Factors Influencing the Adoption of Online Health Consultation Services: The Role of Subjective Norm, Trust, Perceived Benefit, and Offline Habit

Trust: How It Affects the Use of Telemedicine in Improving Access to Assistive Technology to Enhance Healthcare Services

Background

Modern telemedicine (TM) technologies play a crucial role in enhancing access to Assistive Technology in healthcare services. However, the full benefits of this technology will not be realized unless it is widely accepted among service users (patients). This study aimed to investigate the impact of patient trust and perceived risk on the acceptance of TM for Assistive Technology in healthcare.

Materials and Methods

A comprehensive survey instrument was developed and refined through expert feedback and a pilot study, leading to data collection from 917 participants. The theoretical framework guiding this research was based on the Trust factors in TM, which helped in conceptualizing the factors influencing patient acceptance of TM.

Results

The study revealed a significant gap in patient trust in TM and highlighted the multifaceted nature of perceived risk, emphasizing the need to consider individual risk factors separately. Results also indicated that trust in technological reliability and the perceived effectiveness of TM were critical factors influencing its adoption. The findings underscore the importance of building trust among service users and promoting the reliability of TM for achieving desirable medical outcomes.

Conclusion

In conclusion, to facilitate widespread acceptance of TM for Assistive Technology, a multi-faceted approach involving healthcare providers, organizations, and governments is essential to address patient concerns, enhance trust, and promote the benefits of this technology.

Factors Influencing Users' Perceptions of Digital Platform Indispensability: A Comparative Study of Korea and Finland

The pervasive integration of digital platforms into daily life has amplified their perceived indispensability. This study investigates the factors influencing this perception across countries with contrasting platform landscapes, focusing on platform quality and usage patterns. We conducted surveys in Finland and Korea, countries representing distinct platform ecosystems. The results revealed higher perceived indispensability in Korea than in Finland, with usefulness and habitual platform use emerging as significant predictors of indispensability in both countries. However, the specific aspects of platform quality influencing this perception diverged. In Finland, the platform's comprehensiveness and security risk significantly impacted indispensability, while social interaction features played a negligible role. Conversely, in Korea, social interaction features significantly influenced indispensability, while platform comprehensiveness and security risk were non-significant. These findings underscore the multifaceted nature of digital platform indispensability, shaped by the interaction of platform quality and usage patterns. The contextual variations highlighted by our cross-country comparison suggest that a one-size-fits-all approach to platform regulation or user education may be ineffective. Future research should explore these cultural and platform-specific nuances to devise tailored policies.

Consulting doctors online after offline treatment: investigating the effects of online information on patients' effective use of online follow-up services

Introduction

The use of online follow-up services (OFUS) is becoming an increasingly important supplement to hospital care. Through OFUS, patients can find their doctors in online health communities (OHCs) and receive remote medical follow-ups after hospital treatment. However, the rate of effective use of OFUS by current patients is still low, and there is an urgent need for research to investigate the online information factors that affect patients' effective use of OFUS.

Methods

Based on the elaboration likelihood model (ELM) of persuasion and an analysis of a panel dataset including 3,672 doctors in a leading OHC in China, this study explores how online information from doctors' knowledge contributions and patient feedback influences patients' effective use of OFUS.

Results

The results show that both doctors' knowledge contributions and patient feedback positively influence patients' effective use of OFUS. Doctors' paid knowledge contributions and patients' paid feedback have stronger persuasive effects than doctors' free knowledge contributions and patients' free feedback, respectively. Moreover, there is a substitutional relationship between doctors' paid and free knowledge contributions and between patients' paid and free feedback in influencing patients' effective use of OFUS.

Discussion

The findings of this study suggest that OHC platforms and healthcare providers should account not only for the persuasive effects of doctors' knowledge contributions and patient feedback but also for influential differences and relationships between the types of doctors' knowledge contributions and patient feedback to better persuade patients to effectively use OFUS.

Determining factors affecting Filipino consumers' behavioral intention to use cloud storage services: An extended technology acceptance model integrating valence framework

Cloud Storage (CS) is a service that digitally stores, remotely manages, backs up, and renders internet-accessible data. However, despite its known benefits compared to traditional storage devices, this service is not widely used in developing nations such as the Philippines. This study integrated the Valence Theoretical Framework into the Extended Technology Acceptance Model (ETAM) to evaluate the influence of twelve variables on Filipino consumers' behavioral intention (BI) toward adopting CS services. The data is gathered through an online survey. Structural Equation Modeling was employed to examine the responses of 431 cloud users, mainly students and working professionals. Results showed that Perceived Benefit and Perceived Usefulness were the strongest determinants of BI. The Job Relevance was also found to be a significant factor. Therefore, CS providers should find additional ways to make their offerings more beneficial for the daily tasks of students and working individuals. Furthermore, considering the substantial influence of Perceived Risk and Subjective Norms on BI, CS providers must strengthen their security measures to boost users' trust in their services. Consumers who receive excellent service are likely to give positive reviews, which can be helpful to individuals who might also be considering purchasing CS for their data. Although the focus of this study is CS services, this can also serve as a reference when analyzing the BI of consumers concerning the adoption of other novel technologies applied in various sectors, including education, e-commerce, healthcare, and more.

