Development and validation of an instrument to measure user perceived service quality of mHealth

Continuance intention and digital health resources from the perspective of elaboration likelihood model and DART model: a structural equation modeling analysis

Background

Internet hospitals, online health communities, and other digital health APPs have brought many changes to people's lives. However, digital health resources are experiencing low continuance intention due to many factors, including information security, service quality, and personal characteristics of users.

Methods

We used cross-sectional surveys and structural equation modeling analysis to explore factors influencing user willingness to continue using digital health resources.

Results

Information quality (β = 0.31, p < 0.05), service quality (β = 0.19, p < 0.05), platform reputation (β = 0.34, p < 0.05), and emotional support (β = 0.23, p < 0.05) have significant positive effects on user value co-creation behavior. Additionally, user trust and perceived usefulness could mediate the association between user value co-creation behavior and continuance intention, with mediation effects of 0.143 and 0.125, respectively. User involvement can positively moderate the association between user value co-creation behavior and user trust (β = 0.151, t = 2.480, p < 0.001). Also, user involvement can positively moderate the association between value co-creation behavior and perceived usefulness (β = 0.103, t = 3.377, p < 0.001).

Conclusion

The keys to solving the problem of low continuance intention are improving the quality and service level of digital health resources, and promoting users' value co-creation behavior. Meanwhile, enterprises should build a good reputation, create a positive communication atmosphere in the community, and enhance user participation and sense of belonging.

Mobile Technology-Based Interventions for Stroke Self-Management Support: Scoping Review

BACKGROUND

There is growing interest in enhancing stroke self-management support using mobile health (mHealth) technology (eg, smartphones and apps). Despite this growing interest, "self-management support" is inconsistently defined and applied in the poststroke mHealth intervention literature, which limits efforts to synthesize and compare evidence. To address this gap in conceptual clarity, a scoping review was conducted.

OBJECTIVE

The objectives were to (1) identify and describe the types of poststroke mHealth interventions evaluated using a randomized controlled trial design, (2) determine whether (and how) such interventions align with well-accepted conceptualizations of self-management support (the theory by Lorig and Holman and the Practical Reviews in Self-Management Support [PRISMS] taxonomy by Pearce and colleagues), and (3) identify the mHealth functions that facilitate self-management.

METHODS

A scoping review was conducted according to the methodology by Arksey and O'Malley and Levac et al. In total, 7 databases were searched. Article screening and data extraction were performed by 2 reviewers. The data were analyzed using descriptive statistics and content analysis.

RESULTS

A total of 29 studies (26 interventions) were included. The interventions addressed 7 focal areas (physical exercise, risk factor management, linguistic exercise, activities of daily living training, medication adherence, stroke education, and weight management), 5 types of mobile devices (mobile phones or smartphones, tablets, wearable sensors, wireless monitoring devices, and laptops), and 7 mHealth functions (educating, communicating, goal setting, monitoring, providing feedback, reminding, and motivating). Collectively, the interventions aligned well with the concept of self-management support. However, on an individual basis (per intervention), the alignment was less strong.

CONCLUSIONS

On the basis of the results, it is recommended that future research on poststroke mHealth interventions be more theoretically driven, more multidisciplinary, and larger in scale.

A scale to measure the perceived quality of mHealth by elderly patients with hypertension in China

BACKGROUND

The elderly population in China is growing, with hypertension being the most prevalent chronic disease in older adults. Despite the rapid penetration and efficient management effect of mobile health on hypertension healthcare, elderly patients are often less adopted and continue to use mobile health services. Quality perception significantly affects an individual's satisfaction and continued intention to use mobile health services. The evaluation of the significant factors affecting mobile health quality perception by elderly individuals remains largely unexplored. The aim of this study was to develop and validate an evaluation scale to measure the perceived quality of mobile health applications for hypertension and determine the underlying influencing factors.

METHODS

A cross-sectional survey was conducted between November 2018 and October 2019. A quality evaluation scale with three factors and seven indicators was developed based on the Information Systems Success model. Data was analyzed using structural equations modelling (SEM) and one-way analysis of variance (ANOVA). All tests were two-sided and statistically significant at P < 0.05.

RESULTS

The proposed mobile health application quality evaluation scale from the perspective of the elderly was shown to be a hierarchical, multidimensional construct with valid reliability, convergent validity and discriminant validity, which consists of three factors and seven indicators. The SEM results suggested that information quality and service quality had a significant impact on the satisfaction of elderly individual's with mobile health applications for hypertension management. The results also suggest that the elderly individuals had a low evaluation of mobile medical service quality(4.06 ± 0.70), while the score of information quality was the highest, with an average score of 4.36(SD 0.83) out of 5. Male patients were shown to more readily accept mobile health applications, with their perception of system quality being 0.27 higher than female ones (95% CI 0.00 ~ 0.52; P < .05). Patients with 1-5 years hypertension histories assessed the system (95% CI 0.03 ~ 0.63; P < .05), information (95% CI 0.11 ~ 0.65; P < .05), and service quality (95% CI 0.00 ~ 0.47; P < .05) higher than those with hypertension histories > 10 years. Elderly patients who regularly visited primary hospitals assessed the information quality 0.13 higher (95% CI -0.08 ~ 0.34; P < .05) than those visited tertiary hospitals.

