Factors Affecting User Acceptance in Overuse of Smartphones in Mobile Health Services: An Empirical Study Testing a Modified Integrated Model in South Korea

Effectiveness and intention to use a COVID-19 self-management app for epidemiological investigation: a web-based survey study

Introduction

Numerous COVID-19-related apps were widely used during the COVID-19 pandemic. Among them, those supporting epidemiological investigations were particularly useful. This study explored the effectiveness of apps that support epidemiological investigations, factors influencing users' intention to use them, and ways to encourage their use.

Methods

We developed and evaluated the KODARI app to demonstrate its importance in epidemiological investigations. After adapting a questionnaire based on an existing evaluation framework for COVID-19-related apps, we collected data from 276 participants through an online survey conducted between April 28 and May 25, 2023. We conducted two independent sample t-tests to determine the differences between each variable according to demographic characteristics and a multiple regression analysis to identify factors affecting intention to use.

Results

Users were generally satisfied with the KODARI. We observed differences in sex, age, marital status, occupational characteristics, and experience with epidemiological investigation. Females rated the app's information accuracy higher than males. Males had a higher intention to use than females. Participants aged under 35 years rated information accuracy and transparency highly, whereas single participants rated information accuracy higher than married participants. Occupational groups with frequent interactions with others evaluated their self-determination regarding the application. The app's self-determination was highly valued among participants with experience in epidemiological investigations. By investigating the factors affecting the intention to use the app, we confirmed that effectiveness, self-determination, and usability significantly affected the intention to use.

Discussion

This study demonstrated the effectiveness of app supporting epidemiological investigations, identified meaningful factors that influence intention to use, and confirmed the applicability of our new framework by considering the specificity of infectious disease situations such as COVID-19. This study provides a new basis for future epidemiological studies.

Intention to use a mobile phone to receive mental health support and its predicting factors among women attending antenatal care at public health facilities in Ambo town, West Shoa zone, Ethiopia 2022

BACKGROUND

Mental health problems are the most common morbidities of women during the prenatal period. In LMICs mobile phones have been identified as a good vehicle for monitoring individuals with a high risk of mental health conditions. However, evidence is scarce and the purpose of this study was to assess the intention to use a mobile phone to receive mental health support and its predicting factors among women attending antenatal care at public health facilities in Ambo town, Ethiopia 2022.

METHODS AND MATERIALS

An institutional-based cross-sectional study design was conducted from May 20th to June 20th, 2022. A total of 715 prenatal women were included and a systematic random sampling technique was employed. An interviewer-administered structured questionnaire was used. Collected data was exported to SPSS version 25 for the descriptive part, and AMOS 26 structural equation modeling was also used to describe and assess the degree and significance of relationships between variables.

RESULTS

A total of 699 (97.8% response rate) responded to complete all the questionnaires. About 530 (77.3%) 95% CI (74%-80.3%) of women intended to use a mobile phone to receive mental health support. The perceived usefulness has a positive effect on attitude (β = 0.391, p < 0.001) and intention to use (β = 0.253, p < 0.001). The perceived ease of use influences perceived usefulness (β = 0.253, p < 0.001) and attitude β = 0.579, p < 0.001). The intention to use is positively affected by attitude (β = 0.662, p < 0.001).Trust has a positive effect on perceived usefulness (β = 0.580, p < 0.001) and intention to use (β = 0.113, p = 0.005). Subjective norm has a direct positive effect on perceived usefulness (β = 0.248, p < 0.001). Attitude serves as a partial mediator between perceived usefulness and intention to use and a complete mediating role between perceived ease of use and intention to use.

CONCLUSION

The level of intention to use a mobile phone among prenatal women is relatively high and attitude, perceived usefulness, and trust had direct positive effects on intention to use a mobile phone. Therefore, hospitals and healthcare providers should take proactive measures to implement the strategies and policies for providing mobile phone-based mental health support to prenatal women in remote areas.

