Individual motivation and social influence: a study of telemedicine adoption in China based on social cognitive theory

Digital transformation of mental health therapy by integrating digitalized cognitive behavioral therapy and eye movement desensitization and reprocessing

Digital therapy has gained popularity in the mental health field because of its convenience and accessibility. One major benefit of digital therapy is its ability to address therapist shortages. Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that can develop after an individual experiences or witnesses a traumatic event. Digital therapy is an important resource for individuals with PTSD who may not have access to traditional in-person therapy. Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are two evidence-based psychotherapies that have shown efficacy in treating PTSD. This paper examines the mechanisms and clinical symptoms of PTSD as well as the principles and applications of CBT and EMDR. Additionally, the potential of digital therapy, including internet-based CBT, video conferencing-based therapy, and exposure therapy using augmented and virtual reality, is explored. This paper also discusses the engineering techniques employed in digital psychotherapy, such as emotion detection models and text analysis, for assessing patients' emotional states. Furthermore, it addresses the challenges faced in digital therapy, including regulatory issues, hardware limitations, privacy and security concerns, and effectiveness considerations. Overall, this paper provides a comprehensive overview of the current state of digital psychotherapy for PTSD treatment and highlights the opportunities and challenges in this rapidly evolving field.

Exploring Nurses' Behavioural Intention to Adopt AI Technology: The Perspectives of Social Influence, Perceived Job Stress and Human-Machine Trust

AIM

This study examines how social influence, human-machine trust and perceived job stress affect nurses' behavioural intentions towards AI-assisted care technology adoption from a new perspective and framework. It also explores the interrelationships between different types of social influence and job stress dimensions to fill gaps in academic literature.

DESIGN

A quantitative cross-sectional study.

METHODS

Five hospitals in Taiwan that had implemented AI solutions were selected using purposive sampling. The scales, adapted from relevant literature, were translated into Chinese and modified for context. Questionnaires were distributed to nurses via snowball sampling from May 15 to June 10, 2023. A total of 283 valid questionnaires were analysed using the partial least squares structural equation modelling method.

RESULTS

Conformity, obedience and human-machine trust were positively correlated with behavioural intention, while compliance was negatively correlated. Perceived job stress did not significantly affect behavioural intention. Compliance was positively associated with all three job stress dimensions: job uncertainty, technophobia and time pressure, while obedience was correlated with job uncertainty.

CONCLUSION

Social influence and human-machine trust are critical factors in nurses' intentions to adopt AI technology. The lack of significant effects from perceived stress suggests that nurses' personal resources mitigate potential stress associated with AI implementation. The study reveals the complex dynamics regarding different types of social influence, human-machine trust and job stress in the context of AI adoption in healthcare.

IMPACT

This research extends beyond conventional technology acceptance models by incorporating perspectives on organisational internal stressors and AI-related job stress. It offers insights into the coping mechanisms during the pre-adaption AI process in nursing, highlighting the need for nuanced management approaches. The findings emphasise the importance of considering technological and psychosocial factors in successful AI implementation in healthcare settings.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Exploring physicians' expectations of telehealth services implementation in primary care: An application of the social cognitive theory

Background

Understanding healthcare professionals' expectations in telehealth is crucial for successful implementation. The present study used an adaptation of the antecedents-expectations model, supported by the social cognitive theory to evaluate physicians' expectations regarding the implementation of telehealth in primary healthcare (PHC) and to investigate the potential influence, on expectations, of a prior telehealth experience (antecedents) during the Coronavirus disease 2019 (COVID-19) pandemic.

Materials and Methods

A questionnaire-based survey was conducted online, targeting PHC physicians. Expectations covered four telehealth performance domains including public health and health promotion, Care Quality and Workflow Organization, Patient's Convenience and Engagement and Providers' Value and Training. Antecedents included six domains including gain in self-efficacy, gain in knowledge, gain in participation/engagement, gain in experience, enjoyment and satisfaction. Stepwise linear regression was performed to analyse the effect of antecedents on overall expectations.