CONCLUSIONS

These findings have significant implications for theoretical and practical research on mobile health application quality evaluation, which will be helpful for policymakers and mobile health providers in improving the context and utilisation of mobile health to include elderly users. More mobile health applications attributes, such as timely information and interactive services that meet the characteristics of elderly patients with different mental and health demands need to be considered. Deeply embedding mobile health into primary health services is recommended to help increase the perceived quality of mobile health, and ensure the continuous use.

The moderating role of information technology governance in the relationship between board characteristics and continuity management during the Covid-19 pandemic in an emerging economy

The main aim of the current study is to investigate the relationship between governance characteristics, information technology governance, and continuity management during Covid-19 in an emerging economy. The study also examines the moderating role of information technology governance in the relationship between governance characteristics and business continuity management. The quantitative approach is used by utilising a survey questionnaire. A sample of 232 questionnaire surveys has been collected from the board of directors, top and middle management executives, external auditors, information technology experts, and some other respondents. The results were estimated using structural equation modelling. The results indicate that information technology governance has a statistically significant effect on business continuity. Board size, board independence, audit committee independence, audit committee diligence, and external audit have a statistically significant positive effect on information technology governance. Further, the results indicate that information technology governance significantly moderates the effect of board size, board independence, board diligence, audit committee independence, audit committee diligence, and external audit on business continuity. However, information technology governance does not moderate the relationship between board committees and business continuity, which indicates less board involvement in information technology governance. The current research provides insight into the role of information technology governance in business continuity management during crises. The present study provides a unique contribution as it investigates the relationship between corporate governance characteristics, information technology governance, and business continuity management during Covid-19, providing empirical evidence from an emerging country.

Factors Affecting Citizen Adoption of E-Government in Developing Countries

This study aims to examine the critical factors that could influence citizens in their decisions to adopt e-Government services. Based on the review of relevant literature, an extension of the UTAUT research model is developed. Through semi-structured interviews conducted in Indonesia with citizens who have adopted e-Government services, the research model is examined using thematic analysis. Results indicate that performance expectancy, effort expectancy, system quality, and perceived transparency are factors that significantly influence the adoption of e-government in Indonesia, whereas social influence, facilitating conditions, perceived security, information quality, and government encouragement are moderately significant factors. Meanwhile, ICT literacy is the least significant factor in the adoption of e-Government in Indonesia. Such findings are presented in the action priority matrix to offer public organisations with relevant suggestions on how the adoption of e-Government can be improved.

A Conceptual Model to Evaluate Service Quality of Direct-to-Consumer Telemedicine Consultation from Patient Perspective

Objective and Background: This research aims to develop a theoretical service quality (SQ) model for direct-to-consumer (DTC) telemedicine consultations. Although it can change care delivery for the better, it is crucial to create the appropriate measurement tool to collect and analyze patient's perceptions of SQ to identify any service pitfall and encourage a faster adoption. To the best of the authors' knowledge, this article is one of the first to investigate and propose a SQ model for DTC telemedicine consultations. This study is therefore motivated by a clear need for such a model as it is currently inexistent. Methods: A literature review of health and e-service quality (e-SQ) models was conducted to identify a suitable instrument for the research. A total of 60 studies were included. Results: The main findings are threefold: (1) DTC telemedicine SQ is interdisciplinary: it encompasses generic and context-specific dimensions from the health, e-SQ, and information system literature; (2) the existing SQ models are not adequate, they do not cover all dimensions of DTC telemedicine services; (3) although LeRouge et al.'s Telemedicine service encounter quality model was identified as a reference model, it is inadequate to simply transpose it to the context of the study. Thus, the elaboration of a more suitable instrument and creation of a new updated model by the authors. Conclusion: The conceptual model captures three primary dimensions (system quality, interaction quality and use quality) that represent SQ of DTC telemedicine consultations from a patient perspective.

Exploring the factors that affect user experience in mobile-health applications: A text-mining and machine-learning approach

Recent years have witnessed an increased demand for mobile health (mHealth) platforms owing to the COVID-19 pandemic and preference for doorstep delivery. However, factors impacting user experiences and satisfaction levels across these platforms, using customer reviews, are still largely unexplored in academic research. The empirical framework we proposed in this paper addressed this research gap by analysing unmonitored user comments for some popular mHealth platforms. Using topic-modelling techniques, we identified the impacting factors (predictors) and categorised them into two major dimensions based on strategic adoption and motivational association. Findings from our study suggest that time and money, convenience, responsiveness, and availability emerge as significant predictors for delivering a positive user experience on m-health platforms. Next, we identified substantial moderating effects of review polarity on the predictors related to brand association and hedonic motivation, such as online booking and video consultation. Further, we also identified the top predictors for successful user experience across these platforms. Recommendations from our study will benefit business managers by offering an improved service design leading to higher user satisfaction across these m-health platforms.

