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

Investigating Continuance Intention for Telehealth Visits in Children's Hospitals: Survey-Based Study

BACKGROUND

Telehealth visits are remote health care consultations conducted using digital technologies, such as video calls, phone calls, or web-based platforms. This type of service offers numerous benefits for both health care users and health care providers. Users save time and money by avoiding traveling to health care facilities. At the same time, health care providers can expand access to care for users in remote areas and enhance the continuity of care. These advantages are even more evident in pediatric settings, where attending in-person services must align with the commitments of the patient (eg, school activities) and the caregiver. Although the potential benefits of telehealth visits for users and health care providers were already known before the COVID-19 pandemic, its widespread adoption only occurred during it. Having experienced its benefits, hospitals are now, in the postpandemic phase, determined to maintain and strengthen their remote service offerings. It has, therefore, become crucial for them to understand the factors influencing users' intention to continue using telehealth visits (or "continuance intention"), even now after the access restrictions to health care facilities imposed during the COVID-19 pandemic have been lifted. However, the literature lacks comprehensive, valid, and reliable models explaining users' continuance intention toward telehealth visit services.

OBJECTIVE

This study aims to investigate the variables impacting users' continuance intention toward telehealth visits and identify suggestions for improvement.

METHODS

Two models of variables impacting users' continuance intention toward telehealth visits were developed. The first model applied to all users undergoing telehealth visits, while the second one applied only to patients who received a telehealth visit using videoconferencing tools. The models were created based on the literature and a qualitative study comprising interviews with physicians with extensive experience in telehealth visits. The models were then tested using partial least squares structural equation modeling on 477 responses obtained by administering a survey to guardians of patients who had received at least 1 telehealth visit in a major European children's hospital.

RESULTS

Both models showed that the variable information quality positively influenced the variables continuance intention and perceived usefulness and that perceived usefulness positively influenced continuance intention. The first model was robust to the medical specialty and the channel used to deliver the visit. The second model also showed that systems quality positively influenced information quality.

CONCLUSIONS

This study has identified and tested 2 comprehensive, valid, and reliable models on the variables influencing users' continuance intention toward telehealth visits. Moreover, the study's results provide insights for hospitals to improve telehealth visit services.

Patient Adoption of Digital Use Cases in Family Medicine and a Nuanced Implementation Approach for Family Doctors: Quantitative Web-Based Survey Study

BACKGROUND

Digital use cases describe the application of technology to achieve specific outcomes. Several studies in health care have examined patients' overall attitudes toward digitalization and specific use cases. However, these studies have failed to provide a comparison of patient acceptance criteria between inherently different digital use cases in family medicine.

OBJECTIVE

To address this research gap, this paper aimed to assist family doctors in selecting digital use cases by comparing the underlying patient adoption factors and in driving usage of these use cases by presenting a differentiated implementation approach.

METHODS

Adapting an established Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire to 4 digital use cases in family medicine, we surveyed a large cross-sectional sample of adults living in Germany. The results of the web-based survey were then analyzed via descriptive statistics, ANOVA, and hierarchical regression models to compare the effects of sociodemographic and technology acceptance factors on the intention to use a specific use case.

RESULTS

Our web-based survey included 1880 participants. Of these 1880 participants, only 304 (16.2%) agreed that the degree of digitalization is important when selecting a family practice. However, more digitally literate participants attributed greater importance to this criterion (B=0.226, SE 0.023; β=.223; P<.001), and digital literacy was found to be dependent on age (Welch F3,968.29=53.441; P<.001). Regarding sociodemographic characteristics, only digital literacy demonstrated a significant effect on the intention to use for all use cases, particularly scheduling doctor appointments online (B=0.322, SE 0.033; β=.408; P<.001). Furthermore, performance expectancy was the strongest predictor of the intention to use for all use cases, while further effects of technology acceptance factors depended on the use case (receiving medical consultations via video: B=0.603, SE 0.049; β=.527; P<.001; scheduling doctor appointments online: B=0.566, SE 0.043; β=.513; P<.001; storing personal medical information via electronic health records: B=0.405, SE 0.047; β=.348; P<.001; and providing personal information before consultation digitally [digital anamnesis]: B=0.434, SE 0.048; β=.410; P<.001). To illustrate, perceived privacy and security had an effect on the intention to use electronic health records (B=0.284, SE 0.040; β=.243; P<.001) but no effect on the intention to use video consultations (B=0.068, SE 0.042; β=.053; P=.10).