Getting Connected to M-Health Technologies through a Meta-Analysis

The demand for mobile e-health technologies (m-health) continues with constant growth, stimulating the technological advancement of such devices. However, the customer needs to perceive the utility of these devices to incorporate them into their daily lives. Hence, this study aims to identify users' perceptions regarding the acceptance of m-health technologies based on a synthesis of meta-analysis studies on the subject in the literature. Using the relations and constructs proposed in the UTAUT2 (Unified Theory of Acceptance and Use of Technology 2) technology acceptance model, the methodological approach utilized a meta-analysis to raise the effect of the main factors on the Behavioral Intention to Use m-health technologies. Furthermore, the model proposed also estimated the moderation effect of gender, age, and timeline variables on the UTAUT2 relations. In total, the meta-analysis utilized 84 different articles, which presented 376 estimations based on a sample of 31,609 respondents. The results indicate an overall compilation of the relations, as well as the primary factors and moderating variables that determine users' acceptance of the studied m-health systems.

Suitability of the Unified Theory of Acceptance and Use of Technology 2 Model for Predicting mHealth Acceptance Using Diabetes as an Example: Qualitative Methods Triangulation Study

Background

In recent years, the use of mobile health (mHealth) apps to manage chronic diseases has increased significantly. Although mHealth apps have many benefits, their acceptance is still low in certain areas and groups. Most mHealth acceptance studies are based on technology acceptance models. In particular, the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was developed to predict technology acceptance in a consumer context. However, to date, only a few studies have used the UTAUT2 model to predict mHealth acceptance and confirm its suitability for the health sector. Thus, it is unclear whether the UTAUT2 model is suitable for predicting mHealth acceptance and whether essential variables for a health-related context are missing.

Objective

This study aims to validate the suitability of UTAUT2 for predicting mHealth acceptance.

Methods

In this study, diabetes was used as an example as mHealth apps are a significant element of diabetes self-management. In addition, diabetes is one of the most common chronic diseases affecting young and older people worldwide. An explorative literature review and guided interviews with 11 mHealth or technology acceptance experts and 8 mHealth users in Austria and Germany were triangulated to identify all relevant constructs for predicting mHealth acceptance. The interview participants were recruited by purposive sampling until theoretical saturation was reached. Data were analyzed using structured content analysis based on inductive and deductive approaches.

Results

This study was able to confirm the relevance of all exogenous UTAUT2 constructs. However, it revealed two additional constructs that may also need to be considered to better predict mHealth acceptance: trust and perceived disease threat.

Conclusions

This study showed that the UTAUT2 model is suitable for predicting mHealth acceptance. However, the model should be extended to include 2 additional constructs for use in the mHealth context.

The light response in chickens divergently selected for feather pecking behavior reveals mechanistic insights towards psychiatric disorders

Background

Feather pecking is a serious behavioral disorder in chickens that has a considerable impact on animal welfare and poses an economic burden for poultry farming. To study the underlying genetics of feather pecking animals were divergently selected for feather pecking over 15 generations based on estimated breeding values for the behavior.

Methods and results

By characterizing the transcriptomes of whole brains isolated from high and low feather pecking chickens in response to light stimulation we discovered a putative dysregulation of micro RNA processing caused by a lack of Dicer1. This results in a prominent downregulation of the GABRB2 gene and other GABA receptor transcripts, which might cause a constant high level of excitation in the brains of high feather pecking chickens. Moreover, our results point towards an increase in immune system-related transcripts that may be caused by higher interferon concentrations due to Dicer1 downregulation.

Conclusion

Based on our results, we conclude that feather pecking in chickens and schizophrenia in humans have numerous common features. For instance, a Dicer1 dependent disruption of miRNA biogenesis and the lack of GABRB2 expression have been linked to schizophrenia pathogenesis. Furthermore, disturbed circadian rhythms and dysregulation of genes involved in the immune system are common features of both conditions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11033-021-07111-4.