Results

A total of 54 physicians participated in the study. The mean expectation score was 114.15/154 (SD = 28.26), with highest expectations concerning cost-effectiveness, care timeliness and patients' convenience. A previous experience with smart apps and dedicated telehealth platforms was associated with lower expectations scores. Expectations scores were positively correlated with antecedents scores; however, satisfaction was the sole independent factor of overall expectations (regression coefficient B = 4.40, 95%CI: 3.11-5.68).

Conclusion

The findings highlight the significance of previous experience and various antecedents in shaping physicians' expectations about telehealth. These insights can inform the development of strategies and interventions to enhance healthcare professionals' expectations and facilitate the successful implementation of telehealth services.

Exploring the Role of Traditional Chopstick Culture and Interpersonal Communication in Health Campaign-Targeted Behavior

Traditional chopstick culture is widely recognized as a vital factor associated with health behavior. After the outbreak of COVID-19 in China, the Gongkuai campaign aims to change long-held traditions of communal eating habits. Little is known about the effect of individuals' perception of traditional chopstick culture and other factors on Gongkuai campaign-targeted goal. This study investigates how social-environmental and cognitive factors motivate individuals to use serving chopsticks (the Chinese Gongkuai campaign-targeted goal) and how such effects are moderated by traditional chopstick culture. Data was collected using a nationwide online survey and analyzed using structural equation modeling. The findings revealed that campaign-generated interpersonal communication positively affects individual cognitive factors. Furthermore, cognitive factors promote behavioral intentions to use serving chopsticks. While traditional chopstick culture does not directly influence an intention to use serving chopsticks, it plays a different role in the relationships between three cognitive factors and serving chopsticks use intention. Based on the results, policy implications about how to motivate individuals to use serving chopsticks are discussed.

Antecedents and outcomes of cyberbullying among Chinese university students: verification of a behavioral pathway model

Introduction

Cyberbullying is a commonly-seen and hotly-debated social topic around the globe. This negative behavior is the source of many disastrous events, and so leading government bodies, organizations, schools and social communities attach great importance to addressing this topic. However, there is still much work to do in order to be clear about the causes of cyberbullying.

Methods

The previous research cases were mostly viewed from the victims' perspectives; however, there is no comprehensive understanding of the perpetrators' viewpoints. Therefore, based on Social Cognitive Theory (SCT) and analysis of discussion in the literature, the following six variables were chosen as the focus of this study: overconfidence, excessive moral sense, cyberbullying, perceived value, happiness, and continued cyberbullying intention. This study established a research model of continued cyberbullying intention, which was verified by Structural Equation Modeling. In order to achieve the aims of the study, Chinese university students with an average age of 20.29 (SD = 1.43) were recruited as participants, from whom 1,048 valid questionnaires were collected.

Results

The research results are as follows: 1. Overconfidence and excessive moral sense positively predicted cyberbullying behaviors; 2. Overconfidence positively predicted excessive moral sense; 3. Cyberbullying positively predicted perceived value and sense of happiness; and 4. Perceived value and sense of happiness positively predicted continued cyberbullying intentions.

Conclusion

Students' biased self-perception significantly predicts their cyberbullying behaviors and continued cyberbullying intention. What is more, it is interesting to learn that perpetrators will continue to exhibit cyberbullying behaviors when they believe that what they do (cyberbullying) is valuable or allows them to experience positive feelings; this requires our attention.

What would it take to improve the uptake and utilisation of mHealth applications among older Australians? A qualitative study

Objective Health-related apps on mobile devices (mHealth apps) have become an effective self-management tool and treatment support for patients. There is limited research, however, on how older people (50 and over) perceive the opportunity of using mHealth apps. Our aim was to investigate the perceptions of older people in Australia regarding the opportunity of using prescribed or doctor-recommended mHealth apps and provide insights which can enhance their uptake of mHealth. Methods This was a qualitative study using semi-structured interviews involving 21 participants aged 51-82 years. Qualitative thematic analysis was used to categorise the factors that influence the adoption of mHealth apps by older adults. Results We show that beyond the prominent influencing factors from technology adoption research (such as performance and effort expectancy, social influence and facilitating conditions), health-specific factors such as a trusting doctor-patient relationship and strong health self-efficacy positively influence the intended adoption of mHealth apps among older adults. In addition, the IT security and accurate interpretation of participants' input in an mHealth app can present barriers to mHealth app adoption. Conclusion Our analyses provide additional insights complementing existing technology adoption research. Their successful adoption and utilisation require further empirical evidence on its effectiveness along with attention to the voices of those who are meant to use them. To address potential barriers, improve the quality and security of mHealth apps, and thus achieve greater patient safety, the involvement of consumers, regulators and health professionals is necessary.