CONCLUSIONS

In the selection and implementation of digital use cases, family doctors should always prioritize the perceived value of the digital use case for the patient, and further criteria might depend on the digital use case. Practice owners should therefore always harmonize the introduction of digital use cases with their own patient care strategies. Not every digital innovation fits every strategy and therefore every practice.

How eHealth use and cancer information-seeking influence older adults' acceptance of genetic testing: Mediating roles of PIGI and cancer worry

Objective

This study aims to investigate how eHealth use and information-seeking behavior affect older adults' acceptance of genetic testing, focusing on their participation in genetic tests and their willingness to adopt lifestyle changes based on test results. The research highlights the mediating roles of the perceived importance of genetic information (PIGI) and cancer worry.

Methods

This cross-sectional study used secondary data from the Health Information National Trends Survey (HINTS 5, Cycle 4), conducted in 2020. The analysis included 1852 adults aged 60 and above. Two mediation models were tested using SPSS 25. Model 1 examined the relationship between eHealth use, perceived importance of genetic information (PIGI), and genetic test behavior. Model 2 analyzed how cancer information-seeking influences willingness to change lifestyle behavior (WCLB) based on genetic test results, with cancer worry as a mediator.

Results

Both models showed statistically significant mediation effects (p < 0.05). Model 1 found that eHealth use positively influences genetic test behavior through PIGI. Model 2 revealed that cancer information-seeking indirectly impacts willingness to change lifestyle behavior (WCLB) based on the genetic test results via cancer worry, confirming a full mediation effect. Additionally, among demographic variables, educational level was the strongest predictor of genetic test behavior, while gender significantly predicted WCLB, with older female adults showing higher intentions to change their lifestyle based on genetic test results than males.

Conclusion

The study highlights the pivotal roles of PIGI and cancer worry in shaping older adults' acceptance of genetic testing, encompassing both performing genetic test behaviors and adopting lifestyle changes based on test results. These findings offer actionable insights for designing targeted health communication strategies and interventions to enhance genetic testing uptake and foster proactive health management among older populations.

Users' Perceived Service Quality of National Telemedicine Services During the COVID-19 Pandemic in Bangladesh: Cross-Sectional Study

Background

COVID-19 created an opportunity for using teleconsultation as an alternative way of accessing expert medical advice. Bangladesh has seen a 20-fold increase in the use of teleconsultation during the pandemic.

Objective

The aim of our study was to assess the influence of service quality and user satisfaction on the intention to use teleconsultation in the future among users of national teleconsultation services during the pandemic.

Methods

A cross-sectional survey was conducted in 2020 among users of the national teleconsultation service-Shastho Batayon for acute respiratory infection. A validated mobile health service quality model based on structural equation modeling and confirmatory factor analysis was used to analyze the data with SmartPLS (version 3.0).

Results

Among the 2097 study participants, 1646 (78.5%) were male, 1416 (67.5%) were aged 18-39 years, 1588 (75.7%) were urban residents, 1348 (64.2%) had more than 10 years of schooling, and 1657 (79%) were from middle-income households. From a consumer perspective, the quality of the service platform (β=.946), service interaction (β=.974), and outcome (β=.955) contributed to service quality. Service quality was positively associated with user satisfaction (β=.327; P<.001) and intention to use teleconsultation services (β=.102; P<.001). User satisfaction was positively associated with the intention to use teleconsultation services (β=.311; P<.001).