A paradigm shift for medical health care to focus on a service-value approach to achieve greater patient satisfaction

PURPOSE

This study takes a divergent approach to exploring which construct is more predictive of patient satisfaction (SAT) in a service dominant economy within the context of a healthcare setting.

DESIGN/METHODOLOGY/APPROACH

Applying a critical analysis of literature, a service value (SV) model for customer SAT is proposed in this study, which is validated and confirmed with survey data from outpatients at Moorfields Eye Hospital - a world class specialist hospital based in the UK.

FINDINGS

Quality of service had the strongest impact on SV but SV had the strongest impact and mediation effect on patient SAT.

RESEARCH LIMITATIONS/IMPLICATIONS

The study concludes that since SV rather than quality of service is more predictive of patient SAT, health service providers should focus more on SV in addition to quality of service, if they are to meet the dynamic expectations of their patients.

PRACTICAL IMPLICATIONS

Health service providers should focus more on SV in addition to quality of service, if they are to meet the dynamic expectations of their patients.

SOCIAL IMPLICATIONS

This poses a strong argument in favour of a paradigm shift in focus from quality of service-based model to service value-based model for greater patient satisfaction.

ORIGINALITY/VALUE

This is the first study exploring the inter-relationship of four constructs of patient SAT within the context of a leading major UK healthcare hospital service.

Explaining consumers' continuous purchase intention toward subscriber-based knowledge payment platforms: findings from PLS-SEM and fsQCA

Purpose

The purpose of this study is to investigate the influencing mechanism of consumers' continuous purchase intention toward the subscriber-based knowledge payment platforms (SBKPPs).

Design/methodology/approach

This study obtained 226 valid samples through questionnaire surveys and used partial least square structural equation modeling (PLS-SEM) and fuzzy-set qualitative comparative analysis (fsQCA) methods to elucidate the complex causal patterns of consumers' continuous purchase intention toward the SBKPPs.

Findings

The findings revealed that perceived utilitarian value, perceived hedonic value and perceived social value directly affected consumers' continuous purchase intention, while content quality and service quality indirectly affected consumers' continuous purchase intention. In addition, this study also demonstrated that all factors must be combined to play a role, and there exist four configurations resulting in consumers' continuous purchase intention toward the SBKPPs.

Research limitations/implications

The results can help researchers and practitioners better understand the causal patterns of consumers' continuous purchase intention toward the SBKPPs.

Originality/value

This study contributes to the knowledge payment literature by investigating consumers' continuous purchase intention toward the SBKPPs. This study also provides practical enlightenment for the SBKPPs' marketing.

Predicting User Satisfaction of Mobile Healthcare Services using Machine Learning

Outbreak of the COVID-19 leads to rapid development of the mobile healthcare services. Given that user satisfaction is of great significance in inducing marketing success in competition markets, this research explores and predicts user satisfaction with mobile healthcare services. Specifically, the current research aimed to design a machine learning model that predicts user satisfaction with healthcare services using big data from Google Play Store reviews and satisfaction ratings. By dealing with the sentimental features in online reviews with five classifiers, the authors find that Logistic regression with term frequency-inverse document frequency (TF-IDF) and XGBoost with Bag of words (BoW) have superior performances in predicting user satisfaction for healthcare services. Based on these results, the authors conclude that such user-generated texts as online reviews can be used to predict user satisfaction, and Logistic regression with TF-IDF and XGBoost with BoW can be prioritized for developing online review analysis platforms for healthcare service providers.

Using Telemedicine during the COVID-19 Pandemic: How Service Quality Affects Patients' Consultation

The COVID-19 epidemic put pressure on the traditional healthcare system and offline consultation methods. Telemedicine platforms provide a more convenient and safer channel for online health communication. Based on the signaling theory, our study explores the impacts of three dimensions of physicians' service quality (need fulfillment, security, and responsiveness) on online patient consultation on telemedicine platforms. A negative binomial model was used to test cross-sectional data of 2982 physicians obtained from Haodf.com. The results show the following: (1) the need fulfillment dimension variables positively affect online patient consultation; (2) the security dimension variables positively affect online patient consultation; (3) the responsiveness dimension variables positively affect online patient consultation. Our results contribute to the theoretical aspect of signaling theory and service quality in the context of telemedicine platforms and have several practical implications for telemedicine platform physicians and platform operators.

Empowerment through Mobile Apps: A Mixed Methods Case Study of an Application for Pregnant Women

This article analyses the manner in which mobile health applications contribute to the empowerment of patients. The theoretical background included m-health, user empowerment and value co-creation. Quantitative and qualitative methods were used to investigate the representative case study of the Kangaroo application, a free app designed by a health-tech start-up and a reference Brazilian hospital which seeks to make Brazilian women empowered for a healthy pregnancy. The data collection effort comprised application log analysis of 6 months of records of almost one-hundred thousand users, a mobile-based survey with approximately 400 women, and 16 in-depth interviews. The results demonstrated that the app’s social features impacted more than personal features. This research’s results suggested that the perception of patient empowerment is not greater for the active users of the application, so the patient is not related to ‘doing’, but rather to ‘being able to do’. The participation of specialised professionals, who moderate and interact with the app community, is valued by the users and mentioned as a differential among other health information sources available on the Web. This study was approved by the Brazilian Research Ethics Committee.

