Examining Protection Motivation and Network Externality Perspective Regarding the Continued Intention to Use M-Health Apps

Factors Influencing the Acceptance and Adoption of Mobile Health Apps by Physicians During the COVID-19 Pandemic: Systematic Review

BACKGROUND

During the COVID-19 pandemic, the provision of and access to health care have been uniquely challenging, particularly during lockdowns or when dealing with COVID-19 cases. Health care professionals have had to provide patients with the necessary health care. However, delivering health care services while reducing face-to-face interaction puts an immense strain on health systems that are already overburdened. Against this backdrop, it is now more critical than ever to ensure the accessibility of health care services. Such access has been made increasingly available through mobile health (mHealth) apps. These apps have the potential to significantly improve health care outcomes and expectations and address some of the challenges confronting health care systems worldwide. Despite the advantages of mHealth, its acceptance and adoption remain low. Hence, health care organizations must consider the perceptions and opinions of physicians if the technology is to be successfully implemented.

OBJECTIVE

The objective of this systematic review was to explore and synthesize the scientific literature on the factors influencing the acceptance and adoption of mHealth among physicians during the COVID-19 pandemic.

METHODS

A systematic review of the studies published between March 2020 and December 2022 was conducted using the MEDLINE, Scopus, Embase, and ProQuest databases. The database search yielded an initial sample of 455 potential publications for analysis, of which 9 (2%) met the inclusion criteria. The methodology of this review was based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

RESULTS

The factors influencing mHealth acceptance and adoption by physicians were divided into perceived barriers and perceived facilitators, which were further grouped into the following 3 major thematic categories: technological, individual, and organizational barriers and facilitators, respectively. The technological barriers were accessibility, technical issues, usefulness, and data management; individual barriers were perceived patient barriers, time and workload pressure, technical literacy, knowledge of mHealth, and peer support; and organizational barriers were financial factors, management support and engagement, data security, telemonitoring policy, and collaboration. The technological facilitators of uptake were technical factors, clinical usefulness, and data management; individual facilitators were patient-related care, intrinsic motivation, collaboration, and data sharing (individual); and organizational facilitators were workflow-related determinants, organizational financial support, recommendation of mHealth services, and evidence-based guidelines.

CONCLUSIONS

This review summarized the evidence on the factors influencing mHealth acceptance and adoption by physicians during the COVID-19 pandemic. The main findings highlighted the importance of addressing organizational readiness to support physicians with adequate resources, shifting the focus from technological to patient-centered factors, and the seamless integration of mHealth into routine practice during and beyond the pandemic.

TRIAL REGISTRATION

PROSPERO CRD42022356125; https://tinyurl.com/2mmhn5yu.

Do consumers continue to use O2O food delivery services in the post-pandemic era? Roles of sedentary lifestyle

Online-to-offline food delivery (O2OFD) services have become popular worldwide, and consumers' O2OFD usage and sedentary behavior have increased during the COVID-19 pandemic. However, whether consumers will continue to use O2OFD in the post-pandemic era is uncertain, and the relationship between sedentary lifestyle and O2OFD usage is poorly understood to date. Therefore, this study aims to investigate consumers' continued intention to use O2OFD in the post-pandemic era and their subsequent use behavior, as well as to explore the roles of sedentary lifestyle. A research model based on the unified theory of acceptance and use of technology 2 (UTAUT2), integrating network externalities and including sedentary lifestyle, was proposed. A two-stage online survey was conducted in China, with 409 eligible responses used in the data analysis. The results indicate that habit, perceived network size, and perceived complementarity were the main predictors of continued intention, whereas habit and continued intention were the primary determinants of use behavior. Sedentary lifestyle was positively related to O2OFD use behavior and moderated the effects of habit and continued intention on use behavior. In addition to its theoretical contributions, this study has implications for public policies, marketing strategies, and consumer well-being.

Understanding Post-Adoption Behavioral Intentions of Mobile Health Service Users: An Empirical Study during COVID-19

This study aims to understand the post-adoption behaviors of mobile health (m-Health) service users during the COVID-19 pandemic. Drawing on the stimulus-organism-response framework, we examined the effects of user personality traits, doctor characteristics, and perceived risks on user continuance intentions and positive word of mouth (WOM) when using m-Health, as mediated by cognitive and emotional trust. The empirical data were collected via an online survey questionnaire from 621 m-Health service users in China and were verified with partial least squares structural equation modeling. The results showed that personal traits and doctor characteristics were positively associated and the perceived risks were negatively associated with both cognitive and emotional trust. Both cognitive and emotional trust significantly influenced users' post-adoption behavioral intentions in terms of continuance intentions and positive WOM, with different magnitudes. This study provides new insights for the promotion of the sustainable development of m-Health businesses after or during the pandemic.