Understanding psychology students' perspective on video psychotherapy and their intention to offer it after graduation: a mixed-methods study

Introduction

Video psychotherapy (VPT) demonstrated strong clinical efficacy in the past, with patients and psychotherapists expressing satisfaction with its outcomes. Despite this, VPT only gained full recognition from the German healthcare system during the COVID-19 pandemic. As society increasingly relies on new media, it seems likely that VPT will become even more relevant. Previous studies surveyed practicing psychotherapists and patients about advantages and disadvantages of VPT. In contrast, our approach targets a younger generation, specifically psychology students intending to become licensed practitioners after graduation.

Methods

Our mixed-methods study was conducted in an online survey format and had two main objectives. Firstly, we investigated which person-related variables are associated with psychology students' behavioral intention to offer VPT after graduation, using a multiple regression analysis. Secondly, we explored psychology students' perception of advantages and disadvantages of VPT and identified their desired learning opportunities regarding VPT in their study program, using qualitative content analysis.

Results

A sample of 255 psychology students participated. The multiple regression model explains 73% of inter-individual variance in the intention to offer VPT, with attitudes toward VPT showing the strongest relationship with intention to offer VPT. Expected usefulness, satisfaction with video conferencing, and subjective norm also showed significant relations. The students provided 2,314 statements about advantages, disadvantages, and desired learning opportunities, which we coded by means of three category systems. In terms of advantages, the most frequently mentioned categories were low inhibition threshold, flexibility in terms of location, and no need to travel. For disadvantages, the predominant categories included lack of closeness between patient and psychotherapist, lack of nonverbal cues, and problems with technology or internet connection. Regarding desired learning opportunities, training for technical skills, practical application through role-playing and self-experience, and general information about VPT were the most mentioned categories. In addition, we identified numerous other aspects related to these topics, reflecting a differentiated and balanced assessment of VPT.

Discussion

We discuss the theoretical and practical implications of our findings for training the next generation of psychotherapists and outline a specific five-step plan for integrating VPT into study programs.

Nephrology workforce in China: describing current status and evaluating the optimal capacity based on real-world data

OBJECTIVE

This study aims to characterize the current status of the nephrology workforce in China and evaluate its optimal capacity based on real-world patient mobility data.

METHODS

Data on nephrologists in China were collected from two prominent online healthcare platforms using web crawlers and natural language processing techniques. Hospitalization records of patients with chronic kidney disease (CKD) from January 2014 to December 2018 were extracted from a national administrative database in China. City-level paths of patient mobility were identified. Effects of nephrology workforce on patient mobility were analyzed using multivariate Poisson regression models.

RESULTS

Altogether 9.13 nephrologists per million population (pmp) were in practice, with substantial city-level variations ranging from 0.16 to 88.79. The ratio of nephrologists to the estimated CKD population was 84.57 pmp. Among 6 415 559 hospitalizations of patients with CKD, 21.3% were cross-city hospitalizations and 7441 city-level paths of patient mobility with more than five hospitalizations were identified. After making adjustment for healthcare capacity, healthcare insurance, economic status, and travel characteristics, the Poisson regression models revealed that the number of nephrologists in both the source city (incidence rate ratio [IRR] 0.99, per 1 pmp increase) and destination city (IRR 1.07, per 1 pmp increase) were independently associated with patient mobility. An IRR plateau was observed when the number of nephrologists exceeded 12 pmp in the source city, while a rapidly increasing IRR was observed beyond 20 pmp in the destination city.

CONCLUSIONS

The nephrology workforce in China exhibits significant geographic variations. Based on local healthcare needs, an optimal range of 12-20 nephrologists pmp is suggested.

Switching from offline to online health consultation in the post-pandemic era: the role of perceived pandemic risk

Introduction

Due to its effectiveness and various benefits, the use of online health consultation (OHC) has dramatically increased in recent years, especially since the outbreak of the COVID-19 pandemic. However, underlying mechanism whereby the pandemic impacted OHC usage is still unclear.

Methods

Via an online survey (N=318), the present paper measures the users' perceptions towards both offline and online services, their intention to switch to OHC, and the perceived pandemic risks. The relationships among these factors are conceptualized by the push-pull-mooring framework, and tested via structural equation modelling.

Results

Dissatisfaction with offline service (process inefficiency and consultation anxiety), the attractiveness of OHC (perceived benefits and perceived ease of use), and users' behavioral inertia (switching cost and habit) jointly influence the intention to switching to OHC. The significant role of the perceived pandemic risk of going to medical facilities is particularly addressed. On the one hand, the perceived pandemic risk is found with an indirect impact on the switching intention by enlarging the dissatisfaction with offline service and the attractiveness of OHC. On the other hand, a high perceived pandemic risk induces more actual switching behavior and also amplifies the transition from switching intention to behavior.