Social Cognitive Theory and Willingness to Perform Recommended Health Behavior: The Moderating Role of Misperceptions

More than 6 million people have died due to the COVID-19 pandemic. In order to slow down the spread of COVID-19, health authorities have created numerous guidelines. In the current study, we use survey data from the U.S. and social cognitive theory (SCT) to examine the associations among self-efficacy, outcome expectancies, and willingness to perform recommended COVID-19 related health behavior. Considering the misinformation-filled information ecology during the pandemic, we also examine the moderating role of misperceptions in these relationships. Our findings show that in general the SCT hypotheses hold for COVID-19 related behavior willingness. The interaction effects with COVID-19 misperceptions show that self-efficacy is not enough to understand people's health behavior. Higher outcome expectancies are important and may be able to overcome even if people held high misperceptions. Our findings have direct implications for communication theory and for health organizations in the contemporary information ecology.

Online medical consultation in China: Demand-side analysis of obese patients' preferences and willingness-to-pay for online obesity consultations

Objective

With obesity a major health concern and call on healthcare resources in China, we explored the preferences and willingness to pay (WTP) for obesity OMC, including the influencing factors behind WTP and preferences.

Method

We recruited 400 obese participants to undertake a discrete choice experiment (DCE) and the contingent value method (CVM) survey. We used CVM to measure obese participants' WTP for one-click services (OCS) and used DCE to estimate obesity participants' preferences and WTP for OMC with different attributes.

Results

Obese participants were willing to pay more than RMB80 on average for OCS, and more than 50% of participants had a WTP over RMB50 and 5% had a WTP over RMB300, reflecting the strong willingness of Chinese obese patients to pay for OMC. Educational background, income, ethnicity, previous OMC experience and accessibility to offline hospitals with different levels impacted WTP. The relative importance score of attributes in descending order was cost, doctors' hospital level, doctors' level, online waiting time, consultation time and consultation form. Obese patients preferred lower cost, doctors from higher-level hospitals, doctors with higher expertise levels, shorter waiting time and consultation duration, and telephone consultation were preferred. 30-min waiting time, 15-min consultation duration and telephone consultation were the most economically efficient set we found.

Conclusion

To maximize health resources, provincial tertiary and municipal hospitals face different paths to developing obesity OMC platforms. We encouraged young doctors to use OMC. OMC regulators should implement consumer protection policies to optimize OMC pricing and address potential 'unfair' pricing.

Factors influencing telemedicine adoption among physicians in the Malaysian healthcare system: A revisit

Background

The Malaysian healthcare system is under strain due to an aging population, the rising prevalence of chronic diseases, and heavy workloads among physicians. As costs and requirements continue to rise, telemedicine is critical for bridging gaps in supply and demand. However, there are limited studies on telemedicine adoption among Malaysian physicians. Furthermore, the existing literature on telemedicine adoption does not contain a comprehensive framework that integrates the multidimensional social influence, and technological, clinical, and individual factors.

Objective

This research investigates the adoption of telemedicine among Malaysian physicians. It draws from the Technology Acceptance Model (TAM) and Kelman's Social Influence Theory.

Methods

A survey was conducted among 230 participants in hospitals located in Kuala Lumpur and Selangor. The data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM).

Results

The study identified crucial factors influencing telemedicine adoption, including informational influences, rewards, perceived ease of use, and usefulness. Meanwhile, the Importance-performance Map Analysis (IPMA) identified perceived ease of use as the most important factor for physicians, but the highest performance was patient's records.

