A study on Singaporean women's acceptance of using mobile phones to seek health information

Integrating usability and social cognitive theories with the technology acceptance model to understand young users’ acceptance of a health information portal

The past decade has seen the proliferation of health information portals; however, consumer acceptance of the portals has proven difficult and rate of use has been limited. This study developed a consumer acceptance model by integrating usability and social cognitive theories with the technology acceptance model to explain young Internet users’ acceptance of health information portals. Participants (n = 201) completed a self-report questionnaire measuring model constructs after attending a usability testing with a typical health information portal. Results showed that the hypothesized model accounted for 56 percent of the variance in behavioral intention to use the portal and explained consumer acceptance well. Both subjective usability and application-specific self-efficacy served as significant antecedents in the model, while application-specific self-efficacy also moderated the effect of subjective usability on perceived ease of use. The findings can help practitioners with the design and implementation of health information portals and other health informatics applications in support of consumer acceptance.

Mobile health service adoption in China

Purpose

Mobile health service (MHS) can provide users with convenient health services and information to reduce their medical costs from aging or other health issues. Previous studies confirm the underdevelopment of the Chinese MHS. The purpose of this paper is to analyze the factors that affect the intention to use MHS.

Design/methodology/approach

This paper develops a research model that integrates personal health differences with theory of planned behavior (TPB) and protection motivation theory (PMT). This model is empirically tested using data from 494 valid questionnaires. Structural equation modeling is used to test the hypotheses.

Findings

Perceived vulnerability to disease, perceived severity of disease, response efficacy and self-efficacy positively affect attitude, thereby exerting a positive influence on the behavioral intention to use MHS. Subjective norms also influence users’ behavioral intention. Personal health status and personal health value have quasi-moderating effects on the relationship between attitude and behavioral intention.

Originality/value

This paper presents an early attempt to conceptualize and validate a research model of MHS acceptance by integrating TPB and PMT in a complementary manner. The integrated model provides a holistic view of people’s intention to use MHS by considering health threat beliefs, individual role (i.e. attitude and self-efficacy) and social influences (i.e. subjective norms). Furthermore, this research highlights the role of two individual health characteristics (i.e. personal health status and personal health value) in MHS adoption. These new findings are beneficial toward an in-depth understanding of technology adoption in the MHS context.

Investigating Factors Impelling the Adoption of e-Health: A Perspective of African Expats in China

The purpose of the study was to analyze the factors affecting the acceptance and adoption of e-Health applications among African expats in China from the patient’s perspective. This research used extended technology acceptance model (TAM) with the addition of privacy and trust. The survey method with the structured questionnaire was used to collect data from more than 300 African expats in three Tier 1 cities of China. Hypotheses were tested using partial least squares (PLS) method, a structural equation modeling (SEM) based statistical technique. The results show that perceived usefulness, perceived ease of use (PEU), and privacy have significant effects on intention to use (INT) e-Health technologies. Moreover, PEU endorses positive impact on perceived usefulness. The results also revealed that gender was partially associated with the acceptance and use of e-Health technologies. However, surprisingly, trust had an insignificant effect on INT of e-Health. The results of the current research provide the foundation for the development of policies and strategies for the enhancement of e-Health services to African expats in China. Moreover, the acceptance model of current study can be modified easily because of its generic approach for the investigation of adoption of e-Health services among other developing countries’ expats in China.

Enablers and barriers to effective diabetes self-management: A multi-national investigation

OBJECTIVE

The study aimed to identify the common gaps in skills and self-efficacy for diabetes self-management and explore other factors which serve as enablers of, and barriers to, achieving optimal diabetes self-management. The information gathered could provide health professionals with valuable insights to achieving better health outcomes with self-management education and support for diabetes patients.

METHODS

International online survey and telephone interviews were conducted on adults who have type 1 or type 2 diabetes. The survey inquired about their skills and self-efficacy in diabetes self-management, while the interviews assessed other enablers of, and barriers to, diabetes self-management. Surveys were analysed using descriptive and inferential statistics. Interviews were analysed using inductive thematic analysis.

RESULTS

Survey participants (N = 217) had type 1 diabetes (38.2%) or type 2 diabetes (61.8%), with a mean age of 44.56 SD 11.51 and were from 4 continents (Europe, Australia, Asia, America). Identified gaps in diabetes self-management skills included the ability to: recognize and manage the impact of stress on diabetes, exercise planning to avoid hypoglycemia and interpreting blood glucose pattern levels. Self-efficacy for healthy coping with stress and adjusting medications or food intake to reach ideal blood glucose levels were minimal. Sixteen participants were interviewed. Common enablers of diabetes self-management included: (i) the will to prevent the development of diabetes complications and (ii) the use of technological devices. Issues regarding: (i) frustration due to dynamic and chronic nature of diabetes (ii) financial constraints (iii) unrealistic expectations and (iv) work and environment-related factors limited patients' effective self-management of diabetes.

CONCLUSIONS

Educational reinforcement using technological devices such as mobile application has been highlighted as an enabler of diabetes self-management and it could be employed as an intervention to alleviate identified gaps in diabetes self-management. Furthermore, improved approaches that address financial burden, work and environment-related factors as well as diabetes distress are essential for enhancing diabetes self-management.