Discussion

The study provides novel insights into the understanding of OHC usage in the post-pandemic era, and also informs medical facilities, OHC platforms, and policymakers on managing and balancing the online and offline healthcare provision.

Factors Affecting Users' Continuous Usage in Online Health Communities: An Integrated Framework of SCT and TPB

BACKGROUND

Online health communities (OHCs) provide a new channel for users to obtain more health-related information and support, playing an important role in alleviating hospital congestion and uneven medical resource distribution, especially during the COVID-19 pandemic in China. An in-depth study of users' continuous usage is of great value for the long-term development of OHCs.

OBJECTIVE

The purpose of this study is to explore the factors that influence users' continuous usage in online health communities based on the theory of planned behavior (TPB) and social cognitive theory (SCT).

METHODS

Data from 480 users with experience in online health communities were collected through a questionnaire survey, and structural equations were applied to verify the model hypotheses empirically.

RESULTS

Self-efficacy and controllability have significant effects on users' continuous intention; attitude has a significant relationship with continuous intention; social norms have a positive effect on continuous intention. Moreover, the relationship between continuous intention and behavior is positive. Self-efficacy and outcome expectations have significant positive associations with continuous usage. Finally, system quality, information quality, and social interaction ties have significant and positive relationships to continuous usage.

CONCLUSION

To improve the level of user's continuous usage, online health service providers can improve the quality of the community by organizing the website's page layout, navigation menus, and site elements to ensure users quickly search and find what they want meanwhile try to change people's cognition gradually, in addition, decision and policymakers should provide more favorable policies to stimulate and help provider in building and managing strategic plans for sustaining a thriving online community. A supportive climate in society through public service advertisements and others for the sake of OHCs is necessary.

LIMITATIONS

(1) This study collected data through a cross-sectional survey. Thus, it lacked the process of capturing the changes in participants' attitudes toward all variables. (2) The environmental factors in SCT theory need to be more comprehensive, containing online factors without offline factors. (3) The dates were obtained from China, which neglects the different cultural content.

The Roles of Trust and Its Antecedent Variables in Healthcare Consumers' Acceptance of Online Medical Consultation during the COVID-19 Pandemic in China

Online medical consultation (OMC) is generating considerable interest among researchers and practitioners due to the mandatory quarantine measures implemented during the COVID-19 pandemic in China. However, the acceptance rate of OMC has declined over time. This paper aims to empirically investigate OMC acceptance using a proposed research model by integrating the technology acceptance model (TAM) with trust and its antecedent variables. A quantitative self-administered cross-sectional survey was conducted to collect data from 260 healthcare consumers. A partial least squares structural equation modeling method was used to examine the data. Results revealed that healthcare consumers' behavioral intention was influenced by attitudes, while perceived usefulness and trust significantly influenced behavioral intention through attitude as a mediator. In addition, perceived risk, perceived privacy protection, network externalities, cognitive reputation, and interactivity directly influenced trust. Overall, the research model explained 50% of the variance in attitude and 71% of the variance in behavioral intention. The study's findings should provide useful insights into making effective design, development, and implementation decisions for OMC services.

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.

The Effect of Offline Medical Resource Distribution on Online Physician-Patient Interaction: Empirical Study With Online and Offline Data

BACKGROUND

The relationship between online health communities (OHCs) and offline medical care is unclear because both provide physician-patient interaction services and channels. Taking advantage of information and communication technology, patients have been using OHCs widely. However, some physical medical resources (such as hospital beds and medical devices) cannot be replicated by information and communication technologies. Therefore, it is worth studying how offline medical resources affect physician-patient interactions in OHCs and how OHCs help to solve resource scarcity and the uneven distribution of traditional medical treatment.

OBJECTIVE

This study aimed to support the notion that physician-patient consultations in OHCs are influenced by the objective distribution of offline health care capital (accessibility and availability) and to provide suggestions for the allocation of medical resources in practice through the judicious use of offline and online channels.

METHODS

The empirical data in this study were collected from both online and offline channels. The offline data include 9 years (2006-2014) of medical resource statistics of 31 provincial administrative regions in mainland China. Moreover, data regarding the geolocation-based physician-patient interaction network in the OHC were also collected. The online data come from one of China's largest OHCs. We obtained 92,492 telephone consultation records of 6006 physicians using an automatic web crawler program. Social network analysis was used to visualize the descriptive statistics of the offline geolocation-based physician-patient interaction network in the OHC. A regression model with a squared variable was applied to analyze online and offline empirical data to further test our hypothesis. Two types of robustness tests were used to increase the reliability of the test results of the initial model.

RESULTS

The results of our social network analysis show that there is a uniform geographic distribution of patients who use OHCs, whereas the physician relies more on geographic advantage (eg, a higher medical resource capability). Moreover, the empirical results of the regression model support the notion that physician-patient telephone consultations are positively influenced by physicians' online contributions (β_contribution=.210; P<.001) and capital availability (β_bed=.935; P=.07), and, interestingly, spatial accessibility has an inverted U-shaped effect (β_distance=.199; P<.001 and β_distance²=-.00449; P=.008). The results indicate that the use of OHCs, although constrained by offline medical resources, provides a channel for offline resources to flow from areas with high availability to those with low availability.