Social Acceptance of Mobile Health among Young Adults in Japan: An Extension of the UTAUT Model

The unprecedented development of information and communication technologies has opened up immense possibilities in the field of health care. Mobile health (mHealth) is gaining increasing attention as an important technology for solving health-related problems. Although a high rate of smartphone usage among young people in Japan has been identified, smartphone usage for health management is not high. As Japanese youth are important potential users of mHealth, it is necessary to explore theories that influence the behavioral intention of Japanese youth to adopt mHealth. This study conducted a questionnaire survey in a Japanese university and collected 233 valuable responses. This study was adapted and extended from the unified theory of acceptance and use of technology (UTAUT) model to measure eight constructs: health consciousness, social influence, facilitation conditions, perceived risk, trust, performance expectancy, effort expectancy, and behavioral intention. Structural equation modeling was used for hypothesis testing. We found that trust, performance expectancy, and effort expectancy directly influenced the behavioral intention to use mHealth. Health consciousness and social influence indirectly influence behavioral intention through trust and performance expectancy. Facilitation conditions indirectly influenced behavioral intention through effort expectancy. This study makes a vital theoretical contribution to policymakers and product developers for the further diffusion of mHealth among young people in Japan.

Go Green, Go Social: Exploring the Antecedents of Pro-Environmental Behaviors in Social Networking Sites beyond Norm Activation Theory

The paucity of environmental resources and the threatening warning of global climate change have led to increasing research on environmental issues [e.g., pro-environmental behaviors (PEBs)]. Although norm activation theory (NAT) is a well-recognized theory for approaching PEBs, existing works appear insufficient to explain PEB in the context of social networking sites (SNSs) without taking contextual, emotional, and social factors into account. Grounded in the egocentric tactician model (ETM), NAT, along with the notions of guilt and social stressors, this study integrates a new ETM path, a supplemented emotional path, alongside the conventional NAT path to achieve a more complete picture of what are crucial determinants of PEBs in the context of SNSs. Social stressors positively moderate the emotional path. Data collected from 897 Facebook users confirm all of our proposed hypotheses. Results indicate that beyond the traditional NAT path, the new ETM path and the emotional path add values to illustrate PEBs on SNSs, and new constructs of self-influence on SNSs (SIS) and guilt remarkably drive PEBs alongside personal norms. Implications for theory and practice are discussed, and guidelines for future research are identified.

Impact of social influence on users' continuance intention toward sports and fitness applications

The purpose of this paper is to explore how social influence (SI), which is disaggregated into subjective norms (SN), social image (SIM), and social identity (SID), predicts perceived usefulness (PU), perceived pleasure (PP), and continuance intention (CI) toward sports and fitness applications. The underlying context is the socialization and gamification of exercise during the Covid-19 pandemic. Based on the theory of SI and the technology acceptance model, a theoretical framework was built where PU and PP mediate the influence of SI on CI, and proposed hypotheses were tested. The responses of 296 Keep users (a popular sports and fitness application in China) to a questionnaire survey were analyzed. SN and SIM were found to have significant positive effects on SID; SID has significant positive effects on PU and PP; both PU and PP have significant positive effects on the CI of users; SID and PU positively and significantly mediate the relationship between SN/SIM and CI; PU positively and significantly mediates the SID-CI relationship. However, the role of PP in mediating the influence of SI on CI is non-significant. This paper deepens the current understanding of the mechanisms that influence the relationship between SI and CI under the context of socialization and gamification services.

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.

Stimuli Influencing Engagement, Satisfaction, and Intention to Use Telemedicine Services: An Integrative Model

Telemedicine ensures quality, cost-effective, and equally accessible healthcare services for everyone. Nonetheless, a poor usage rate could curb its progression in developing cultures like Bangladesh. Therefore, this research examines how external stimuli promote the continuous usage intentions of synchronous telemedicine services through engagement and satisfaction by deploying the stimulus-organism-response framework. A final sample of 312 telemedicine users was analyzed using the structural equation modeling in AMOS. The average age of the participants was 26.28 (std. deviation 5.53), and their average use of telemedicine was 2.39 times (std. deviation 1.31) over the last six months. This study empirically endorsed that the stimuli, including performance expectancy, information quality, and contamination avoidance, as well as organismic factors such as engagement and satisfaction, directly impacted the continuance desires for telemedicine use. In addition, the analyses validated the mediation roles of engagement and satisfaction. Furthermore, performance and effort expectancies influenced engagement, which affected satisfaction along with performance expectancy, functionality, and information quality. Accordingly, telemedicine facilitators should integrate these critical attributes into the system to sustain engagement, satisfaction, and usage intentions. This study has pioneered the effects of performance and effort expectancies on continuous usage intentions facilitated by engagement and satisfaction in the telemedicine landscape.

Factors Influencing Continued Usage Behavior on Mobile Health Applications

(1) Background: As people pay more attention to health, mobile health applications (mHealth apps) are becoming popular. These apps offer health services that run on mobile devices to help improve users’ health behaviors. However, few studies explore what motivates users to continue to use these apps. This study proposes antecedents influencing users’ electronic satisfaction (e-satisfaction) and their continued behaviors of using mHealth apps. Based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2), this study constructs a research model including perceived reliability and online review to predict the continued usage behavior on mHealth apps in China; (2) Methods: We conduct an online survey to collect data from participants who have used mHealth apps. This study receives 327 valid responses and tests the research model using the partial least squares structural equation model approach; (3) Results: Our results find that antecedents positively affect continued usage intention through the mediation role of e-satisfaction with mHealth apps. Interestingly, this study reveals that habit positively affects the continued usage behavior and moderates the effect of e-satisfaction and continued intention of using mHealth apps; (4) Conclusions: This study presents theoretical implications on the extended UTAUT2 and provides practical implications understanding of managing mHealth apps in China.