Agricultural Informatization and Technical Efficiency in Maize Production in Zambia

The cropland productivity gap between Africa and the rest of the world is widening. Fortunately, increasing farmers’ access to useful agricultural information reduces the costs of searching for information, thereby leading to higher agricultural productivity and sustainability. This study investigates the association between the adoption of mobile phones to collect agricultural information and farmers’ technical efficiency (TE) in Zambia. Different from previous studies, we focus on the actual use of mobile phones by farmers rather than mere ownership. Farmers were selected using a two-stage sampling procedure, and the Cobb-Douglas (CD) production function is adopted to estimate the association using two approaches—the conventional stochastic production frontier (SPF) and propensity score matching-stochastic production frontier (PSM-SPF) model. In both cases, we found that the use of mobile phones is significantly and positively associated with farmers’ TE. However, the conventional SFP model exaggerates the TE scores by 5.3% due to its failure to mitigate biases from observed variables. Regarding the agricultural growth indicators (income and output) related to TE, a close inspection reveals that increasing mobile phone use to close the TE gap between the two groups could result in a 5.13% and 8.21% reduction in severity of poverty and extreme poverty, respectively. Additional research is essential to corroborate the findings and analyze the potential causal mechanisms. Our study provides strong evidence to promote mobile phone use in agricultural production in rural Zambia.

User acceptance of an app-based adherence intervention: Perspectives from patients taking oral anticancer medications

BACKGROUND

Widespread adoption by patients is imperative for the success of app-based interventions for enhancing adherence to oral anticancer medications. Patients' attitudes and beliefs should be evaluated to understand determinants of their acceptance and adoption of such interventions.

OBJECTIVE

To identify factors that influence cancer patients' intention to adopt an app-based system for enhancing oral anticancer medication adherence.

METHODS

This study was conducted as part of the usability evaluation of an app-based system for enhancing adherence. We followed the grounded theory approach employing audio-recorded face-to-face interviews for data collection from patients taking oral anticancer medications (n = 15) and caregivers of such patients (n = 3). Data analysis involved verbatim transcription of all interviews, coding of the transcripts and field notes, detailed memo writing, and constant comparative evaluation of emergent categories.

RESULTS

A conceptual framework of facilitating and hindering factors for users' adoption intention for an oral anticancer medication adherence app was developed. Findings suggest that facing difficulties in maintaining adherence and patients' perceived superiority of the app over their current methods facilitate adoption intention. In contrast, having to pay, lack of language options and users' perception of low competence in using an app were the hindrance factors.

CONCLUSION

This study showed that adoption of adherence apps could be explained by technology acceptance constructs, such as performance expectancy. Adoption intention was also facilitated by patients perceived vulnerabilities in maintaining adherence to their medications, which was a health behaviour construct. Implementation of app-based programs should address patients' perceived vulnerabilities and relative advantage of the app over their current methods. Clinicians and app developers should also consider the financial, technological and language barriers for end users.

Health information in the digital age: an empirical study of the perceived benefits and costs of seeking and using health information from online sources

OBJECTIVE

This paper aims to explore the determinants of the online health information seeking (OHIS) and usage (OHIU) behaviours of consumers based on the perceived benefits and costs of such activities.

METHODS

This study applies questionnaires and empirical research methods. A questionnaire is designed according to the hypothesis model. A total of 282 questionnaires are obtained from patients and their accompanying families in two large hospitals, and the SPSS 17.0 and AMOS 17.0 (IBM, Almond, NY, USA) software are used to analyse the sample data and to test the research models.

RESULTS

Three key findings are obtained from the analysis. Firstly, functional, learning, social and personal integrative benefits positively affect the OHIS intent of consumers. Secondly, cognitive costs negatively influence the OHIU behaviour of consumers. Thirdly, personal integrative benefits and OHIS behaviour significantly influence the OHIU behaviour of consumers.

CONCLUSION

This paper highlights the differences between OHIS and OHIU based on their impact factors and applies social exchange theory to understand such factors. Online health information providers must improve the ease of use of their websites or applications, enhance the quality of their health information and focus on their functionality.

Factors Affecting Consumer Acceptance of an Online Health Information Portal Among Young Internet Users

Despite the proliferation of health and nursing informatics applications in the past decade, factors influencing consumer acceptance of the applications are not well understood. This study was conducted to investigate factors affecting acceptance of a consumer-used nursing informatics application (ie, online health information portal) within the framework of the Technology Acceptance Model. A cross-sectional study was conducted in which 201 Chinese young adults were invited to participate in usability testing with a typical health information portal and to complete a self-report questionnaire measuring the model's constructs and five hypothesized variables drawn from consumer and portal characteristics. Hierarchical regression analyses were used to test research hypotheses. Fifteen of the 22 research hypotheses were supported. Perceived ease of use and perceived usefulness predicted satisfaction and behavioral intention, respectively, over and above the portal and consumer characteristics examined in the study. All portal and consumer characteristics had significant, although varied, impacts on the original model constructs. This study demonstrated that an adapted Technology Acceptance Model, extended with portal and consumer characteristics, provides an effective means to understand consumer acceptance of health portals. The findings hold important implications for design and implementation strategies to increase the likelihood of acceptance of consumer-used nursing informatics applications.

What Predicts Patients' Adoption Intention Toward mHealth Services in China: Empirical Study

Background

With the increasing concerns about the health of individuals in China and the development of information technology, mHealth enables patients to access health information and interact with doctors anytime and anywhere. Examining patients’ willingness to use mHealth is considered critical because its success depends on the adoption of patients.

Objective

The objective of our study was to explore the determinants of mHealth service adoption among Chinese patients using an extended technology acceptance model (TAM) with trust and perceived risks.

Methods

We conducted a questionnaire-based survey in 3 large hospitals in China and analyzed the data using structural equation modeling.

Results

The results corroborated that the proposed model fits well. Trust, perceived usefulness, and perceived ease of use positively correlated with mHealth service adoption. Privacy and performance risks negatively correlated with the patients’ trust and adoption intention toward mHealth services. In addition, patients’ age and chronic diseases can help predict their trust level and adoption intention toward mHealth, respectively.