CONCLUSIONS

This study explores the relationship between online and offline channels by investigating online physician-patient interactions and offline medical resources. In particular, this study analyzes the impact of offline channels on online channels and verifies the possibility of OHC capital use shifting from a high-availability area to a low-availability area. In addition, it provides a theoretical and practical basis for understanding the interaction of online and offline channels of medical care.

The impact of users' trust on intention to use the mobile medical platform: Evidence from China

Introduction

The mobile medical platform effectively complements offline medical services as it can provide patients with broader and more convenient medical services, effectively solving the shortage of medical resources in the public health system. Although the public interest in healthcare service platforms continues to rise, the market data shows that the adoption and acceptance have not reached a high level. How to increase the utilization rate of the mobile medical platform to relieve medical pressure has become an urgent issue to be discussed. Based on the framework of "trust-intention" this research introduces innovation acceptance and technical risk concerns as the two moderating variables to attempt to build a research model of users' intention to use the mobile medical platform. The analysis illustrated that users' trust in the mobile medical platform would positively affect their use intention. The researchers further explored the moderating role of innovation acceptance and technical risk concerns.

Methods

Use questionnaire to collect data in China, then use the OLS least square method for the regression test.

Results

The results showed that users with high personal innovation acceptance would positively promote the relationship between trust and use intention. In contrast, users who are more concerned about the risks of innovative technologies will weaken the relationship between trust and use intention.

Discussion

The findings theoretically extend the academic research of use intention to the specific context of the mobile medical platform and enrich the research framework of "trust-intention".

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.

Online selection of a physician by patients: the impression formation perspective

Background

With the rapid development of online health communities (OHCs), an increasing number of physicians provide services in OHCs that enable patients to consult online in China. However, it is difficult for patients to figure out the professional level of doctors before consultation and diagnosis because of information asymmetry. A wealth of information about physicians is displayed in their profiles as a new way to help patients evaluate and select quickly and accurately.

Objective

This research explores how the profile information (PI) presented in OHCs influences patients' impression formation, especially the perception of professional capital (i.e., status capital and decisional capital). The impression influences their intention to consult further, which is partially mediated by the initial trust. The Toulmin’s model of argumentation is used to decide the strength of the argument presented in physicians’ homepage information and divide it into claim, data, and backing.

Methods

This study conducts an internet experiment and recruits 386 subjects through the internet to investigate the effect of impression formation on online selection behavior by a patient.

Results

The results show that the strength of argument has a significant positive association with the perception of professional capital. Perceptions of professional capital are highest when a fully composed argument (claim/data/backing) is included in a profile, with claim/data being the next highest and claim only the lowest. Recommendations from connections have the strongest impact. In turn, patients' selection decisions are influenced by their perception of professional capital, which is partially mediated by initial trust.

Conclusions

This study is significant in terms of its implications for theory and practice. On the one hand, this research contributes to the online health community literature and suggests that the perception of professional capital on physicians should be pre-presumed and built based on the information before in-person interaction online. On the other hand, this study is helpful in understanding the effect of various components included in PI on perceiving physicians’ abilities, and not all information is equally important.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01936-0.

Health Literacy, Misinformation, Self-Perceived Risk and Fear, and Preventive Measures Related to COVID-19 in Spanish University Students

The "infodemic" is one of the main obstacles in the fight against the COVID-19 pandemic. In order to face it, health literacy (HL) is essential since it allows for knowledge about COVID-19 and the practice of preventive measures to be fostered. This is especially relevant in university students due to their idiosyncrasy. This study aims to evaluate the level of HL related to COVID-19 (HLC), risk perception, misinformation, and the attitudes and behaviors adopted to prevent the spread of coronavirus in Spanish university students. An online questionnaire was administered to 499 Spanish university students. The HLC index presented a mean of 33.89 out of 50; a total of 63.8% had an inadequate level of HLC. They practiced a mean of 7.54 out of 9 preventive behaviors, and the mean knowledge score was 10.40 out of 13. The HLC showed significantly different scores for the degree, the practice of preventive measures, and some sources of information. The level of HL correlates with the adoption of preventive measures. The higher the severity and perceived susceptibility, the more preventive measures are taken by the students. Therefore, there is a need to strengthen the HL skills of university students and address the dissemination of misinformation. Although caution should be taken when generalizing these results due to the limitations inherent within a cross-sectional study and the convenience sampling, our results can guide the establishment of health education strategies and policies for the management of the infodemic in pandemic situations, according to this target population.