Identifying major impact factors affecting the continuance intention of mHealth: a systematic review and multi-subgroup meta-analysis

The mobile health (mHealth) industry is an enormous global market; however, the dropout or continuance of mHealth is a major challenge that is affecting its positive outcomes. To date, the results of studies on the impact factors have been inconsistent. Consequently, research on the pooled effects of impact factors on the continuance intention of mHealth is limited. Therefore, this study aims to systematically analyze quantitative studies on the continuance intention of mHealth and explore the pooled effect of each direct and indirect impact factor. Until October 2021, eight literature databases were searched. Fifty-eight peer-reviewed studies on the impact factors and effects on continuance intention of mHealth were included. Out of the 19 direct impact factors of continuance intention, 15 are significant, with attitude (β = 0.450; 95% CI: 0.135, 0.683), satisfaction (β = 0.406; 95% CI: 0.292, 0.509), health empowerment (β = 0.359; 95% CI: 0.204, 0.497), perceived usefulness (β = 0.343; 95% CI: 0.280, 0.403), and perceived quality of health life (β = 0.315, 95% CI: 0.211, 0.412) having the largest pooled effect coefficients on continuance intention. There is high heterogeneity between the studies; thus, we conducted a subgroup analysis to explore the moderating effect of different characteristics on the impact effects. The geographic region, user type, mHealth type, user age, and publication year significantly moderate influential relationships, such as trust and continuance intention. Thus, mHealth developers should develop personalized continuous use promotion strategies based on user characteristics.

Online health management continuance and the moderating effect of service type and age difference: A meta-analysis

Numerous empirical studies have been carried out to explore factors of online health management continuance. However, results were not unified. We thus conducted a meta-analysis to identify influential factors and potential moderators. A systematic literature search was performed in nine databases (PubMed, Web of Science, the Cochrane Library, Ovid of JBI, CINAHL, Embase, CNKI, VIP, and CBM) published up to December 2020 in the English or Chinese language. Meta-analysis of combined effect size, heterogeneity, moderator analysis, publication bias assessment, and inter-rater reliability was conducted. Totally 41 studies and 12 pairwise relationships were identified. Confirmation, perceived usefulness, satisfaction, information quality, service quality, perceived ease of use, and trust were all critical predictors. Service type and age difference showed their moderating effects respectively. The perceived usefulness was more noteworthy in medical service than health and fitness service. The trust was more noteworthy in young adults. The results confirmed the validity and robustness of the Expectation Confirmation Model, Information Systems Success Model, and trust theory in online health management continuance. Moderators included but are not limited to age difference and service type. The elderly research in the healthcare context and other analytical methods such as qualitative comparative analysis should be applied in the future.

Determinants of continuous usage of library resources on handheld devices: findings from PLS-SEM and fuzzy sets (fsQCA)

Purpose

This study aims to investigate the key factors that motivate learners to use handheld devices to access library resources. To do so, this study integrates the technology acceptance model (TAM) and the DeLone and McLean information systems success (D and M-ISS) model.

Design/methodology/approach

The relationship between the causes and the outcomes may not be symmetrical. To test this proposition, data were collected from 210 respondents in a Gulf country and analysed using structural equation modelling (SEM) and complemented by fuzzy set qualitative comparative analysis (fsQCA).

Findings

The SEM results revealed that three constructs – perceived ease of use (PEOU), service quality (SQ) and system quality (SEQ) are strong drivers of students’ continuous intention to use handheld devices to access library resources. However, perceived usefulness (PU) and information quality (IQ) do not significantly influence students’ intentions. Besides, SQ and PEOU are positively related to PU. Furthermore, fsQCA results show that two different conjunctions, PU*PEOU*IQ*SEQ and PEOU*SQ*IQ*SEQ, cause the students to show a continuous intention to use handheld devices to access library resources.

Originality/value

Unlike previous studies on mobile library resource utilization, this analysis extends TAM to investigate the linear additive influence of two basic TAM constructs: PEOU and PU, and three constructs, namely, SEQ, SQ and IQ of the ISS model, on students’ library resource utilization. Furthermore, the findings of SEM were complemented by a set theory-based configuration method, fsQCA, to investigate the asymmetrical, equifinal and configurational causation leading to the desired outcome. The findings of this study have theoretical and practical implications.