Conclusions

We concluded that the TAM generally works in the context of mHealth adoption, although its significance has declined. In addition to technical factors, trust and perceived risks are critical for explaining mHealth service adoption among Chinese patients.

A Systematic Review of the Technology Acceptance Model in Health Informatics

BACKGROUND

One common model utilized to understand clinical staff and patients' technology adoption is the technology acceptance model (TAM).

OBJECTIVE

This article reviews published research on TAM use in health information systems development and implementation with regard to application areas and model extensions after its initial introduction.

METHOD

An electronic literature search supplemented by citation searching was conducted on February 2017 of the Web of Science, PubMed, and Scopus databases, yielding a total of 492 references. Upon eliminating duplicates and applying inclusion and exclusion criteria, 134 articles were retained. These articles were appraised and divided into three categories according to research topic: studies using the original TAM, studies using an extended TAM, and acceptance model comparisons including the TAM.

RESULTS

The review identified three main information and communication technology (ICT) application areas for the TAM in health services: telemedicine, electronic health records, and mobile applications. The original TAM was found to have been extended to fit dynamic health service environments by integration of components from theoretical frameworks such as the theory of planned behavior and unified theory of acceptance and use of technology, as well as by adding variables in specific contextual settings. These variables frequently reflected the concepts subjective norm and self-efficacy, but also compatibility, experience, training, anxiety, habit, and facilitators were considered.

CONCLUSION

Telemedicine applications were between 1999 and 2017, the ICT application area most frequently studied using the TAM, implying that acceptance of this technology was a major challenge when exploiting ICT to develop health service organizations during this period. A majority of the reviewed articles reported extensions of the original TAM, suggesting that no optimal TAM version for use in health services has been established. Although the review results indicate a continuous progress, there are still areas that can be expanded and improved to increase the predictive performance of the TAM.

Understanding the Acceptance of an eHealth Technology in the Early Stages of Development: An End-User Walkthrough Approach and Two Case Studies

Background

Studies that focus on the acceptance of an electronic health (eHealth) technology generally make use of surveys. However, results of such studies hold little value for a redesign, as they focus only on quantifying end-user appreciation of general factors (eg, perceived usefulness).

Objective

We present a method for understanding end-user acceptance of an eHealth technology, early in the development process: The eHealth End-User Walkthrough.

Methods

During a walkthrough, a participant is guided by using the technology via a scenario, a persona, and a low-fidelity protoype. A participant is questioned about factors that may affect acceptance during and after the demonstration. We show the value of the method via two case studies.

Results

During the case studies, participants commented on whether they intend to use a technology and why they would (not) use its main features. They also provided redesign advice or input for additional functions. Finally, the sessions provide guidance for the generation of business models and implementation plans.

Conclusions

The eHealth End-User Walkthrough can aid design teams in understanding the acceptance of their eHealth application in a very early stage of the design process. Consequently, it can prevent a mismatch between technology and end-users’ needs, wishes and context.

Online health information seeking among women: the moderating role of health consciousness

Purpose

The purpose of this paper is two fold: to test the moderating effect of health consciousness (HC) on the influence of attitude towards internet (AI) internet usage for health information seeking (IHI) behaviour; and examine whether HC moderates the influence of perceived health risk (PHR) on the internet usage for health information which is mediated by perceived usefulness of internet (PUI) and AI usage in an integrated model underpinned by health belief model and the technology acceptance model.

Design/methodology/approach

Data obtained for the current study were collected using convenience sampling and the sample consisted of women who not only have internet access but used the internet in their daily life. Partial Least Squares Structural Equation Modelling (PLS-SEM) method was used to test the research hypotheses developed from a sample of 270 respondents.

Findings

Findings revealed that HC moderates the influence of AI use for health information seeking. In addition, the results also showed that the positive indirect effect of PHR on IHI through PUI and AI usage is significant for high level of HC but not for the medium and low levels of HC.

Originality/value

Major contribution of this study is in the testing of the moderating role of HC on the mediating effect of perceived usefulness of the internet and attitude on PHR and IHI.

Public attitudes towards mobile health in Singapore: a cross-sectional study

BACKGROUND

Smartphone-mediated mobile health (mHealth) may assist patients with medication adherence, and disease monitoring. This study aimed to describe awareness and usage of, and attitudes towards, mHealth among the public in Singapore who own a smartphone. It also aimed to identify factors that influenced the above in the study population.

METHODS

An online cross-sectional survey was administered via convenience sampling in November 2017. Participants were included if they were at least 18 years old and owned a smartphone. No identifiable data was collected. Responses were summarized using descriptive statistics. Multiple logistic regression analysis was used to identify factors associated with awareness and usage of, and attitudes towards, mHealth.

RESULTS

Participants (n=199) were mostly of Chinese ethnicity (84.4%), female (64.8%), young (mean age 33.7 years), and generally healthy (86.9% reported no chronic medical conditions). On average, participants were aware of 4.4 out of 7 mHealth functions and used 2.2 functions. Managing appointments, and fitness/diet tracking were the most well-known (93.5% and 82.4% respectively), and widely used (80.6% and 59.8% respectively) functions. A simple interface, data security, and being free to use, were rated as the most important factors influencing participants' willingness to use mHealth. Most (64.3%) participants were keen to learn to use mHealth in future, 49.7% believed mHealth could help improve their health, but only 13.1% were willing to pay for it. Being employed (OR 3.71) was associated with higher mHealth usage, adjusted for baseline smartphone usage. Participants living in non-subsidized housing were more keen to try (OR 3.18), and willing to pay (OR 3.36) for mHealth.

