if organizations were prepared to manage mHealth it is very likely that physicians could improve the quality of care for their patients. However, many organizations including Marshfield Clinic are not yet prepared to prescribe or prohibit the use of mHealth technologies. Healthcare institutions should consider investing in mHealth analysis, tool development, and the promotion/recommendation of sanctioned tools for clinicians to use with patients.