Understanding the Antecedents of the Routine Use of Mobile Health Services: A Person–Technology–Health Framework

Although numerous studies have been conducted to understand the antecedents of usage of mobile health (mHealth) services, most of them solely focus on characteristics of mHealth services themselves but neglect taking users’ psychological and health-related factors into consideration. Besides, the comprehensive understanding of what influences users’ routine use intentions regarding mHealth services is lacking. Therefore, this study proposes a person–technology–health framework that underlines how personal factors (e.g., personal innovativeness in IT), technological factors (e.g., trust), and health factors (e.g., perceived health severity) jointly influence individuals’ routine use intentions regarding mHealth services. The proposed research model and related hypotheses were tested based on survey data from 270 respondents. The results indicate that personal innovativeness in IT, trust, and perceived health severity are important for enhancing routine use intention of mHealth services. Specifically, in situations of high perceived health severity, trust relates less positively to routine use intention than personal innovativeness in IT. In contrast, in situations of low perceived health severity, trust relates more positively to routine use intention than personal innovativeness in IT. The research findings extend the existing literature on routine use intention related to mHealth services and provide significant implications for practitioners.

The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective

The use of mobile technology and equipment has been found to be successful in the governance of public health. In the context of the coronavirus disease 2019 (COVID-19) pandemic, mobile health (mhealth) apps are expected to play an important role in the governance of public health. This study establishes a structural equation model based on the digital content value chain framework, identifies the main values created by mhealth apps in the prevention and control of COVID-19, and surveys 500 citizens of China. The data were analyzed using an independent t-test and partial least squares structural equations (PLS-SEM). The results showed that people who use mhealth apps are more satisfied with public health governance than those who do not; the healthcare assurance value of mhealth apps and healthcare confidence positively influence the interaction between users and mhealth app functions, the interaction with information, and the interaction with doctors to improve users’ satisfaction with public health governance; and the parasocial relationships between doctors and users of mhealth apps positively affect the interactions between users and doctors to improve users’ satisfaction with public health governance. This study confirms the potential of mhealth apps toward improving public health governance during the COVID-19 pandemic from a new perspective and provides a new theoretical basis whereby mobile technology can contribute toward improving public health governance.

The Effects of Service Characteristics on Intention to Use Mobile Health Services: The Moderating Role of Innovativeness and Privacy Concern

Objectives: In this study, we explored how service characteristics (service relevance and service accuracy) interact to influence individuals' use intention of mHealth services. We also investigated the moderating roles of innovativeness and privacy concerns. Methods: To meet these objectives, we developed 6 hypotheses that were subsequently empirically validated using a survey to test the effects of service characteristics and personal traits on intention to use mHealth. Results: We confirm that service relevance and service accuracy positively and directly influence individuals' intention to use mHealth services. In addition, innovativeness positively affects the relationship between service relevance and use intention. Privacy concern negatively influences the relationship between service relevance and use intention, but positively influences the relationship between service accuracy and use intention. Conclusions: The present study provides new insights into the influencing factors of individuals' usage behavior toward mHealth services. Such insight could provide further understanding of how individuals adopt new information services or technologies, which contribute to both information system and healthcare research areas in a promising way.

e-Healthcare service quality: consumer satisfaction and its association with demographic characteristics

PURPOSE

Use of technology for quality healthcare services has developed into a new field known as "e-Healthcare services." Healthcare providers often judge their quality of services with consumer satisfaction. With e-Healthcare services, consumer satisfaction is influenced by the quality of healthcare services provided and the demographic characteristics. The purpose of the present case study is to recognize the important predictors of quality, which are significant for consumer satisfaction with e-Healthcare services by using Zineldin's 5Qs model. It also aims to find the strength of association among the predictors of consumer satisfaction and the demographic characteristics of the respondents.

DESIGN/METHODOLOGY/APPROACH

A questionnaire-based study was conducted at a public (PGIMER, Chandigarh) and a private hospital (Fortis Hospital, Mohali) of Punjab, India, from February 2018 to March 2019. The structured, closed-ended questionnaire, to be marked on a 1-5 point Likert scale, was adapted from Zineldin's 5Qs model and was distributed to the respondents sitting in the waiting halls of the selected hospitals. The respondents comprised of both the patients and their attendants who were aware of e-Healthcare services and were using them.

FINDINGS

The analysis identified quality of interaction, quality of hospital atmosphere and quality of object to be the key predictors of consumer satisfaction with e-Healthcare services. The results reveal a strong association between different demographic characteristics and overall consumer satisfaction with e-Healthcare services.

PRACTICAL IMPLICATIONS

The results suggest that improvements in the quality of interaction, quality of hospital atmosphere and quality of object may result in higher consumer satisfaction with e-Healthcare services. Working on the identified dimensions of quality will help the e-Healthcare providers in identifying functional problems of e-Healthcare services and developing improvement strategies, which will also result in better health and quality outcomes. The results of this study will help the e-Healthcare providers in better segmentation of e-Healthcare consumers based on their demographic characteristics and in developing better marketing strategies.

ORIGINALITY/VALUE

This paper focuses on the quality of e-Healthcare services only and attempts to identify the quality dimensions, which leads to the satisfaction of e-Healthcare consumers. The identified quality dimensions will help in designing better e-Healthcare services and framing policies. It also highlights the association of demographic characteristics with important quality dimensions.