CONCLUSIONS

Participants generally held positive attitudes towards mHealth, although usage was low. Lack of willingness to pay, and socioeconomic factors, are potential barriers to the widespread adoption of mHealth. Future research specifically involving patients is needed.

Patients' Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test

BACKGROUND

Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology.

OBJECTIVE

The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients' acceptance of smartphone health technology for chronic disease management.

METHODS

Multiple theories and factors that may influence patients' acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients' acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients' actual use of a smartphone health app. The partial least square method was used to test the theoretical model.

RESULTS

The model accounted for .412 of the variance in patients' intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients' smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients' intentions to use the technology. Age and gender had no significant influence on patients' acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management.

CONCLUSIONS

This study developed a theoretical model to predict patients' acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients' awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community.

Students Seeking Health-related Information over Internet

The use of Internet to search information related to health has become a common phenomenon. This article investigates the seeking of health-related information of the college going students over the Internet. The researchers have tested the technology acceptance model (TAM) to determine the behavioural intention of the students to seek health-related information over the Internet. A self-administered questionnaire was distributed among the students who were involved in Internet use. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to the responded data. The results showed that it is the perceived usefulness (PU) which has a direct impact on the behavioural intention of the Internet users to search health-related information over the Internet.

A study on students' acceptance of mobile phone use to seek health information in South Africa

BACKGROUND

In South Africa, inequitable access to healthcare information has made many young people with limited resources more vulnerable to health risks. Mobile phones present a unique opportunity to address this problem due to the high penetration of mobile phones in South Africa and the popularity of these devices among young adults.

OBJECTIVE

This research sought to examine the adoption of mobile phones to access health information among students at a traditional university in the Eastern Cape, South Africa.

METHOD

A cross-sectional survey approach was used to collect information from a convenience sample of 202 university students (58 males; 104 females), the majority (71.3%) of whom were aged between 18 and 27 years and of Black African ethnicity (75.2%). The unified theory of acceptance and use of technology (UTAUT) framework formed the theoretical foundation for the questionnaire. A research model was developed to test the hypotheses that behavioural intention to use a mobile phone to access health information would be influenced by: perceived usefulness (PU), perceived effort, social influence (SI), attitude towards technology (AT) and mobile phone experience.

RESULTS

Factor analyses indicated that the research model explained 36% of the variance in behavioural intention to use mobile devices to search for health-related queries, with PU being the largest predictor, followed by mobile experience, SI, and AT. Perceived effort did not make a statistically significant contribution.

CONCLUSION

Using mobile phones to disseminate health information to students is a useful, convenient, and cost-effective health-promotion strategy. This research has contributed to the body of knowledge concerning the applicability of the UTAUT framework to study the adoption of technology and provided useful information to guide future research and implementation of mHealth initiatives.

Seeking Health Information Online: The Moderating Effects of Problematic Situations on User Intention

Purpose

This study investigates how online user intention in searching health information is affected by problematic situations.

Design/methodology/approach

Based on the Theory of Reasoned Action, the Technology Acceptance Model, and Sense-making theory, we propose two dimensions of problematic situations: urgency and severity of health issues being searched online. Data were collected through a questionnaire survey among 214 Wuhan University students and analyzed using hierarchical regression analysis.

Findings

Perceived usefulness, perceived ease of use, and subjective norm can influence user intention to seek health information online. The urgency of problematic situations has a negative moderating effect on the relationship between perceived ease of use and user intention and the relationship between subjective norm and user intention. The severity of problematic situations has a negative moderating effect on the relationship between subjective norm and user intention.

Research limitations

The respondents of the survey are limited to students in one Chinese university, so whether this study’s results can be applied to another population or not remains to be verified. In addition, only two dimensions of problematic situations are considered in this study.

Practical implications

The paper puts forward the moderating effect of problematic situations and verifies it, which is the compensation for online health information-seeking behavior research. Besides, our analyses have implications for professional design of health care systems and related consumer information searches, and improve their performance.

Originality/value

Previous work has reported the effects of problematic situation on user intention to seek health information online, ignoring its influence on other factors. This empirical study extends that work to identify the influence of problematic situation when seeking intention-behavior data in two dimensions, urgency and severity.

A meta-analysis of e-health applications acceptance

Purpose

The increasing importance of electronic health (e-health) has raised the significance of exploring the factors influencing the users’ acceptance of e-health applications. There has been an extensive usage of the technology acceptance model (TAM) in e-health applications acceptance research. However, not all TAM relationships are borne out in all the studies. There is a variation in predicted effects in several studies with different user type and application type. The purpose of this paper is to bridge a research gap by providing a holistic view of the e-health applications acceptance research by integrating the findings of existing relevant literature.

Design/methodology/approach

A statistical meta-analysis of the effect size of causal relationships between common TAM constructs was conducted on 111 peer-reviewed academic studies published in various journals.

Findings

The results confirm the validity and robustness of the TAM in e-health applications acceptance research. Further, a moderator analysis based on user type and e-health application type demonstrated that the effect size of causal relationships between TAM constructs majorly depends on the user type, but not on e-health application type.

Research limitations/implications

This research provides a ready reference of the existing studies on e-health applications acceptance to the researchers. Further, if researchers or practitioners want to learn more about the particular user or application type, they may find the results valuable.

Practical implications

This research suggests that the general public can be used as the surrogates for patients in e-health applications acceptance research. The implementation strategy found successful for medical staff may not work for general public and patients. This research also suggests ways to enhance acceptance of e-health applications among different user groups.

Originality/value

The research is original and is based on the existing literature and its interpretation.

