College of Medicine (COM-R), King Saud bin-Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. The Ministry of National Guard Health Affairs (MNGHA) serves National Guard's employees and their families and Saudi nationals in specific cases such as cancer patients. The MNGHA has installed systems and networks in all of its hospitals and it has implemented electronic medical record (EMR) systems, Picture Archiving and Communication Systems (PACS), and other systems.
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. 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 . Medical students of both sexes, in both steams, during the study period will make the target of this study.
A cross-sectional study to assess the levels of knowledge, attitude and practice of medical students on e-health in medical field. Students were 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.
A previously validated self-administered questionnaire  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]. For the purpose of this study, e-health was defined as “internet-based health-related information seeking and developing to support health services locally, regionally, and globally” . However, this definition was concerned with only patients seeking health information on the internet. Thus, this survey was not designed to include telemedicine as a subset of e-health.
Knowledge: Knowledge about e-health was assessed in terms of 3 domains: what is e-health (13 statements), fields of its application (7 statements) and methods of its use (6 statements). 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 in each domain for each student was calculated by summing scores for all responses, and the overall level of knowledge was assessed by summing scores for all reponses in the 3 domains, 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.
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. To predict the significant predictors of student’s practice, multiple regression analysis was applied. Significance was considered at p-value <0.05.
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].