Conclusions

The proposed integrated model enhances the understanding of telemedicine adoption and highlights the differential effects of individual, technological, clinical, and multidimensional social influence factors from the physicians' perspective. The findings can guide future studies and influence implementation strategies for telemedicine promotion in the Malaysian healthcare context. Hospitals should prioritize user-friendly technology and information provision, while telemedicine providers should enhance the accessibility of patient records to facilitate telemedicine adoption. Policymakers should consider supporting training programs that will boost physicians' confidence in effectively utilizing telemedicine.

Empowerment of the older adults in the context of Chinese culture: an evolutionary concept analysis

Background

With the increasing focus on addressing the challenges of aging, researchers have begun to recognize the potential impact of empowering older individuals in addressing retirement issues. However, within different cultural contexts, there still needs to be a more precise analysis regarding the definition of empowering older individuals.

Objective

To define and analyze the concept of empowering older individuals within the cultural context of China.

Method

Using Rodgers' concept analysis approach, a search was conducted in five databases (PubMed, Web of Science, China National Knowledge Infrastructure, Wan fang Data, and VIP Chinese Journal Platform) for studies on empowering older individuals from the time the databases were established until February 2023. The main disciplines involved in the search included nursing, medicine, and public health.

Results

Out of the 7,028 studies, 50 articles met the inclusion criteria. The identified attributes are as follows: support system, belief change, and behavioral autonomy. The antecedents were grouped into four categories: physical obstacles, psychological concerns, personal needs and external challenges. The consequences were determined to be improved quality of life, reduced burden of old-age care, gain respect, and self-actualization.

Conclusion

Empowering older individuals is a dynamic and evolving concept that involves aligning personal aspirations with appropriate external resources and expressing a certain degree of belief and behavioral change. This study deepens our understanding of empowering older individuals through comprehensive concept analysis, and the identified attributes, antecedents, and consequences of empowering older individuals can be utilized in practice, education, and research.

Investigating the Predictors of Telemedicine Service Usage Intention in China During the COVID-19 Pandemic: An Extended Technology Acceptance Perspective

Introduction: In China, digital health and telemedicine services grew particularly rapidly during the COVID-19 pandemic. The goal of this study was to examine the effects of technology acceptance model (TAM) predictors, previous social media health service exposure, and telemedicine experience on individual telemedicine service usage intention within the extended theoretical framework of TAM and TAM2. Methods: The study adopted a cross-sectional survey to collect data (N = 1,088) through a Chinese online panel provider (wenjuan.com). Structural equation modeling was performed to examine relationships between the variables in the proposed model. Results: Our results indicated that technology anxiety (TA) was negatively related to perceived ease of use (PEOU) and usage intention. PEOU mediated the relationship between TA and usage intention. Social media health information consumption was positively associated with perceived usefulness (PU). Previous telemedicine satisfaction was positively related to PEOU and PU, but the direct relationship between satisfaction with telemedicine and usage intention was not found to be significant. Besides, PEOU and PU mediated the relationship between previous telemedicine satisfaction and usage intention. Conclusions: Findings of the study not only contribute to literature pertaining to telemedicine promotion by identifying important mediation relationships but also help identify potential users and provide a convenient internet-based promotion channel since they reveal that social media health information consumption is positively related to PU of telemedicine services.

A comparative analysis of outpatient nutrition clinic scheduling outcomes based on in-person and telehealth patient care delivery modalities☆

During the start of the global COVID-19 pandemic in March 2020, patient care modalities changed from in-person to telehealth to comply with physical distancing guidelines. Our study uniquely examines operations data from three distinct periods: before the transition to telehealth, early transition from in-person care to telehealth, and the eventual adoption of telehealth. We present a comparative analysis of outpatient nutrition clinic scheduling outcomes based on care delivery modality. We used descriptive statistics to report means and variance and frequencies. We used inferential statistics to make comparisons: categorical data were compared using chi- square analysis with post-hoc comparisons using a z-test with alpha at 0.05. Means of continuous variables were compared using ANOVA with Tukey HSD post-hoc analysis. We found patient demographics remained widely unchanged across the three distinct periods as the demand for telehealth visits increased, with a notable rise in return patient visits, signaling both adaptability across the patient population and acceptance of the telehealth modality. These analyses along with evidence from the included literature review point to many the benefits of telehealth, thus telehealth as a healthcare delivery modality is here to stay. Our work serves as a foundation for future studies in this field, provides information for decision-makers in telehealth-related strategic planning, and can be utilized in advocacy for the extension of telehealth coverage.