Encouraging physicians' continuous knowledge-sharing in online health communities: A motivational perspective

Online health communities (OHCs) as an essential means of patient education can significantly improve patients' health literacy and treatment outcomes. However, sustaining these social benefits brought by OHCs establishes the prerequisite that physicians can continuously share their knowledge on OHCs. Although previous studies have explored physicians' knowledge-sharing in OHCs, scholarly knowledge related to the means of motivating physicians to continue sharing their knowledge remains limited. Therefore, this study developed a research model based on motivation theory to explore the influence of practical benefits, psychological rewards, and perceived connectedness with OHCs on physicians' continuous knowledge-sharing behaviors and the contingent role of physicians' online seniority status. The research model and relevant hypotheses were examined using objective data from one of the leading OHCs in China. The empirical results reveal that both practical benefits and psychological rewards positively affect physicians' continuous knowledge-sharing behaviors. However, an unexpected finding is that perceived connectedness is negatively associated with physicians' continuous knowledge-sharing behaviors. In addition, physicians' online seniority status strengthens the relationship between practical benefits and continuous knowledge-sharing behaviors but weaken the role of psychological rewards and perceived connectedness on continuous knowledge-sharing behaviors. This study contributes to the understanding of the motivational mechanisms underlying physicians' continuous knowledge-sharing behaviors in OHCs and provides significant practical implications for practitioners of OHCs.

To join the rebuild or not? An exploration of the factors influencing the public's intention to participate in urban renewal

Due to the lack of trust in the builder and indeterminate benefits, it is a struggle for people in Taiwan to make up their minds to participate in urban renewal. This leads to the completion rate of urban renewal of fewer than one ten-thousandth of the new construction needed. This study investigated the perspective on the research variables for people in Taiwan and how those influence their intention to participate in urban renewal. Using the Theory of Planned Behavior, the research framework is designed with the trust of urban renewal project builders and the perceived benefits of public participation as the independent variables. Attitudes, subjective norms, and perceived behavioral control are the mediating variables, and the general public's intention to participate in urban renewal is the dependent variable. A total of 545 valid questionnaires were collected through the survey. The results showed that the respondents' trust in the builder of the urban renewal project positively and significantly influenced their perceived benefits of the project, and the respondents' trust in the builder significantly influenced their subjective norms. The perceived benefits positively and significantly affected their attitudes and subjective norms, and people's attitudes, subjective norms, and perceived behavioral control positively and significantly affected their intention to participate in urban renewal. People's perceived benefits in urban renewal projects affected their participation intention through attitudes and subjective norms. The variable perceived benefits most strongly influenced people's intention to participate in urban renewal in this study. This study provides practical suggestions for the government and builders to increase people's intention to participate in urban renewal. This study modeled two independent variables, trust in the builder and perceived benefits, under the urban renewal context in Taiwan. In future works, other factors could be included, such as tax incentives, floor area rewards, and fair appraisal.

Research on patients' willingness to conduct online health consultation from the perspective of web trust model

Background and aims

The online health platform becomes an important choice for users to receive health services. While bringing convenience to users, it also provides lots of overloaded information for users and leads them to have trouble in making online medical choice decisions. In order to understand what types of information on the online health platform play key roles in the user's decision choice, this research explores the effects of cognition-based information, affect-based information and institution-based information on patients' willingness to conduct online health consultation from the perspective of Web Trust Model.

Methods

Responses of 412 valid questionnaires were collected via online surveys.

Results

The results showed that: (1) cognition-based information, affect-based information and institution-based information positively predict patients' willingness to conduct online health consultation; (2) online trust significantly mediates the relationship between online health platform information and willingness to conduct online health consultation; (3) health consciousness significantly moderates the mediating effect of online trust in the effect of online health platform information on patients' willingness to conduct online health consultation.

Conclusions

The findings make theoretical contributions by extending the Web Trust Model to the research field of online health service and offers practical implications for how to effectively provide information on the online health platform.

Is physician online information sharing always beneficial to patient education? An attention perspective

Aims

With the development of information technology, online health platforms and physician online information sharing play an important role in public health management and patient education. Is physician online information sharing always beneficial to patient education? From the attention perspective, this study aims to explore how physician online information sharing influences patient education, considering the contingent roles of physician online reputation and offline expertise.

Methods

A 6-month panel data of 61,566 physician-month observations from an online health platform in China was used to tested the proposed hypotheses. Considering the inefficiency and estimated bias of the ordinary least squares regression model, this study conducted the fixed models to test the direct and moderating effects.

Results

The results indicate that physician online information sharing is positively related to potential patient education, while the relationship between physician online information sharing and realized patient education is an inverted U-shape. Physician online reputation enhances the positive relationship between physician online information sharing and potential patient education, but physician offline expertise weakens the abovementioned relationship. In addition, physician offline expertise flattens the curvilinear effect of physician online information sharing on realized patient education.

Conclusion

This study contributes to the literature about attention theory and information sharing for patient education, and provides implications for practice.