Moderating factors influencing adoption of a mobile chronic disease management system in China

Mobile chronic disease management systems (MCDMS) have become increasingly important in recent years, but in China, challenges remain for their adoption. Existing empirical studies have not completely explored the adoption behavior of potential MCDMS users. This article presents a study in which we investigated factors that influence chronically ill patients in China and their families to adopt or decline to use MCDMS. We applied a research model based on the technology acceptance model (TAM) as well as four contextual constructs (perceived disease threat, perceived risk, initial trust, and technology anxiety) to a survey of 279 potential MCDMS service participants in China. Our key findings include: (1) as consistent with current research, both perceived usefulness and perceived ease of use have positive impact on potential users' MCDMS adoption intention; (2) both perceived disease threat and initial trust have positive impact on MCDMS adoption intention; (3) the impact of perceived risk is negative, and technology anxiety has negative impact on perceived ease of use of MCDMS; (4) young people place more importance on their perceptions of usefulness, ease of operation, and disease threat than middle-aged and older users; (5) family members are more influenced by their perception of ease of use and disease threat than chronically ill patients, while chronically ill patients place more importance on perceived usefulness than family members. This article concludes by discussing the implications of our study for research and practice, as well as limitations and future research directions.

Adoption of Mobile Devices in the Australian Healthcare

In recent years, the potential use of mobile devices has significantly positively impacted healthcare globally. Despite global claims of widespread use of mobile devices in healthcare, its adoption in the Australian healthcare context is slow. Limited research is available on slow adoption of mobile devices in the Australian healthcare context. Therefore, this chapter is designed to investigate the factors influencing adoption of mobile devices from healthcare professionals' perspective and develop a health specific conceptual framework. The influential factors for the adoption of mobile devices in the Australian health context may be intention, individual readiness, advantages, safety issues, features, self-efficacy, complexity, training, compatibility, social influences, age and gender.

A review of theory-driven models of trust in the online health context

Generally speaking, theory-driven studies are more successful in producing a desired result than those missing the theoretical grounds. This paper aims to provide an informal assessment of theoretical foundations of trust models in online health context. After a review of literature, 12 theory-driven models were analysed in detail. The findings showed that previous models benefited from different theories within different disciplines (mostly from psychology). The technology acceptance model, the elaboration likelihood model, the theory of reasoned action and the health belief model were the most frequently used theoretical frameworks. The reviewed models were able to account for 23–69% of variance in dependent variables. In conclusion, although the health studies are very open to interdisciplinary theories, the inclusion of institutional and national cultural theories in future researches may enrich the current individualistic perspective with a broader context of society that jointly form trust behaviour and credibility judgements of health consumers in digital health environments.

An empirical study of mHealth adoption in a developing country: the moderating effect of gender concern

BACKGROUND

mHealth has become a valuable tool for providing health care services in developing countries. Despite the potential benefits of mHealth, its adoption remains a very challenge in developing countries like Bangladesh. The aim of this study is to investigate the factors that affect the adoption of mHealth services in Bangladesh using Extended Technology Acceptance Model (TAM).

METHODS

Data were collected from over 250 respondents in Dhaka, Bangladesh. The data were analyzed using the Partial Least Squares (PLS) method, a statistical analysis technique based on the Structural Equation Modeling (SEM).

RESULTS

The study found that perceived ease of use, perceived usefulness and subjective norm (p < 0.05) had significant positive impact on the intention to adopt mHealth services. Surprisingly, the effects of personal innovativeness in IT (p > 0.05) on mHealth adoption were insignificant. This study also revealed that gender was strongly associated with the adoption and use of mHealth in developing countries.

CONCLUSIONS

The findings of this study can be used by government, policy makers, and mobile phone Company to maximize the acceptance of mHealth services in Bangladesh. The paper concludes with a discussion of research results and draws several implications for future research.

Investigating factors influencing the adoption of e-Health in developing countries: A patient's perspective

PURPOSE

The aim of the study was to investigate factors that influence the adoption and use of e-Health applications in Bangladesh from citizens' (patients') perspectives by extending the technology acceptance model (TAM) to include privacy and trust.

METHODS

A structured questionnaire survey was used to collect data from more than 350 participants in various private and public hospitals in Dhaka, the capital city of Bangladesh. The data were analyzed using the partial least-squares (PLS) method, a statistical analysis technique based on structural equation modeling (SEM).

RESULTS

The study determined that perceived ease of use and perceived usefulness and trust (p < 0.05) were significant factors influencing the intention to adopt e-Health. Privacy (p > 0.05) was identified as a less significant factor in the context of e-Health in Bangladesh. The findings also revealed that gender was strongly associated with the adoption and use of e-Health services.

CONCLUSIONS

The findings of the present study contribute to the development of strategies and policies to enhance e-Health services in Bangladesh. Furthermore, as a result of the generic approach used in this study, the acceptance model developed can be easily modified to investigate the adoption of e-Health in other developing countries.

What Predicts Patients' Willingness to Undergo Online Treatment and Pay for Online Treatment? Results from a Web-Based Survey to Investigate the Changing Patient-Physician Relationship

Background

Substantial research has focused on patients’ health information–seeking behavior on the Internet, but little is known about the variables that may predict patients’ willingness to undergo online treatment and willingness to pay additionally for online treatment.

Objective

This study analyzed sociodemographic variables, psychosocial variables, and variables of Internet usage to predict willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the general practitioner (GP).

Methods

An online survey of 1006 randomly selected German patients was conducted. The sample was drawn from an e-panel maintained by GfK HealthCare. Missing values were imputed; 958 usable questionnaires were analyzed. Variables with multi-item measurement were factor analyzed. Willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the GP were predicted using 2 multiple regression models.