Factors influencing the mobile instant messaging application usage behaviours among home healthcare providers

AIMS AND OBJECTIVES

To explore the practice related to mobile instant messaging applications usage among home healthcare providers in Taiwan; and based on the unified theory of acceptance and usage of technology and perceived risk theory to examine the influencing factors.

BACKGROUND

Previous work has indicated the potential for using mobile instant messaging applications in chronic disease, disasters and public health emergencies. However, few studies have conducted to understand how healthcare professionals use them.

DESIGN

A cross-sectional design was used in the study.

METHODS

A wide-ranging empirical investigation was conducted in Taiwan. A total of 102 home agencies participated in this study, and 331 valid data were collected. The ODS guideline was followed.

RESULTS

69% of the participants had used mobile instant messaging applications, with high functionality and interesting value can integrate various messages and contribute to adoption. Performance expectancy, effort expectancy, and social influence were significantly positively correlated with behavioral intention. The perceived risk had a significant negative correlation with performance expectancy and use behavior. Among the relevant influencing factors, different types of organization, job position, and institutional policy were related to significant differences in use behaviors.

CONCLUSIONS

Our research reported on mobile instant messaging applications usage and behavioral intention among home healthcare providers. This study also highlighted the need to establish regulations within the applications and improve safety and security guidelines. Further research may extend the understanding of the organizations' influencing factors.

RELEVANCE TO CLINICAL PRACTICE

This study may help programmers, managers and policymakers improve their strategies for expanding usage of mobile instant messaging applications.

Determinants of pro-environmental behavior among excessive smartphone usage children and moderate smartphone usage children in Taiwan

INTRODUCTION

Although there is evidence linking the relationships between smartphone usage with health, stress, and academic performance, there is still inadequate knowledge about the influence on pro-environmental behaviors. This study seeks to bridge this gap by adapting the theory of attribution framework to examine the effects of personal norms, social norms, perceived behavioral control on pro-environmental behavior of smartphone usage in children.

METHODS

A total of 225 children aged between 11 to 12 from eight selected public primary schools at the Hsinchu Science and Industrial Park in Taiwan were surveyed. Two distinct groups (excessive versus moderate usage) were purposefully selected for comparison, of which 96 participants were excessive smartphone users while the remaining 129 were moderate smartphone users.

RESULTS

Findings revealed significant differences between excessive and moderate smartphone usage children groups in personal norms (p < 0.001), social norms (p = 0.002), perceived behavioral control (p = 0.001), and pro-environmental behavior (p = 0.001). Findings for excessive smartphone usage children showed that social norms (β = 0.428, t = 4.096***, p < 0.001) had a direct predictive impact on pro-environmental behavior. In contrast, while there was no direct path established between personal norms and pro-environmental behavior (β = 0.177, t = 1.580, p > 0.05), as well as social norms and pro-environmental behavior for moderate smartphone usage children (β = 0.181, t = 1.924, p > 0.05), but such a relationship could be developed through the mediating effect of perceived behavioral control (β = 0.497, t = 4.471***, p < 0.001).

DISCUSSION

The results suggested that excessive smartphone usage children lack positive perceived behavioral control, and their pro-environmental behavior could only be predicted through explicit social norms, whereas pro-environmental behavior of moderate smartphone usage children was implicitly influenced by personal norms through perceived behavioral control.

Behavioral Intention to Use a Smartphone Usage Management Application Between a Non-Problematic Smartphone Use Group and a Problematic Use Group

Despite the many advantages of smartphone in daily life, there are significant concerns regarding their problematic use. Therefore, several smartphone usage management applications have been developed to prevent problematic smartphone use. The purpose of this study is to investigate the factors of users' behavioral intention to use smartphone usage management applications. Participants were divided into a smartphone use control group and a problematic use group to find significant intergroup path differences. The research model of this study is fundamentally based on the Technology Acceptance Model and Expectation-Confirmation Theory. Based on this theorem, models were modified to best suit the case of problematic smartphone use intervention by smartphone application. We conducted online surveys on 511 randomly selected smartphone users aged 20-60 in South Korea, in 2018. The Smartphone Addiction Proneness Scale was used to measure participants' smartphone dependency. Descriptive statistics were used for the demographic analysis and collected data were analyzed using IBM SPSS Statistics 24.0 and Amos 24.0. We found that in both non-problematic smartphone use group and problematic smartphone use group, facilitating factors and perceived security positively affect the intentions of users to use the application. One distinct difference between the groups was that the latter attributed a lower importance to perceived security than the former. Some of our highlighted unique points are envisioned to provide intensive insights for broadening knowledge about technology acceptance in the field of e-Addictology.