How to Promote Online Education through Educational Software—An Analytical Study of Factor Analysis and Structural Equation Modeling with Chinese Users as an Example

Online learning has emerged as a fresh method to successfully prevent teacher and student gatherings as well as the propagation of viruses in the context of the ongoing influence of the COVID-19. A problem deserving of consideration is how to increase users’ desire to participate in online learning through online class APPs, identify the variables that affect users’ use of them, and create a useful assessment scale. In this study, user ratings from 68 students who had used an online class APP were collected using the combination of qualitative and quantitative research, and 200 online questionnaires were sent out to complement the interview findings, based on which 328 assessment questionnaires were gathered and 23 valid items were obtained. The influencing elements that had an impact on users’ online learning experiences were identified using factor analysis, and the relationships among the components were investigated using structural equation modeling. Perceived benefits are the main influencing factors, subjective norms and functional quality are the direct factors influencing users’ perceived benefits, and self-efficacy is influenced by subjective norms while promoting the perception of functional quality. The factors influencing users’ use of online class APPs are ultimately identified as perceived benefits, functional quality and self-efficacy. In order to facilitate users’ online learning, user psychological traits, social ties and software functions should be integrated into a cohesive system while designing online class APPs.

An Investigation of Patient Decisions to Use eHealth

eHealth service has received increasing attention. Patients can consult online doctors via the Internet, and then physically visit the doctors for further diagnosis and treatments. Although extant research has focused on the adoption of eHealth services, the decision-making process from online to offline health services still remains unclear. This study aims to examine patients’ decisions to use online and offline health services by integrating the extended valence framework and the halo effect. By analyzing 221 samples with online consultation experiences, the results show that trust significantly influences perceived benefits and perceived risks, while trust, perceived benefits, and perceived risks significantly influence the intention to consult. The intention to consult positively influences the intention to visit. Considering the moderating effects of payment types, the influence of perceived risks on the intention to consult is larger for the free group than for the paid group. The findings are useful to better understand patients’ decisions to use eHealth.

Continuance Intention of Online Healthcare Communities- The Mediation Mechanism of Social Interaction Ties

The purpose of this research is to evaluate the continuance usage intention on online healthcare community (OHC) platform for patients and examine the "doctor-OHC-patient" relationship. The proposed model attempted to integrate social interaction ties, shared value, trust with the indirect effects on the relationship between the determinants and continuous usage intention of the OHC platform. The empirical results showed that perceived critical mass, social identity, and para-social interaction would strengthen continuance intention via the social interaction ties. In addition, this study found that the shared values and trust increase users' willingness to continue usage of OHC. This study provides OHC platform managers with an in-depth understanding of the "doctor-OHC-patient" online social interaction. The results of this study may also help hospitals, health policy makers, and related healthcare practitioners to improve the way they use the web for advocacy and guidance, and provide insight into the intent of promoting the ongoing use of OHC platforms.

Role of Infodemics on Social Media in the Development of People’s Readiness to Follow COVID-19 Preventive Measures

Unparalleled levels of misinformation have contributed to widespread misunderstandings about the nature of the coronavirus, its cure and preventative measures. Misinformation crosses borders rapidly with the help of social media, and this phenomenon is constantly increasing. Thus, the current study proposes a research framework to explore how citizens’ trust in government and social media influences their readiness to follow COVID-19 preventive measures. Additionally, the role of a health infodemic was explored in perceptions and relationships among factors influencing an individual’s readiness to follow COVID-19 preventive measures with data collected from 396 participants in Taiwan. The findings indicate citizens’ trust in social media (TRSM), attitude (ATT), perceived benefit (PBT), personal innovativeness, and how peer referents positively influence their readiness. However, the relationship between citizens’ trust in the government (TRGT) and their readiness to follow COVID-19 preventive measures (INT) is not statistically significant. The current study also explores the negative moderating effect of health infodemics on the relationship between TRSM and INT, TRGT and INT, ATT and INT, PBT and INT. Thus, the Taiwanese government must consider the current study’s findings to develop attractively, informed, and evidence-based content, which helps its citizens improve their health literacy and counter the spread of misinformation.

A fuzzy trust measurement method considering patients' trust opinions in Internet plus Healthcare

With the outbreak of COVID-19, Internet plus Healthcare has developed rapidly with a number of Internet plus Healthcare platforms emerging. The problem of doctor-patient trust is a key issue restricting the development of the Internet plus Healthcare, which has aroused extensive attention of scholars. The patient's perceived trust on the Internet plus Healthcare platform has the characteristics of subjectivity, ambiguity, and high perceived risk. Therefore, existing trust calculation method becomes inapplicable because these characteristics have not been considered. In order to solve this problem, this study extracts influencing factors of patient trust on the Internet plus Healthcare platform, gives a trust calculation method based on intuitionistic fuzzy set theory, and added a risk preference coefficient in order to integrate the characteristics of patients' high perceived risk into the proposed method. This method is conducive to the platform to provide patients with more accurate doctor recommendations

The Associations Between Mental Health Problems and Attitudes Toward Web-Based Health and Social Care Services: Evidence From a Finnish Population-Based Study

BACKGROUND

The significance of web-based health and social care services has been highlighted in recent years. There is a risk that the digitalization of public services will reinforce the digital and social exclusion of vulnerable groups, such as individuals with mental health problems.