Conclusions

The increase in the use of teleconsultation during the pandemic indicated that such services were potentially used for emergencies. However, the future use of teleconsultation will be dependent on the quality of service and user satisfaction. Our findings are relevant for low-income contexts where teleconsultation services are used to address gaps in service delivery.

Quality factors affecting the continued use of mobile health apps in ethnic minority regions of Southwest China using PLS-SEM and ANN

Mobile technology has significantly accelerated the rapid development of healthcare services. Despite the convenience brought by the proliferation of mobile health (mHealth) apps, the challenge of promoting their continued use among patients has garnered attention from many scholars and administrators. Based on the Expectation Confirmation Model (ECM), this study explores the impact of quality elements on the continuance intention of mHealth apps in Southwest China's ethnic minority regions. Researchers conducted a structured questionnaire survey on 337 users of mHealth apps in these regions to measure their self-reported responses to seven constructs: information quality, system quality, service quality, perceived usefulness, confirmation, satisfaction, and continuance intention. The study uses the structural equation model-artificial neural network (SEM-ANN) approach to interpret the compensatory and non-linear relationships between predictors and continuance intention. The findings reveal that user satisfaction and perceived usefulness significantly predict the continuance intention to use mHealth apps. All other relationships were confirmed except for the non-significant relationships between service quality and confirmation, service quality and perceived usefulness, and system quality and perceived usefulness. Furthermore, based on the normalized importance obtained from the multilayer perceptron, the most critical predictors identified were satisfaction (100%), followed by information quality (70.2%), perceived usefulness (43.2%), system quality (25.1%), and confirmation (17.6%). Finally, this study presents theoretical and practical implications for the continuance intention towards mHealth apps in Southwest China's ethnic minority regions.

Social influence, performance expectancy, and price value as determinants of telemedicine services acceptance in Chile

Medicine is a discipline based on and nurtured by scientific research and technological development. The use of health services supported by information technology is increasing worldwide, and Latin America is no exception. Factors such as needing more specialists in peripheral cities, large geographic areas, and socio-cultural aspects limit the possibility of receiving timely and quality medical care services. Information Technology (IT) for health purposes, such as e-health, is a cost-effective solution for equitable access to quality healthcare services and optimization of the rising associated costs. As an e-health service, telemedicine facilitates and mediates distance communication between the patient and medical staff. Even though Latin America is at the beginning of the development of telemedicine, it would have a relevant impact, given the geographic and socioeconomic conditions of the population in this part of the world. Drawing on the extended Unified Theory of Acceptance and Use of Technology (UTAUT2) theory, we developed a theoretical model to identify the latent factors influencing the public acceptance of telemedicine and examined their interrelationships. A survey questionnaire was designed and administered to 391 residents in Antofagasta, a mine region of Chile. After that, structural equation modeling was employed to analyze the survey data. The results reveal that the UTAUT2 factors' performance expectancy, social influence, and price value significantly impact the intention to use (R 2 = 0.693). Additionally, the model presented a good fit. This study enriches the existing theoretical research on the acceptance of telemedicine services and offers insights into understanding and managing technology in the Chilean health sector.

Antecedents of patient health engagement in the radiotherapy service (evidence from Indonesia)

Background

Private radiotherapy (RT) facilities in emerging countries are growing with cancer incidence. Private healthcare providers must provide better care based on patient perspectives to reach more patients.

Aim

This study investigated the relationship between antecedents of patient health engagement (PHE) with revisit intention (RVI) and intent to recommend (ITR) in private RT facilities.

Setting

The survey was conducted in a private hospital with a RT service in Central Java province, Indonesia.

Methods

A quantitative, cross-sectional design with a purposive sampling method was used. Patient questionnaire survey modified from validated self-administered radiotherapy experience (RTEQ) and PHE questionnaire were used to collect data. Partial least squares-structural equation modelling was used to analyse the data.

Results

In this study, 173 respondents consented to participate, which demonstrated that seven of the eight experience antecedents of PHE measured by reliable and valid RTEQ and were significantly related to PHE (p-value <0.05). At the same time, the degree of PHE has a significant relationship with RVI and ITR (p-value <0.05).