Parents' Attitudes Toward School Students' Overuse of Smartphones and Its Detrimental Health Impacts: Qualitative Study

BACKGROUND

Parents' awareness of the risks of the overuse of smartphones (SPs) among their children and parents' attitudes toward this societal phenomenon are crucial factors to consider when investigating the causes and effects of, as well as interventions to control, this public health issue.

OBJECTIVE

This study aimed to explore the awareness and attitudes of parents regarding SP overuse among their children and the detrimental impacts associated with it.

METHODS

The qualitative method of semistructured face-to-face interviews was used to collect data from fathers and mothers of children aged 6-18 years from all 6 educational/governorate regions in the governmental sector in Kuwait.

RESULTS

A total of 120 parents agreed to participate in the study; there were more female (75/120, 62.5%) than male (45/120, 37.5%) respondents. Almost all of the participants (118/120, 98.3%) were aware that the overuse of SPs could lead to their children becoming addicted to the devices; they were also aware that there could be side effects on their children's health (117/120, 97.5%). Although the participants, mostly the mothers, supervised their children's use of SPs closely (106/120, 88.3%), the majority could not control their children's length of time using SPs, as the children considered this a deprivation of their rights. Eye-related problems, headaches, and anger were the most common side effects experienced by the children.

CONCLUSIONS

Although the parents were aware of the detrimental impacts of SP overuse, the majority could not control the length of time their children spent using the devices. It was found that strong social bonds among family members play a large role in controlling the use of SPs. A number of solutions for families and the government to combat the overuse of SPs are suggested.

Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study

Background

Information in health care is rapidly expanding and is updated very regularly, especially with the increasing use of technology in the sector. Due to this, health care providers require timely access to the latest scientific evidence anywhere. Smartphone medical apps are tools to access the latest reputable scientific evidence in the discipline. In addition, smartphone medical apps could lead to improved decision making, reduced numbers of medical errors, and improved communication between hospital medical staff.

Objective

The aim of this study was to assess smartphone medical app use and associated factors among physicians working at referral hospitals of the Amhara region, Ethiopia.

Methods

An institution-based cross-sectional study design was conducted among physicians working at 5 referral hospitals in the Amhara region, Ethiopia, from February 5 to May 27, 2019. A simple random sampling method was used to select 423 physicians. A self-administered questionnaire was used to collect the data and analyzed using SPSS, version 21 (IBM Corp). Binary and multivariable logistic regression analysis was performed to assess factors associated with smartphone medical app use among physicians. A value of P<.05, corresponding to a 95% CI, was considered statistically significant. The validity of the questionnaire was determined based on the view of experts and the reliability of it obtained by calculating the value of Cronbach alpha (α=.78)

Results

In this study, most of the 417 respondents (375, 89.9%) had medical apps installed on their smartphones. Of those 375 respondents, 264 (70.4%) had used medical apps during clinical practice. The medical apps most commonly used by the respondents were UpToDate, Medscape, MedCalc, and Doximity. According to multivariable logistic regression analysis, attitude (adjusted odds ratio [AOR] 1.64, 95% CI 1.05-2.55), internet access (AOR 2.82, 95% CI 1.75-4.54), computer training (AOR 1.71, 95% CI 1.09-2.67), perceived usefulness of the app (AOR 1.64, 95% CI 1.05-2.54), information technology support staff (AOR 2.363, 95% CI 1.5-3.08), and technical skill (AOR 2.52, 95% CI 1.50-4.25) were significantly associated with smartphone medical app use.