Results

Exploratory factor analyses revealed that the disposition of patients’ personality to engage in information-searching behavior on the Internet was unidimensional. Exploratory factor analysis with the variables measuring the motives for Internet usage led to 2 separate factors: perceived usefulness (PU) of the Internet for health-related information searching and social motives for information searching on the Internet. Sociodemographic variables did not serve as significant predictors for willingness to undergo online treatment offered by the GP, whereas PU (B=.092, P=.08), willingness to communicate with the GP more often in the future (B=.495, P<.001), health-related information–seeking personality (B=.369, P<.001), actual use of online communication with the GP (B=.198, P<.001), and social motive (B=.178, P=.002) were significant predictors. Age, gender, satisfaction with the GP, social motive, and trust in the GP had no significant impact on the willingness to pay additionally for online treatment, but it was predicted by health-related information–seeking personality (B=.127, P=.07), PU (B=–.098, P=.09), willingness to undergo online treatment (B=.391, P<.001), actual use of online communication with the GP (B=.192, P=.001), highest education level (B=.178, P<.001), monthly household net income (B=.115, P=.01), and willingness to communicate with the GP online more often in the future (B=.076, P=.03).

Conclusions

Age, gender, and trust in the GP were not significant predictors for either willingness to undergo online treatment or to pay additionally for online treatment. Willingness to undergo online treatment was partly determined by the actual use of online communication with the GP, willingness to communicate online with the GP, health information–seeking personality, and social motivation for such behavior. Willingness to pay extra for online treatment was influenced by the monthly household net income category and education level. The results of this study are useful for online health care providers and physicians who are considering offering online treatments as a viable number of patients would appreciate the possibility of undergoing an online treatment offered by their GP.

Cultural Influence on Adoption and Use of e-Health: Evidence in Bangladesh

BACKGROUND

E-health is an important initiative among the public and private hospitals in Bangladesh in the last few years. The factors influencing e-health adoption have been a well-investigated research area in both developed and developing countries. However, there have been only a few studies exploring the role of cultural factors in the adoption and use of e-health, particularly in developing countries. In this study, we investigated the influence of culture on the adoption of e-health in Bangladesh.

MATERIALS AND METHODS

This study developed a more adequate research framework by integrating Hofstede's cultural dimension model and the Technology Acceptance Model (TAM). A structured questionnaire was used to collect data from respondents in different private and public hospitals in Bangladesh. The partial least squares method, a statistical analysis technique based on the Structural Equation Model, was used to analyze the collected data.

RESULTS

The study found that cultural dimensions such as Power Distance, Masculinity, and Restraint had significant impacts on Intention to Use e-Health, whereas Uncertainty Avoidance, Collectivism, and Pragmatism had no significant impact on Intention to Use e-Health in Bangladesh. The results also revealed that Perceived Usefulness was a significant indicator of e-health adoption decisions, whereas Perceived Ease of Use was an insignificant predictor of e-health adoption.

CONCLUSIONS

The findings of this study may assist governments, organizations, and policy makers to understand the key factors affecting e-health adoption and to develop strategies and policies to enhance e-health services in Bangladesh.

The health information seeking and usage behavior intention of Chinese consumers through mobile phones

Purpose

– Although the health information seeking behavior of consumers through the internet has received great attention, limited attempt has been made to integrate both the health information seeking behavior and the usage behavior in a mobile online context. The purpose of this paper is to explore the factors that influence consumer mobile health information seeking (MHIS) and usage behavior based on information quality, perceived value, personal health value, and trust.

Design/methodology/approach

– A survey was conducted to collect data. A two-step approach of structure equation modeling based was used to test the measurement model and hypothesis model.

Findings

– Information quality, perceived value, and trust were found to have positive effects on both the intention to seek and to use health information, and that the intention to seek affects the intention to use. Among the three components of perceived value, the utilitarian and epistemic values were found to have significant effects on intention to seek. In addition, the current health status of health consumers moderates the relationships between MHIS and usage intention and their determinants.

Originality/value

– Studies have primarily focussed on online health information seeking behavior, whereas a few of these studies have examined the seeking behavior intention and the usage behavior intention in a general model. The results indicate that health information usage behavior intention is closely related to the seeking behavior intention in the mobile context, which enriches the research on the relationship between information seeking and its outcomes. Furthermore, this study highlights the impact of information quality, perceived value, and trust on the intention to seek, and the impacts of information quality and trust on the intention to use, which have been overlooked in previous studies on MHIS.

The influence of telemedicine experience on physicians' perceptions regarding adoption

BACKGROUND

The purposes of this study were to explore the factors influencing physicians' intention of adopting telemedicine and to conduct a multigroup analysis comparing the perceptions about telemedicine adoption between experienced and inexperienced physicians. Based on the Theory of Planned Behavior, we conducted a cross-sectional survey to collect data from 15 hospitals in Taiwan.

MATERIALS AND METHODS

In total, 106 valid questionnaires were returned. We used structural equation modeling to analyze the collected data.

RESULTS

Attitude (AT), subjective norm (SN), and perceived behavioral control (PBC) were found to be positively related to behavioral intention (BI) for combined data. Moreover, the relationships between AT→BI, SN→BI, and PBC→BI varied significantly between experienced and inexperienced physicians. Experienced physicians held stronger beliefs about the relationship between AT→BI than inexperienced physicians.

CONCLUSIONS

According to the results, our study suggests that differing strategies for experienced and inexperienced physicians must be formulated to substantially boost the adoption of telemedicine technology.