Determinants Impacting User Behavior towards Emergency Use Intentions of m-Health Services in Taiwan

Emergency usage intention and behavior are crucial to business service success for m-Health providers and patient healthcare service. This study aimed to identify the factors that influence m-Health acceptance and the effect of emergency use intentions on usage behavior among Taiwanese m-Health users by adopting and extending the Unified Theory of Acceptance and Use of Technology (UTAUT). This study also examines the moderating role of gender and age in the effects of the independent variables on satisfaction with m-Health services. An online questionnaire was used to collect data from 371 participants. The results revealed that performance expectancy, facilitating conditions, and trust had positive effects on user satisfaction. Additionally, m-Health knowledge and user satisfaction had positive effects on emergency use intentions. However, social influence and effort expectancy did not have a significant effect on satisfaction. Moreover, age and gender significantly moderated the effects of some predictors.

Health-tech startups in healthcare service delivery: A scoping review

BACKGROUND

An efficient and affordable healthcare service delivery to everyone is a prerogative of the national governments. Such delivery is quite exacting, and gaps remain. In this regard, startups are trying to disrupt the market with innovative solutions and reach the underserved market. Though anecdotal evidence remains, a rigorous literature review is missing. This paper attempts to understand the status of health-tech startups in healthcare service delivery.

METHODS

We scanned a total of 110 journals - Financial Times top 50, top ten information systems journals listed by the Australian Business Dean Council, and the top 50 Scopus indexed journals in health informatics and health information management. We followed a systematic process for this scoping review - reading of titles, abstracts, and then full papers for final analysis based on inclusion and exclusion criteria.

RESULTS

A total of 76 articles met the inclusion criteria. Only five studies portrayed the status of health-tech startups in healthcare service delivery. To capture the overall startup ecosystem, we continued with a scoping review of all the 76 articles.

DISCUSSIONS

The identified five themes are Technology adoption, Electronic health services, Business planning and framework, Psychographics, and Regulations. There is evidence of technology adoption in service delivery and its nature in the businesses undertaken by startups. Very few studies represented the patterns of the existing business model. The acceptance of the services is dependent on service effectiveness and affordability. The challenges are licensing, policies, data privacy and security, and inadequate technology access among healthcare seekers.

CONCLUSIONS

Albeit the feasibility potential, research concerning the impact of health tech startups in healthcare service delivery is emerging but incipient. The review indicates that research on startups is inadequate, especially related to entrepreneurship, business frameworks, and regulations. Future research should explore the same.

Cleaner production practices at company level enhance the desire of employees to have a significant positive impact on society through work

Implementation of cleaner production practices (CPP), service quality (SQ) and corporate social responsibility (CSR) is often studied at organizational level. A number of studies on trio have reported it's significant impact on overall organizational performance and profitability across the globe. However, not much is studied about the individual level micro influence of these constructs on employee engagement (EE), organizational pride (OP), organizational identification (OI) and "desire to have a significant impact through work" (DSIW). Therefore, this study presents a comprehensive framework for assessing the impact of the implementation of CPP, SQ and CSR on EE, OP, OI and DSIW. Data collected from 320 non-managerial staff members employed at a garments manufacturing company in Pakistan was analyzed using partial least square (PLS) approach. Findings revealed that the implementation of CPP, SQ and CSR plays an important role in shaping EE, OP, OI and DSIW in the garments manufacturing industry. Further, it is found that the implementation of CPP has a non-significant impact on SQ. Additionally, results of the importance-performance map analysis (IPMA) have also confirmed that the implementation of CPP at company level has shown a highest importance and performance amongst all the latent constructs proposed as predictors of DSIW in the garments manufacturing industry. These findings are a step forward and unique contribution of this study in the domain of CPP, SQ, CSR, EE, OP, OI and DSIW.

Measuring hospital process service quality: emerging technologies’ challenge

Purpose

In the mobile internet era, the path and mechanism of hospital patient-perceived quality have been changed radically. The purpose of this study is to develop a scale that adequately captures the characteristics of hospital service quality from the patient’s perspective under the background of the mobile internet.

Design/methodology/approach

Based on previous related research and interviews with focus groups, this paper conceptualized, constructed, refined and tested a multiple-item scale that examined key dimensions of hospital process service quality in the mobile context. To validate this scale, data were collected through two formal surveys in Chinese hospitals and were used to test the reliability and validity of the instrument.

Findings

The final measurement scale contains three dimensions, that is, environment conditions, attitude and behavior and technical convenience. With the help of this quality scale, hospital managers could have a better understanding of patients’ expectations under the new condition and pinpoint appropriate initiatives to fill the service gap.

Originality/value

This study focuses on service quality measurement issues related to the application of mobile internet technology in traditional clinical settings, such as hospitals. This paper develops an original and specific service quality scale that catches the online and offline characteristics of the hospital process in the mobile setting and considers both human-technology interaction and human-human interaction.