Conclusions

Most respondents have a smartphone medical app and have used it in clinical practice. Attitude, internet access, computer training, perceived usefulness of the app, information technology support staff, and technical skill are the most notable factors that are associated with smartphone medical app use by physicians. 

Culture in the design of mHealth UI

Purpose

Designers of mobile applications have long understood the importance of users’ preferences in making the user experience easier, convenient and therefore valuable. The cultural aspects of groups of users are among the key features of users’ design preferences, because each group’s preferences depend on various features that are culturally compatible. The process of integrating culture into the design of a system has always been an important ingredient for effective and interactive human computer interface. This study aims to investigate the design of a mobile health (mHealth) application user interface (UI) based on Arabic culture. It was argued that integrating certain cultural values of specific groups of users into the design of UI would increase their acceptance of the technology.

Design/methodology/approach

A total of 135 users responded to an online survey about their acceptance of a culturally designed mHealth.

Findings

The findings showed that culturally based language, colours, layout and images had a significant relationship with users’ behavioural intention to use the culturally based mHealth UI.

Research limitations/implications

First, the sample and the data collected of this study were restricted to Arab users and Arab culture; therefore, the results cannot be generalized to other cultures and users. Second, the adapted unified theory of acceptance and use of technology model was used in this study instead of the new version, which may expose new perceptions. Third, the cultural aspects of UI design in this study were limited to the images, colours, language and layout.

Practical implications

It encourages UI designers to implement the relevant cultural aspects while developing mobile applications.

Originality/value

Embedding Arab cultural aspects in designing UI for mobile applications to satisfy Arab users and enhance their acceptance toward using mobile applications, which will reflect positively on their lives.

Factors Influencing Patients' Intentions to Use Diabetes Management Apps Based on an Extended Unified Theory of Acceptance and Use of Technology Model: Web-Based Survey

BACKGROUND

Diabetes poses heavy social and economic burdens worldwide. Diabetes management apps show great potential for diabetes self-management. However, the adoption of diabetes management apps by diabetes patients is poor. The factors influencing patients' intention to use these apps are unclear. Understanding the patients' behavioral intention is necessary to support the development and promotion of diabetes app use.

OBJECTIVE

This study aimed to identify the determinants of patients' intention to use diabetes management apps based on an integrated theoretical model.

METHODS

The hypotheses of our research model were developed based on an extended Unified Theory of Acceptance and Use of Technology (UTAUT). From April 20 to May 20, 2019, adult patients with diabetes across China, who were familiar with diabetes management apps, were surveyed using the Web-based survey tool Sojump. Structural equation modeling was used to analyze the data.

RESULTS

A total of 746 participants who met the inclusion criteria completed the survey. The fitness indices suggested that the collected data fit well with the research model. The model explained 62.6% of the variance in performance expectancy and 57.1% of the variance in behavioral intention. Performance expectancy and social influence had the strongest total effects on behavioral intention (β=0.482; P=.001). Performance expectancy (β=0.482; P=.001), social influence (β=0.223; P=.003), facilitating conditions (β=0.17; P=.006), perceived disease threat (β=0.073; P=.005), and perceived privacy risk (β=-0.073; P=.012) had direct effects on behavioral intention. Additionally, social influence, effort expectancy, and facilitating conditions had indirect effects on behavioral intention that were mediated by performance expectancy. Social influence had the highest indirect effects among the three constructs (β=0.259; P=.001).

CONCLUSIONS

Performance expectancy and social influence are the most important determinants of the intention to use diabetes management apps. Health care technology companies should improve the usefulness of apps and carry out research to provide clinical evidence for the apps' effectiveness, which will benefit the promotion of these apps. Facilitating conditions and perceived privacy risk also have an impact on behavioral intention. Therefore, it is necessary to improve facilitating conditions and provide solid privacy protection. Our study supports the use of UTAUT in explaining patients' intention to use diabetes management apps. Context-related determinants should also be taken into consideration.