Integrating health belief model and technology acceptance model: an investigation of health-related internet use

BACKGROUND

Today, people use the Internet to satisfy health-related information and communication needs. In Malaysia, Internet use for health management has become increasingly significant due to the increase in the incidence of chronic diseases, in particular among urban women and their desire to stay healthy. Past studies adopted the Technology Acceptance Model (TAM) and Health Belief Model (HBM) independently to explain Internet use for health-related purposes. Although both the TAM and HBM have their own merits, independently they lack the ability to explain the cognition and the related mechanism in which individuals use the Internet for health purposes.

OBJECTIVE

This study aimed to examine the influence of perceived health risk and health consciousness on health-related Internet use based on the HBM. Drawing on the TAM, it also tested the mediating effects of perceived usefulness of the Internet for health information and attitude toward Internet use for health purposes for the relationship between health-related factors, namely perceived health risk and health consciousness on health-related Internet use.

METHODS

Data obtained for the current study were collected using purposive sampling; the sample consisted of women in Malaysia who had Internet access. The partial least squares structural equation modeling method was used to test the research hypotheses developed.

RESULTS

Perceived health risk (β=.135, t1999=2.676) and health consciousness (β=.447, t1999=9.168) had a positive influence on health-related Internet use. Moreover, perceived usefulness of the Internet and attitude toward Internet use for health-related purposes partially mediated the influence of health consciousness on health-related Internet use (β=.025, t1999=3.234), whereas the effect of perceived health risk on health-related Internet use was fully mediated by perceived usefulness of the Internet and attitude (β=.029, t1999=3.609). These results suggest the central role of perceived usefulness of the Internet and attitude toward Internet use for health purposes for women who were health conscious and who perceived their health to be at risk.

CONCLUSIONS

The integrated model proposed and tested in this study shows that the HBM, when combined with the TAM, is able to predict Internet use for health purposes. For women who subjectively evaluate their health as vulnerable to diseases and are concerned about their health, cognition beliefs in and positive affective feelings about the Internet come into play in determining the use of health-related Internet use. Furthermore, this study shows that engaging in health-related Internet use is a proactive behavior rather than a reactive behavior, suggesting that TAM dimensions have a significant mediating role in Internet health management.

Complementary relationships between traditional media and health apps among american college students

OBJECTIVE

This study explored the potential relationships between existing media and health apps for health information among college students.

PARTICIPANTS

This study collected and analyzed a total of 408 surveys from students of 7 universities across the United States.

METHODS

In order to explore the research questions and test the hypotheses, quantitative data from the online survey were analyzed through hierarchical regression analyses.

RESULTS

Results from the hierarchical regression analyses indicated that the perceived credibility of health information from traditional mass media was positively and significantly associated with college students' perception of health apps. However, there was no significant effect in regards to online media.

CONCLUSIONS

This study's consideration of the relationships between existing media and health apps may guide health practitioners in their strategic approaches to improve the well-being of college students.

Cognitive factors of using health apps: systematic analysis of relationships among health consciousness, health information orientation, eHealth literacy, and health app use efficacy

BACKGROUND

Interest in smartphone health apps has been increasing recently. However, we have little understanding of the cognitive and motivational factors that influence the extent of health-app use.

OBJECTIVE

This study aimed to examine the effects of four cognitive factors-health consciousness, health information orientation, eHealth literacy, and health-app use efficacy-on the extent of health-app use. It also explored the influence of two different use patterns-information and information-behavior use of health apps-with regard to the relationships among the main study variables.

METHODS

We collected and analyzed 765 surveys in South Korea. According to the results, there was a negligible gender difference: males (50.6%, 387/765) and females (49.4%, 378/765). All participants were adults whose ages ranged from 19 to 59. In order to test the proposed hypotheses, we used a path analysis as a specific form of structural equation modeling.

RESULTS

Through a path analysis, we discovered that individuals' health consciousness had a direct effect on their use of health apps. However, unlike the initial expectations, the effects of health information orientation and eHealth literacy on health-app use were mediated by health-app use efficacy.

CONCLUSIONS

The results from the path analysis addressed a significant direct effect of health consciousness as well as strong mediating effects of health-app use efficacy. These findings contribute to widening our comprehension of the new, digital dimensions of health management, particularly those revolving around mobile technology.

A survey aimed at general citizens of the US and Japan about their attitudes toward electronic medical data handling

Objectives: To clarify the views of the general population of two countries (US and Japan), concerning the handling of their medical records electronically. Methods: We contacted people nationwide in the United States at random via Random Digit Dialing (RDD) to obtain 200 eligible responders. The questionnaire was for obtaining the information on their attitudes towards handling of their medical records, disclosure of the name of disease, secondary usage of information, compiling their records into a lifelong medical record, and access to their medical records on the Internet. We had also surveyed people of Shizuoka prefecture in Japan using same questionnaires sent by mail, for which we obtained 457 valid answers. Results: Even in an unidentifiable manner, US people feel profit-oriented usage of medical data without specific consent is not acceptable. There is a significant difference between usage of unidentifiable medical data for profit (about 50% feel negatively) and for official/research purposes (about 30% feel negatively). About 60% of the US responders have a negative view on the proposal that unidentifiable medical information be utilized for profit by private companies to attain healthcare cost savings. As regards compiling a lifelong medical record, positive answers and negative answers are almost equally divided in the US (46% vs. 38%) while more positive attitudes are seen in Japan (74% vs. 12%). However, any incentive measures aimed at changing attitudes to such a compiling including the discount of healthcare costs or insurance fees are unwelcomed by people regardless of their age or health condition in both surveys. Regarding the access to their own medical record via the Internet, 38% of the US responders feel this is unacceptable while 50.5% were willing to accept it. Conclusions: Participants from the US think that the extent of the sharing their identifiable medical records should be limited to the doctors-in-charge and specified doctors referred to by their own doctors. On the other hand, Japanese people find it acceptable for doctors of the same hospital to share their medical records. Even in unidentifiable manner, people in both countries think the profits resulting from the secondary use of medical records should be returned to the public or patients. With regard to compiling a lifelong medical record, participants from the US provided both positive answers and negative answers, while more positive attitudes were observed in Japan. However, any incentives or measures aimed at changing attitudes towards such a compilation, including provision of a discount on healthcare costs or insurance fees, were not welcomed by participants from US as well as those from Japan, regardless of their age or health condition.

mHealth Series: Factors influencing sample size calculations for mHealth-based studies - A mixed methods study in rural China

Background

An important issue for mHealth evaluation is the lack of information for sample size calculations.