A comparative analysis of digital health usage intentions towards the adoption of virtual reality in telerehabilitation

BACKGROUND

With the rapid development of the metaverse and the problem of non-attendance in traditional rehabilitation, virtual reality in telerehabilitation has become increasingly vital in modern medicine. However, research on determining predictors that influence the public's behavioral intention to adopt VR-based telerehabilitation has not been extensively studied.

OBJECTIVE

This study aims to propose a new research model with a comparative analysis on understanding factors affecting the public's behavioral intention to adopt VR in telerehabilitation for different user groups.

METHODS

A total of 215 respondents from the general public completed an online questionnaire to validate the proposed research model. The collected data was analyzed using SPSS and AMOS. The proposed model was additionally validated using CFA and multiple linear regression.

RESULTS

This study found that effort expectancy, threat appraisals, and trust had a positive significant influence on the public's behavioral intention to adopt VR in telerehabilitation. However, performance expectancy and facilitating conditions had no significant relationship with behavioral intention. Notably, the average of the primary factors for older adults was generally higher than for younger adults.

CONCLUSIONS

The present study confirms the applicability of the proposed research model. Our findings contribute up-to-date insights for related stakeholders to minimize implementation failures and develop successful adoption strategies for the future expansion of telerehabilitation.

Understanding online health information seeking behavior of older adults: A social cognitive perspective

Introduction

Online health information seeking has been verified to play a crucial role in improving public health and has received close scholarly attention. However, the seeking behavior of older adults, especially the underlying mechanism through which they are motivated to seek health information online, remains unclear. This study addresses the issue by proposing a theoretical model leveraging social cognitive theory.

Methods

IT self-efficacy and IT innovativeness were identified as personal factors and professional support and social support were identified as environmental factors. We conducted a survey that included 347 older people in China and examined the research hypotheses with a structural equation model.

Results

IT self-efficacy and IT innovativeness facilitate older adults to seek health information online by increasing their perceived benefit of using the internet. Additionally, professional support and social support enhanced older adults' online seeking behavior by promoting their health awareness. We also found that perceived benefit displayed a stronger impact than health awareness on older adults' behavior related to searching for health information online.

Conclusion

This study reveals that IT self-efficacy, IT innovativeness, professional support, and social support will promote older adults to seek health information online by enhancing their health awareness and perceived benefit. The findings of this study provide significant theoretical and practical implications.

Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study

BACKGROUND

The shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking.

OBJECTIVE

We aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China.

METHODS

Our study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis.

RESULTS

A total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70% (1364/2101, 72.94%) of the household respondents were male. Less than 1% (14/2101, 0.67%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support.

CONCLUSIONS

This study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support.

Understanding the perceived behavior of public utility bus passengers during the era of COVID-19 pandemic in the Philippines: Application of social exchange theory and theory of planned behavior

Over the years, passengers in the Philippines have relied on public utility bus (PUB) to reach a destination. However, PUB has been greatly affected by the adverse effects of the coronavirus disease (COVID-19) outbreak. Therefore, the study analyzed passengers' behavior using PUB during the COVID-19 pandemic by integrating social exchange theory (SET) and the theory of planned behavior (TPB). A total of 505 PUB users completed the online questionnaire containing sixty-seven (67) measures. Through confirmatory factor analysis - structural equation modeling (CFA-SEM), all the twelve (12) hypotheses were found significant. Accessibility, safety, economic benefit, and crisis management had a significant and positive influence on passengers' trust. Moreover, passengers' trust produced a significant positive influence on attitude, subjective norm, and perceived behavioral control. Additionally, attitude, subjective norm, and perceived behavioral control generated a significant positive influence on the intention to use PUB. Furthermore, perceived behavioral control had a significant positive influence on perceived passenger behavior. Lastly, the intention to use PUB developed a substantial and positive influence on perceived passenger behavior. PUB companies and policymakers can utilize these findings to develop additional PUB reforms for the benefit of passengers, drivers, operators, companies, and the government during the COVID-19 pandemic.