Physician-user interaction and users' perceived service quality: evidence from Chinese mobile healthcare consultation

Purpose

The significance of physician-user interaction has been widely acknowledged in offline and online healthcare consultation. However, limited attempts have been made to explore the influence of physician-user interaction on users' perceived service quality (PSQ) in the mobile context. Based on the literature on physician-user interaction and media synchronicity theory, this study proposes a theoretical model where the interactive factors common across the offline, online and mobile context, i.e. physicians' informational support and emotional support, the interactive factors unique in the mobile context, i.e. physicians' response speed and voice service, and the interaction between the two categories of interactive factors predict users' PSQ in mobile consultation.

Design/methodology/approach

This study collects consultation records between 25,225 users and 738 physicians from a leading Chinese mobile consultation application, and employs linear regression to verify the proposed theoretical model.

Findings

Physicians' informational, emotional support, response speed and voice service are found to have significant positive impacts on users' PSQ. Besides, physicians' response speed strengthens the positive impacts of physicians' informational and emotional support on users' PSQ, while physicians' voice service weakens the positive link between physicians' informational support on users' PSQ.

Originality/value

This study contributes to the antecedents for users' PSQ in mobile consultation by identifying unique interactive factors in the mobile context, and highlighting the individual and interaction effects of different physician-user interactive factors. Besides, this study employs novel methods, which leverages text classification and text pattern recognition to more accurately depict physicians' online behaviors based on objective communication records.

Examining User's Initial Trust Building in Mobile Online Health Community Adopting

Due to the high perceived risk, it is critical to foster users’ initial trust in the promotion of mobile online health community (MOHC) adoption. The present study focused on the role of two different trust elements and examined the initial trust building process based on elaboration likelihood model and trust transfer theory. The results indicated that initial trust in MOHC context was composed of two interrelated components: health service provider (doctor) and underlying technology (MOHC platform). Especially, the initial trust in MOHC platform exerted greater effects on adopting intention. Both performance-based cue (doctors’ information quality and interaction quality) and transfer-based cue (trust in the offline doctors’ health service) positively shaped the initial trust in doctor. Meanwhile, only the performance-based cue (MOHC platform’s information quality and service quality) has significant positive association with initial trust in MOHC platform. However, interpersonal recommend is insignificantly related to the initial trust in doctor. Trust in the mobile internet service is insignificantly related to the initial trust in MOHC platform.

Proposal for the User-Centered Design Approach for Health Apps Based on Successful Experiences: Integrative Review

Background

Different strategies encompassed within mHealth have shown themselves to be effective for maintaining good health or controlling certain diseases. However, there is usually a very high rate of abandonment of health apps. Therefore, it would seem obvious that there is a need for involving the end users (whether they are health professionals, patients, or both) in the design process from the early stages in order to enable their needs and characteristics to be identified. In this sense, it is common knowledge that focusing on the user permits the consideration of valuable details aimed at making the correct adjustment between the patient, the technology, and the organization of attention.

Objective

The goal of the research was to propose a methodology based on the review of previous successful user experiences in setting up health apps by using qualitative techniques (focus groups and discussion groups) that includes the participation of information technology and health professionals and the patients themselves.

Methods

An integrative review was made of studies in which a qualitative methodology was employed mainly through focus and/or discussion groups for the design and development of health apps, consulting diverse databases (PubMed, Scopus, and Proquest) with the following search strategy: “mHealth AND apps AND focus group OR discussion group.” A total of 69 papers were included in the review.

Results

A proposal structured in 4 sessions of variable duration was made in which information technology and health professionals and patients take part: composing, preparing, and organizing contents (session 1); testing structure and usability (session 2); does the app fit the needs of end users? (session 3); and last testing—keep on improving (session 4). Throughout the sessions, we propose studying aspects like previous user experiences in mHealth, barriers to the adoption of mHealth, interface contents, management and browsability, usability, perceived quality, security and privacy, capacity to self-manage disease with the app, ergonomics, and glanceability, etc. Specific tools that have proved useful in previous research for measuring these aspects are presented.

Conclusions

These work sessions would be based on predominantly qualitative methodologies although, as they evolve, validated questionnaires permitting the assessment of the objectivity of certain technical aspects could be incorporated. With this proposal, a project centered on end users could be effected, responding to their needs. However, this requires validation that will be made via implementation in the development of health apps, with the subsequent measurement of results in terms of adherence and improvement in the clinical variables of the end users.

The Antecedents of Poor Doctor-Patient Relationship in Mobile Consultation: A Perspective from Computer-Mediated Communication

This study aims to understand the underlying reasons for poor doctor-patient relationships (DPR). While extant studies on antecedents of poor DPR mainly focus on the offline context and often adopt the patients' perspective, this work focuses on the mobile context and take both doctors' and mobile consultation users' perspectives into consideration. To fulfill this purpose, we first construct a theoretical framework based on the Computer-Mediated Communication (CMC) literature. Then we coded 592 doctor-user communication records to validate and elaborate the proposed theoretical model. This work reveals that characteristics of mobile technologies pose potential challenges on both doctors' and patients' information providing, informative interpreting, and relationship maintaining behaviors, resulting in 10 and 6 types of inappropriate behaviors of doctors and users, respectively, that trigger poor DPR in the mobile context. The findings enrich the research on online DPR and provide insights for improving DPR in the mobile context.