OBJECTIVE

This study aims to examine the associations between mental health problems and attitudes toward web-based health and social care services in the general population. The attitudes measured include lack of interest, perceived need for face-to-face encounters, and concern for safety. The study also evaluates whether sociodemographic characteristics (age, gender, education level, and poverty) modify these associations.

METHODS

Cross-sectional population-based data were collected from 4495 Finnish adults in 2017. Linear regression was used to examine the main effects and interactions of poor mental health and sociodemographic characteristics on attitudes toward web-based health and social care services.

RESULTS

The results show that mental health was associated with attitudes toward web-based health and social care services. Individuals with mental health problems were especially concerned about the safety of web-based services. Poor mental health was independently associated with negative attitudes toward web-based services over the effects of sociodemographic factors. Some of the associations between poor mental health and negative attitudes toward web-based services were stronger among older people and men. With regard to sociodemographic characteristics, particularly higher age, low education, and poverty were associated with negative attitudes toward web-based health and social care services.

CONCLUSIONS

Poor mental health is associated with negative attitudes toward web-based health and social care services and thus indirectly with exclusion. It seems that being older and being male both reinforce the link between poor mental health and exclusion. In supporting the digital inclusion of people with mental health problems, attention should be paid to guidance and counseling, reliability, and the user-friendliness of web-based services as well as to the prevention of poverty. In addition, it is essential to see web-based services as complementary to, and not a substitute for, face-to-face services.

Middle-aged and elderly users' continuous usage intention of health maintenance-oriented WeChat official accounts: empirical study based on a hybrid model in China

Background

Although middle-aged and elderly users are the main group targeted by health maintenance-oriented WeChat official accounts (HM-WOAs), few studies have explored the relationship of these accounts and their users. Exploring the factors that influence the continuous adoption of WOAs is helpful to strengthen the health education of middle-aged and elderly individuals.

Objective

We developed a new theoretical model and explored the factors that influence middle-aged and elderly individuals' continuous usage intention for HM-WOA. Performance expectancy mediated the effects of the model in explaining continuous usage intention and introduced health literacy into the model.

Methods

We established a hybrid theoretical model on the basis of the unified theory of acceptance and use of technology 2 model (UTAUT2), the health belief model (BHM), protection motivation theory (PMT), and health literacy. We collected valid responses from 396 middle-aged and elderly users aged ≥ 45 years in China. To verify our hypotheses, we analyzed the data using structural equation modeling.

Results

Performance expectancy (β = 0.383, P < 0.001), hedonic motivation (β = 0.502, P < 0.001), social influence (β = 0.134, P = 0.049), and threat appraisal (β = 0.136, P < 0.001) positively influenced middle-aged and elderly users' continuous usage intention. Perceived health threat (β =  − 0.065, P = 0.053) did not have a significant effect on continuous usage intention. Both threat appraisal (β = 0.579, P < 0.001) and health literacy (β = 0.579, P < 0.001) positively affected performance expectancy. Threat appraisal indirectly affected continuous usage intention through performance expectancy mediation.

Conclusions

Our new theoretical model is useful for understanding middle-aged and elderly users' continuous usage intention for HM-WOA. Performance expectancy plays a mediation role between threat appraisal and continuous usage intention, and health literacy positively affects performance expectancy.

Cruise transport service usage post COVID-19: The health belief model application

This study investigates the key psychological factors that influence customer's intention to use cruise services post COVID-19. A theoretical model grounded on consumer and health-driven theories (i.e. perceived value, perceived trust and health belief model) is developed. A survey questionnaire is designed and administered to 376 Chinese consumers. The theoretical model was tested via structural equation modelling. Results reveal that the constructs of the health belief model (i.e. perceived benefits, perceived health threat, self-efficacy and cues to action) have a significant effect on customers' perceived value towards cruise services. Perceived value then has direct and indirect effects on customers' cruise intention through perceived trust. This study enhances academic research by justifying customers' intention to use cruise services via consumer and health-belief viewpoints and provides implications for cruise management and policy formulation.

Determinants of Catalan public primary care professionals' intention to use digital clinical consultations (eConsulta) in the post-COVID-19 context: optical illusion or permanent transformation?

BACKGROUND

During lockdown due to the COVID-19 pandemic, telemedicine has become a necessary component of clinical practice for the purpose of providing safer patient care, and it has been used to support the healthcare needs of COVID-19 patients and routine primary care patients alike. However, this change has not been fully consolidated.

OBJECTIVE

The objective of this study was to analyse the determinants of healthcare professionals' intention to use the eConsulta digital clinical consultations tool in the post-COVID-19 context.

METHODS

A literature review of the Technology Acceptance Model (TAM) allowed us to construct a theoretical model and establish a set of hypotheses derived from it about the influence that a variety of different factors relating to both healthcare professionals and the institutions where they work had on those professionals' intention to use eConsulta. In order to confirm the proposed model, a mixed qualitative and quantitative methodology was used, and a questionnaire was designed to serve as the data collection instrument. The data were analysed using univariate and bivariate analysis techniques. To confirm the theoretical model, exploratory factor analysis and binary logistic regression were applied.