The Effect of Presentation Characteristics of "Quantified Self" Data on Consumers' Continuance Participation Intention: An Empirical Study Based on Health-Related Apps

PURPOSE

The COVID-19 pandemic has greatly influenced the health and lifestyles of individuals. Increasing numbers of consumers now participate in quantified self (QS) process to learn more about their health-related behaviors. Understanding how to increase consumers' QS continuance participation intention is critical. Drawing on Social Cognitive Theory and Self-Construal Theory, this study investigates how the presentation characteristics of QS data and consumers' self-construal can influence their continuance participation intention during QS process.

METHODS

Three between-subjects scenario simulation experiments were conducted to examine the influence mechanisms of the presentation mode and type of QS data and self-construal on consumers' continuance participation intention.

RESULTS

The study found: (1) the presentation mode (horizontal comparison vs vertical comparison) and type (descriptive vs analytic) of QS data had significant interaction effects on consumers' continuance participation intention; (2) consumers' self-construal (interdependent vs independent) and the presentation mode of QS data had obvious interaction effects on their continuance participation intention; and (3) consumers' self-construal and the presentation type of QS data had interaction influences on their continuance participation intention.

CONCLUSION

This research combined Social Cognitive Theory and Self-Construal Theory to analyze the influence mechanisms of the presentation characteristics of QS data and consumers' self-construal on their continuance participation intention. These findings not only expand the research field and the scope of application of Social Cognitive Theory, but also provide new insights for the study of consumers' QS problems. They have reference value for the optimization of the presentation features of QS data, and for improving the match between QS data presentation and consumers' self-construal types, to motivate continued participation in QS process.

Awareness and Use of Virtual Clinics following the COVID-19 Pandemic in Saudi Arabia

Studies have shown that virtual clinics enjoyed high use and high patient satisfaction during the COVID-19 pandemic. Thus, virtual clinics are expected to be the new normal mode of receiving care after the COVID-19 pandemic. This study aimed to assess public awareness and use of virtual clinics following the pandemic and identify factors associated with virtual clinic use. Methods: A cross-sectional design was employed in which data were collected via a structured online questionnaire based on the Technology Acceptance Model (TAM) domains: perceived usefulness, perceived ease of use, and social influence. Participants were selected based on the non-probability sampling of convenience. Univariate, bivariate, and binary logistic regression models were used for analysis. Results: A total of 405 responses were received; of those, 286 (70.6%) were aware of the existence of virtual clinics and 99 (34.6%) were post-pandemic users. Among users, 50% used virtual clinics more than two times, 72% used virtual clinics to seek care for themselves, with the vast majority using it via voice calls (83.8%), and for visits to the family medicine clinic (55%). Young adults, females, single adults, those with a higher level of education, the employed, and those with lower income were more likely to use virtual clinics (p < 0.05). The logistic regression model showed that 20% of the variation in virtual clinic use was explained by perceived usefulness and perceived use (p < 0.001). Conclusion: This study showed high awareness of virtual clinics among the population following the COVID-19 pandemic, with one-third being active users. Age, gender, marital status, education, income, employment status, perceived usefulness, and ease of use are associated with virtual clinics’ awareness and use. Considering those factors is important when planning for sustained use of e-health and virtual care.

Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends

Background

The adoption of telehealth services has been a challenge in rural communities. The reasons for the slow adoption of such technology-driven services have been attributed to social norms, health care policies, and a lack of infrastructure to support the delivery of services. However, the COVID-19 pandemic–related shutdown of in-person health care services resulted in the usage of telehealth services as a necessity rather than a choice. The pandemic also fast-tracked some needed legislation to allow medical cost reimbursement for remote examination and health care services. As services return to normalcy, it is important to examine whether the usage of telehealth services during the period of a shutdown has changed any of the trends in the acceptance of telehealth as a reliable alternative to traditional in-person health care services.

Objective

Our aim was to explore whether the temporary shift to telehealth services has changed the attitudes toward the usage of technology-enabled health services in rural communities.

Methods

We examined the Medicaid reimbursement data for the state of Alabama from March 2019 through June 2021. Selecting the telehealth service codes, we explored the adoption rates in 3 phases of the COVID-19 shutdown: prepandemic, pandemic before the rollout of mass vaccination, and pandemic after the rollout of mass vaccination.