Conclusion

Patient informational needs elements from the patient experience, followed by situational repose, were shown to have a prominent relation to PHE. The management of private RT facilities needs to focus more on these elements to encourage PHE to establish hospital performance.

Contribution

The findings denote that six elements of RTEQ relate to PHE and further hospital outcomes. Hospital management could utilise this approach to improve the quality of care in RT facilities, specifically in private hospitals in emerging countries.

COVID-19 and telemedicine: A netnography approach

The COVID-19 pandemic has consolidated some trends that already existed in our society. Perhaps one of the most visible is the transformation of society towards greater digitisation. Digitalisation has gained weight in all aspects of our lives, and from the point of view of the health system we find an example in the slow historical adoption of telemedicine, which contrasts sharply with the massive conversion to this technology as a tool for social distancing. In this sense, the homebound population is the one most affected by the pandemic and the one that could benefit the most from the use of telemedicine. Using a netnography approach and based on the stimulus-organism-response paradigm, this study proposes to analyse the evolution of perception about telemedicine using the opinions expressed on Twitter. The primary technical tasks of the study incorporate the analysis of topics and the review of emotions and positive image perception using natural language processing. Specifically, tweets about telemedicine generated by the Spanish community are analysed in this work. The findings show that the COVID-19 pandemic has affected emotions and topics of interest related to telemedicine. This has changed the image that it had and the behaviour of the Twitter community in Spain. In conclusion, the study results suggest that changes in health systems affect people's emotions and behaviours.

Increasing acceptance of medical AI: The role of medical staff participation in AI development

BACKGROUND

Medical artificial intelligence (AI) in varying degrees has exerted significant influence on many medical fields, especially in the midst of the COVID-19 pandemic. However, little is known regarding how to address the reluctance of medical staff to use AI technology. While recent research has highlighted the importance of medical staff participation in the development of AI, the current understanding of influence of medical staff participation on acceptance of AI is limited.

OBJECTIVES

To provide insights into the mechanism that how medical staff participation impacts on the medical staff's acceptance of AI and to examine the moderating effect of speciesism.

METHODS

This study was conducted from 6th August to 3rd September. Data was collected from doctors and nurses and a total of 288 valid questionnaires were obtained. Smart PLS 3.2.8 was used as partial least square (PLS) software to validate the research model.

RESULTS

The study determined that medical staff participation had a significant impact on acceptance of medical AI-IDT (β = 0.35, p ≤ 0.001) and acceptance of medical AI-ADT (β = 0.44, p ≤ 0.001). The results also show that AI self-efficacy and AI anxiety have significant mediating effects and speciesism has significant moderating effects among the theoretical model.

CONCLUSIONS

This study provides insights into ways to explore influence factors of acceptance of AI based on user participation perspective. The results indicate that medical staff participation enhances acceptance of medical AI through the cognitive path (i.e., AI self-efficacy) and the affective path (i.e., AI anxiety). These results have practical implications for how organizations assist the staff to accommodate themselves to AI technology in the future.

Patient's and Practionner's Experiences of a First Face-to-Face vs. Remote Orthodontic Consultation: A Randomized Controlled Trial

(1) Aim: The purpose of this study was to assess patients' and practitioners' reported experience measures (PREMs) following a first standard orthodontic consultation (face-to-face consultation) versus a first orthodontic teleconsultation (video-assisted remote orthodontic consultation).; (2) Materials and Methods: This study was designed as a randomized controlled trial in which 60 patients were randomly allocated to two groups. In the control group, patients received a first face-to-face consultation (n = 30) whereas, in the test group, patients received a first orthodontic teleconsultation (n = 30). Patients as well as the orthodontic practitioners completed questionnaires after the experience. (3) Results: From the patients' point of view, overall satisfaction was comparable between the control group and the test group (p = 0.23). Quality of communication with the clinician, understanding of the explanations provided and a sense of privacy were also comparable between the two groups. However, from the practitioners' perspective, overall satisfaction after the face-to-face consultation was significantly higher than after the first remote consultation (p < 0.01). (4) Conclusions: In the context of a first orthodontic consultation, teleorthodontics appears to be an interesting and complementary approach to a classical face-to-face appointment, but which should by no means become systematic.