A framework for m-health service development and success evaluation

The emergence of mobile technology has influenced many service industries including health care. Mobile health (m-Health) applications have been used widely, and many services have been developed that have changed delivery systems and have improved effectiveness of health care services. Stakeholders of m-Health services have various resources and rights that lends to a complexity in service delivery. In addition, abundance of different m-Health services makes it difficult to choose an appropriate service for these stakeholders that include customers, patients, users or even providers. Moreover, a comprehensive framework is not yet provided in the literature that would help manage and evaluate m-health services, considering various stakeholder's benefits. In this paper, a comprehensive literature review has been done on famous frameworks and models in the field of Information Technology and electronic health with the aim of finding different aspects of developing and managing m-health services. Using the results of literature review and conducting a stakeholder analysis, we have proposed an m-health evaluation framework which evaluates the success of a given m-health service through a three-stage life cycle: (1) Service Requirement Analysis, (2) Service Development, and (3) Service Delivery. Key factors of m-health evaluation in each step are introduced in the proposed framework considering m-health key stakeholder's benefits. The proposed framework is validated via expert interviews, and key factors in each evaluation step is validated using PLS model. Results show that path coefficients are higher than their threshold which supports the validity of proposed framework.

The Factors Affecting Older Adults' Intention toward Ongoing Participation in Virtual Reality Leisure Activities

Due to the aging of organs, older adults may have limited physical strength for participating in outdoor activities. Therefore, indoor activities offer an alternative for maintaining the health of older adults. Following advances in technology, individuals can use virtual reality to exercise in their homes and are no longer subject to the constraints of the outdoor environment or weather conditions. In addition, these activities are easier to participate in when compared to real-world leisure activities. The present research included 294 older adults as its research subjects. They were given firsthand experience of Wii games for 10 weeks, in order to examine the ongoing participation intention of older adults following an experience with virtual reality leisure activities. The study found that experience attributes, experience consequences, and experience values were important factors in determining ongoing participation intention and can effectively predict ongoing participation intention. Four experience attributes-ease of use, usefulness, safety and flexibility, and fun-significantly influenced the experience value and experience consequences of older adults' participants. Experience values also influenced ongoing participation intention.

Service quality and satisfaction in healthcare sector of Pakistan- the patients' expectations

Purpose The purpose of this paper is to assess the influence of patients' expectations from healthcare service quality on their satisfaction with nursing in public and private hospitals of Pakistan. Design/methodology/approach Data ( n=456) were collected from three public sector hospitals and three private sector hospitals of Lahore, the capital of Pakistan's most populous province. Male and female patients who have experience of both sectors were surveyed using a self-administered questionnaire developed using the original SERVQUAL approach. Data were analyzed using the statistical techniques and the Laplace criterion. Findings This paper attempts to explain degree of influences of five service quality constructs (empathy, responsiveness, tangibility, reliability and assurance) on Pakistani patients' expectations from the private and public sector hospitals and thus patient satisfaction. Further, this work can offer several intuitions into the effect of five constructs of service quality on patients' expectations of healthcare service quality and patient satisfaction with the service providers/nursing. The results reveal that the patient satisfaction is most strongly related to empathy in public sector and to responsiveness in private sector. Research limitations/implications In light of the previous studies and the current research findings, the study anticipates no apparently significant improvement in healthcare sector of Pakistan in near future considering various factors discussed in the study. The study will also help the service providers and the policy makers in understanding the deteriorating situation of the Pakistani healthcare sector and will guide them in identifying the areas by improving which not only the healthcare service quality in the country can be improved but also the image of healthcare sector among the masses and competitiveness of the healthcare sector can be enhanced. Originality/value The value of the study rests in its critical analysis of the current status of the healthcare sector of Pakistan with a view to suggest the areas that need to be worked on by the service providers and policy makers. Also, the study tries to settle a controversy within Pakistani healthcare literature concerning the question that who is producing more satisfied patients: private hospitals or their public counterparts?

Branding in a multichannel retail environment

Purpose

The purpose of this paper is to investigate the structural relationship between online brand equity, brand experience, brand attitude, and brand attachment while considering the moderating effect of store type (online stores vs app stores) and product type.

Design/methodology/approach

A total of 459 completed online questionnaires were collected from experienced online (n=254) and app shoppers (n=205) to empirically test the proposed model. Partial least squares path modeling approach, a variance-based structural equation modeling, was performed to evaluate the measurement and the structural model.

Findings

The study’s empirical investigation validates the proposed model and implies that online brand equity, brand experience, and brand attitude explain 66 percent of variances in brand attachment. Partial least square-multi group analysis reveals that the type of store and product type are moderators to all the proposed relationships except the hypothesis on the relationship between online brand equity and brand attachment.

Originality/value

With the tremendous advancement of information technology that enables firms to deploy multichannel strategy in their core business activities, the role of brand in a multichannel retail environment has been ignored. This study is among several attempts to examine the role of brand among consumers experienced with online and app stores. The practical implications and limitation are discussed.