Results

The trend in telemedicine claims had an opposite pattern to that in nontelemedicine claims across the 3 periods. The distribution of various characteristics of patients who used telemedicine (age group, gender, race, level of rurality, and service provider type) was different across the 3 periods. Claims related to behavior and mental health had the highest rates of telemedicine usage after the onset of the pandemic. The rate of telemedicine usage remained at a high level after the rollout of mass vaccination.

Conclusions

The current trends indicate that adoption of telehealth services is likely to increase postpandemic and that the consumers (patients), service providers, health care establishments, insurance companies, and state and local policies have changed their attitudes toward telehealth. An increase in the use of telehealth could help local and federal governments address the shortage of health care facilities and service providers in underserved communities, and patients can get the much-needed care in a timely and effective manner.

A nonlinear population dynamics model of patient diagnosis and treatment involving in two level medical institutions and its qualitative analysis of positive singularity

In this article, we firstly establish a nonlinear population dynamical model to describe the changes and interaction of the density of patient population of China's primary medical institutions (PHCIs) and hospitals in China's medical system. Next we get some sufficient conditions of existence of positive singularity by utilising homotopy invariance theorem of topological degree. Meanwhile, we study the qualitative properties of positive singularity based on Perron's first theorem. Furthermore, we briefly analyze the significance and function of the mathematical results obtained in this paper in practical application. As verifications, some numerical examples are ultimately exploited the correctness of our main results. Combined with the numerical simulation results and practical application, we give some corresponding suggestions. Our research can provide a certain theoretical basis for government departments to formulate relevant policies.

Determinants of Continuance Intention to Use Health Apps among Users over 60: A Test of Social Cognitive Model

Promoting healthy behavior among seniors is important in reducing the burden of care and healthcare expenses in a rapidly aging society. Health apps can play an important role in health promotion for older adults, but the level of user retention in health apps is low. To increase continued health app use among older adults, this study examined the factors influencing older users’ continuance intentions to use health apps. The research model was developed based on the social cognitive theory of health behavior, which integrates cognitive, environmental, and behavioral perspectives. To test the research model, an anonymous online survey was conducted among respondents aged 60 to 79 years who were using health apps. The measurement items in the questionnaire were developed based on validated scales from the literature. A total of 250 samples were analyzed. The assessment of the measurement model indicates that the reliability and validity of the items are satisfactory. The results of testing the structural model illustrate the determinants of health app continuance intention: health technology self-efficacy, self-evaluative outcome expectations, self-regulation, and privacy risk. The interrelationships among determinants are also investigated. Theoretical and practical implications are suggested to encourage older adults’ continued health app use and promote their health behavior over the long term.

Impact of Physicians' Competence and Warmth on Chronic Patients' Intention to Use Online Health Communities

In China, medical resources are unevenly distributed, and hospitals are very congested. Online health communities (OHCs) provide a new way for patients to communicate and obtain health-related information, thereby alleviating the pressure of treatment in hospitals. However, little is known about how to increase individuals’ use intention for OHCs from the perspective of physicians. This study aims to investigate the impact of physicians’ competence and warmth on chronic patients’ intention to use physician-centered OHCs based on the technology acceptance model. A formal investigation was anonymously conducted through a web-based questionnaire survey addressed to participants, and 710 valid responses were received. A research model was constructed and the hypotheses were tested by structural equation modeling. The findings suggest that competence and warmth positively affect chronic patients’ behavioral intention to use (BIU) OHCs through the mediation of perceived usefulness (PU) and perceived ease of use (PEOU). All hypotheses were supported at the 0.05 significant level. Compared with competence, warmth has a slightly stronger impact on PU and PEOU. PEOU has a stronger impact on chronic patients’ BIU OHCs than PU. This study provides a comprehensive understanding of the impacts of physicians’ characteristics in physician-driven OHCs. Compared with competence, physicians’ warmth should be paid more attention to motivate more chronic patients to use OHCs. Enhancing physicians’ warmth and the ease of use are the preferred ways to improve chronic patients’ intention to use OHCs.