Objective

To explore factors that influence sample size calculations for mHealth–based studies and to suggest strategies for increasing the participation rate.

Methods

We explored factors influencing recruitment and follow–up of participants (caregivers of children) in an mHealth text messaging data collection cross–over study. With help of village doctors, we recruited 1026 (25%) caregivers of children under five out of the 4170 registered. To explore factors influencing recruitment and provide recommendations for improving recruitment, we conducted semi–structured interviews with village doctors. Of the 1014 included participants, 662 (65%) responded to the first question about willingness to participate, 538 (53%) responded to the first survey question and 356 (35%) completed the text message survey. To explore factors influencing follow–up and provide recommendations for improving follow–up, we conducted interviews with participants. We added views from the researchers who were involved in the study to contextualize the findings.

Results

We found several factors influencing recruitment related to the following themes: experiences with recruitment, village doctors’ work, village doctors’ motivations, caregivers’ characteristics, caregivers’ motivations. Village doctors gave several recommendations for ways to recruit more caregivers and we added our views to these. We found the following factors influencing follow–up: mobile phone usage, ability to use mobile phone, problems with mobile phone, checking mobile phone, available time, paying back text message costs, study incentives, subjective norm, culture, trust, perceived usefulness of process, perceived usefulness of outcome, perceived ease of use, attitude, behavioural intention to use, and actual use. From our perspective, factors influencing follow–up were: different caregivers participating in face–to–face and text message survey, sending text messages manually, participants responding incorrectly, and technical issues. Participants provided several recommendations for improving follow–up and we added our views to these.

Conclusions

This is the first study to evaluate factors influencing recruitment and follow–up of participants in an mHealth study in a middle–income setting. More work is needed to assess effectiveness of our suggested strategies. This work would improve evaluation of mHealth interventions.

Patients' acceptance towards a web-based personal health record system: an empirical study in Taiwan

The health care sector has become increasingly interested in developing personal health record (PHR) systems as an Internet-based telehealthcare implementation to improve the quality and decrease the cost of care. However, the factors that influence patients' intention to use PHR systems remain unclear. Based on physicians' therapeutic expertise, we implemented a web-based infertile PHR system and proposed an extended Technology Acceptance Model (TAM) that integrates the physician-patient relationship (PPR) construct into TAM's original perceived ease of use (PEOU) and perceived usefulness (PU) constructs to explore which factors will influence the behavioral intentions (BI) of infertile patients to use the PHR. From ninety participants from a medical center, 50 valid responses to a self-rating questionnaire were collected, yielding a response rate of 55.56%. The partial least squares (PLS) technique was used to assess the causal relationships that were hypothesized in the extended model. The results indicate that infertile patients expressed a moderately high intention to use the PHR system. The PPR and PU of patients had significant effects on their BI to use PHR, whereas the PEOU indirectly affected the patients' BI through the PU. This investigation confirms that PPR can have a critical role in shaping patients' perceptions of the use of healthcare information technologies. Hence, we suggest that hospitals should promote the potential usefulness of PHR and improve the quality of the physician-patient relationship to increase patients' intention of using PHR.

An investigation of the effect of nurses' technology readiness on the acceptance of mobile electronic medical record systems

BACKGROUND

Adopting mobile electronic medical record (MEMR) systems is expected to be one of the superior approaches for improving nurses' bedside and point of care services. However, nurses may use the functions for far fewer tasks than the MEMR supports. This may depend on their technological personality associated to MEMR acceptance. The purpose of this study is to investigate nurses' personality traits in regard to technology readiness toward MEMR acceptance.

METHODS

The study used a self-administered questionnaire to collect 665 valid responses from a large hospital in Taiwan. Structural Equation modeling was utilized to analyze the collected data.

RESULTS

Of the four personality traits of the technology readiness, the results posit that nurses are optimistic, innovative, secure but uncomfortable about technology. Furthermore, these four personality traits were all proven to have a significant impact on the perceived ease of use of MEMR while the perceived usefulness of MEMR was significantly influenced by the optimism trait only. The results also confirmed the relationships between the perceived components of ease of use, usefulness, and behavioral intention in the Technology Acceptance Model toward MEMR usage.

CONCLUSIONS

Continuous educational programs can be provided for nurses to enhance their information technology literacy, minimizing their stress and discomfort about information technology. Further, hospital should recruit, either internally or externally, more optimistic nurses as champions of MEMR by leveraging the instrument proposed in this study. Besides, nurses' requirements must be fully understood during the development of MEMR to ensure that MEMR can meet the real needs of nurses. The friendliness of user interfaces of MEMR and the compatibility of nurses' work practices as these will also greatly enhance nurses' willingness to use MEMR. Finally, the effects of technology personality should not be ignored, indicating that hospitals should also include more employees' characteristics beyond socio-demographic profiles in their personnel databases.