Counseling for Health: How Psychological Distance Influences Continuance Intention towards Mobile Medical Consultation

As mobile healthcare services entered the public sight with high frequency during the COVID-19 pandemic, patients are increasingly recognizing the effectiveness of mobile medical consultation (MMC). Earlier studies have investigated what influences continuance intention (CI) towards MMC, but few studies have scrutinized it from the perspective of patients' psychological distance. We formulated a framework to examine the psychological factors influencing CI towards MMC by integrating the information systems continuance model and psychological distance theory. The framework was validated using the partial least squares structural equation modeling (PLS-SEM) approach and data from 475 MMC users in China. The empirical results revealed that immediacy, telepresence, intimacy, and substitutability were significant predictors of CI, while satisfaction mediated these pathways. Pandemic-induced anxiety positively moderated the effect of immediacy on satisfaction and the effect of satisfaction on CI. Practical implementations for MMC healthcare practitioners, designers, and marketers are drawn.

Effects of electronic personal health information technology on American women's cancer screening behaviors mediated through cancer worry: Differences and similarities between 2017 and 2020

Backgrounds

Thanks to their accessibility and low cost, electronic personal health information (ePHI) technologies have been widely used to facilitate patient-physician communication and promote health prevention behaviors (e.g. cancer screening). Despite that empirical evidence has supported the association between ePHI technology use and cancer screening behaviors, the underlying mechanism through which ePHI technology use influences cancer screening behaviors remains a topic of discussion.

Objective

This study investigates the relationship between ePHI technology uses and cancer screening behaviors of American women and examines the mediating role of cancer worry.

Methods

Data for this study were from the Health Information National Trends Survey (HINTS) collected in 2017 (HINTS 5 Cycle 1) and 2020 (HINTS 5 Cycle 4). The final sample included 1914 female respondents in HINTS 5 Cycle 1 and 2204 in HINTS 5 Cycle 4. Mann-Whitney U test, two-sample t-test, and mediation analysis were performed. We also referred to the regression coefficients generated by min-max normalization as percentage coefficients (bp) for the comparison.

Results

This study reports increased usage of ePHI technologies (from 1.41 in 2017 to 2.19 to 2020), increased cancer worry (from 2.60 in 2017 to 2.84 in 2020), and a stable level of cancer screening behaviors (from 1.44 in 2017 to 1.34 in 2020) among American women. Cancer worry was found to mediate the ePHI effect on cancer screening behaviors (bp = 0.005, 95% confidence interval [0.001, 0.010]) in a positive complementary mediation in 2020.

Conclusions

The research findings support a positive association between ePHI technology use and cancer screening behaviors, and cancer worry has been identified as a salient mediator. An understanding of the mechanism that prompts US women's cancer screening practices provides practical implications for health campaign practitioners.

Measuring the Impact of Virtual Communities on the Intention to Use Telemedicine Services

Digital marketing has given new life to healthcare services by enhancing their visibility in the online space. People choose online healthcare services because they can receive instant answers and communicate with specialists in their comfortable environment at the right time. The purpose of this study was to understand the impact of virtual communities on the intention to use telemedicine. The model is based on a combination of consumer desire (psychological objective) and loyalty through promotional formats (economic objective), as well as data collected from 442 respondents analyzed using structural equation modeling. The research results show that by analyzing target groups in social networks, content can be individualized, and an accurate measurement of e-patient satisfaction must be conducted in order to improve the experience of future consumers of telemedicine services. The results of this study explain what makes people want to use digital healthcare services and can serve as a guide for people who run virtual communities and help digital healthcare service providers figure out how to market their services.