RESULTS

The most important variables were those referring to perceived benefits (B=2.408) and the type of use that individuals habitually made of eConsulta (B=0.715). Environmental pressure (B=0.678), experience of technology (B=0.542), gender (B=0.639) and the degree of eConsulta implementation (B=0.266) were other variables influencing the intention to use the tool in the post-COVID-19 context. When replicating the previous analysis by professional group, experience of technology and gender in the physician group, and experience of the tool's use and the centre where a professional works in the nurse group, were found to be of considerable importance.

CONCLUSIONS

The implementation and use of eConsulta had increased significantly as a consequence of the COVID-19 pandemic, and the majority of the healthcare professionals were satisfied with its use in practice and planned to incorporate it into their practices in the post-COVID-19 context. Perceived benefits and environmental pressure were determining factors in the attitude towards and intention to use eConsulta.

CLINICALTRIAL

Prisoners as Users of Digital Health Care and Social Welfare Services: A Finnish Attitude Survey

Prisoners are a group of people with many health and social problems. However, in prisons the use of the Internet is controlled. Thus, prisoners’ access to digital health care and social welfare services is limited. In addition, there are many cognitive and attitudinal barriers to the use of digital health care and social welfare services for prisoners. Cross-sectional survey data (N = 225) were collected from eleven prisons in different parts of Finland and analysed using linear regression analysis. The results are consistent with Ajzen’s theory and previous studies on the acceptance of information systems in health care. Prisoners’ behavioural intentions related to the use of digital health care and social welfare services are influenced by their perceptions of their capacity to use digital services, the expectations of their close people and their attitudes, as well as by trust in the Internet and services. In contrast, the age of prisoners’ indirectly affects their willingness to use digital services. The study recommends that prisoners are supported in the use of digital health care and social welfare services by prison staff and other people. Digital skills training is also needed in order to support digital inclusion, especially for older and long-term prisoners.

Antecedents of Intention to Adopt Mobile Health (mHealth) Application and Its Impact on Intention to Recommend: An Evidence from Indonesian Customers

INTRODUCTION

Mobile health (mHealth) applications gain popularity due to the increasing number of mobile phone usage and internet penetration, which might help some of Indonesia's medical issues. However, the uptake of mHealth applications is still low in Indonesia. This study is aimed at understanding the factors that drive individuals to adopt mHealth applications and their impact on the intention to recommend.

METHODS

We applied a new model that combines three different theories with some other constructs: an extended unified theory of acceptance and use of technology, diffusion of innovation, and the internet customer trust model. The study used a cross-sectional study design with partial least squares causal modeling approach.

RESULTS

There are 787 respondents in our study, with the majority of them being female, young adults. Our model could explain 53.2% of the variance of intention to adopt while explaining 48.3% of the variance of intention to recommend. Initial trust in mHealth platform (β = 0.373, p = <0.001), facilitating conditions (β = 0.131, p = <0.01), and performance expectancy (β = 0.099, p = <0.05) are the top three most important drivers of intention to adopt mHealth applications. Lastly, importance-performance map analysis (IPMA) showed that the mHealth application's initial trust is the most important construct with a high-performance score. Discussion. Mobile health developers and managers need to improve initial trust in the mHealth platform, facilitating conditions, and performance expectancy when developing the applications. With a medium Q 2 predict, these factors can be applied out of the research context with medium predictive power.

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.

Patient-Physician Interaction and Trust in Online Health Community: The Role of Perceived Usefulness of Health Information and Services

Background: In recent years, China has witnessed a surge in medical disputes, including many widely reported violent riots, attacks, and protests in hospitals. Asymmetric information between patient and physicians is one of the most critical enablers in this phenomenon, but the Web has become the primary resource for Chinese Internet applications to learn about health information and could potentially play a role in this pathway to patient–physician interaction and patient–physician trust. While considerable attention has been paid in some countries, there are few researches about China’s situation for this issue. The purpose of this quantitative study was to examine the influence of online health information and the online guidance of doctors in patient health information literacy on patient–physician interaction and patient–physician trust in China. Methods: A web-based survey was conducted to collect data from online applications with health problems. A structural equation modeling was used to analyze the data to test the hypotheses. A total of 446 participants from the Tongji Hospital in Wuhan and Huazhong University of Science and Technology hospital participated in the study. Results: Our analysis shows that the usefulness of online health information and the online guidance of doctors both significantly influence the trust of the patient toward physicians and interaction with physicians. Furthermore, the patient–physician interaction also has a significant impact on the patient–physician trust. Conclusions: There are many studies on the influence of online health information on the doctor–patient relationship, whereas a little research has examined this relationship between health information online support from doctors and patient–physician interaction by quantitative empirical analysis. This study also explores the online guidance role of doctors and whether doctor–patient communication will affect the trust of doctors and patients. The practical implications of this study include an improved understanding of the function of online health information and potential impacts regarding the interaction with physicians and trust toward physicians that can be used to resolve conflicts between doctors and patients.