Determinants of Telehealth Continuance Intention: A Multi-Perspective Framework

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.

Modeling telemedicine continuance usage: findings from PLS-SEM and fsQCA

PURPOSE

With the pandemic reshaping healthcare delivery, telemedicine has emerged as a vital solution for overcoming access barriers, particularly in resource-constrained settings. Hence, this study explores the key drivers behind the sustained use of telemedicine services in low-income countries during the post-pandemic period.

DESIGN/METHODOLOGY/APPROACH

Using a quantitative research approach and purposive sampling technique, 273 valid responses were gathered from participants in Bangladesh. A comparative analysis utilizing partial least squares structural equation modeling (PLS-SEM) and fuzzy-set qualitative comparative analysis (fsQCA) were conducted to ensure greater accuracy.

FINDINGS

The PLS-SEM analysis revealed that expectation confirmation and perceived ease of use positively influence satisfaction. Similarly, perceived usefulness and perceived ease of use directly impact Attitude toward telemedicine services. However, perceived usefulness and perceived security were not significantly associated with satisfaction and attitude toward telemedicine services, respectively. The findings highlight that user satisfaction drives continuance use intention for telemedicine services, but only when it also cultivates a positive attitude toward telemedicine services. While the PLS-SEM findings indicate that perceived usefulness has no significant relationship with satisfaction and perceived security is not significantly associated with attitude toward telemedicine services, the fsQCA results offer a different perspective. fsQCA reveals that perceived usefulness retains a significant association with satisfaction and that perceived security, regardless of whether its effect is high or low, is equally effective in contributing to the intention for continuous telemedicine use. These findings underscore fsQCA's ability to provide deeper insights into the complex causal relationships among the antecedents.

PRACTICAL IMPLICATIONS

The findings provide valuable insights for hospitals, doctors and telemedicine providers on retaining existing users. Additionally, governments can leverage this information to address healthcare disparities between urban and rural areas. The study also identifies strategies to reduce costs and improve the efficiency of healthcare services.

ORIGINALITY/VALUE

This study advances telemedicine research by employing the extended technology continuance theory (ETCT) alongside a hybrid analytical approach that integrates PLS-SEM and fsQCA. It highlights that telemedicine organizations can boost patient confidence and encourage continued use by enhancing satisfaction and cultivating a positive user attitude. The innovative use of ETCT and the combined methodologies provide a comprehensive analysis, offering actionable strategies to retain telemedicine users in low-income countries during the post-pandemic period.

Telehealth Perceived Benefits and Self-Efficacy Do Not Mediate the Effects of Demographic, Health, and Social Determinants on Telehealth Use of Low-Income African American and Latino Residents of Public Housing in Los Angeles

BACKGROUND

Marginalized low-income racial and ethnic minority residents of public housing represent an intersectional population with multiple health needs and low healthcare utilization. Telehealth has been proposed as a solution to address healthcare access disparities, yet the role of telehealth attitudes, including perceived benefits and self-efficacy, in influencing telehealth use of this population remains unknown.

OBJECTIVE

This study investigates whether two domains of telehealth attitudes, namely self-efficacy and perceived benefits (expectancy), mediate the relationship between demographic, health, and social determinants of telehealth use among low-income racial and ethnic minority residents of public housing in Los Angeles.

METHODS

This cross-sectional study analyzed data collected from low-income racial and ethnic minority residents of public housing in Los Angeles. Measures included demographic factors (age and gender), social determinants of health (e.g., education, language, and primacy care provider), health (chronic illnesses and physical mobility), telehealth attitudes (perceived benefits and self-efficacy), and telehealth use frequency. Mediation analysis was conducted to test whether telehealth attitudes explained the association between demographic, social, and health determinants of telehealth use.

RESULTS

The findings revealed that neither of the two domains of telehealth attitudes, including perceived benefits and self-efficacy, were significantly associated with telehealth use. As such, these attitude domains did not operate as mediators of the relationship between demographic, health, and social determinants of telehealth use.

CONCLUSION

The study results suggest that structural barriers, rather than individual attitudes, primarily drive telehealth use disparities among this intersectional population. Interventions aimed at increasing telehealth adoption should prioritize addressing systemic inequities rather than focusing solely on changing individual attitudes. These findings underscore the importance of structural solutions to promote equitable telehealth access in marginalized communities.

From Acceptance to Dependence: Exploring Influences of Smart Healthcare on Continuous Use Intention of Mobile Health Services Among Older Adults with Chronic Illnesses in China

With the acceleration of the aging process in China, chronic diseases have become one of the main health threats for older adults, creating significant pressure on society and the healthcare system. As information technology and artificial intelligence advance rapidly, smart health services have become readily accessible. However, utilization rates among the older adults, especially those with chronic illnesses, remain low, preventing them from fully benefiting from these advanced technologies. The value of mobile health (mHealth) services can only be realized through sustained use. Therefore, this study empirically investigates the continuous use intention of mHealth services from the perspective of older adults with chronic illnesses, integrating the Technology Acceptance Model (TAM) and Value-Based Adoption Model (VAM). A total of 372 questionnaires were collected from various cities in China, and data were analyzed using SPSS 24.0 and Partial Least Squares Structural Equation Modeling (PLS-SEM). Results indicate that perceived ease of use (β = 0.155, p = 0.004; β = 0.116, p = 0.027) and perceived usefulness (β = 0.175, p = 0.001; β = 0.151, p = 0.004) have a significant positive impact on attitude and perceived value. Perceived enjoyment significantly influences attitude (β = 0.147, p = 0.010), while perceived risk (β = -0.189, p < 0.001; β = -0.281, p < 0.001) and perceived cost (β = -0.155, p = 0.003; β = -0.130, p = 0.022) have a significant negative impact on attitude and perceived value. Both attitude (β = 0.357, p < 0.001) and perceived value (β = 0.314, p < 0.001) positively impact continuous intention. In total, only one of the twelve hypotheses was not supported. This study not only provides strong evidence for the effectiveness of the integrated TAM and VAM model in the mHealth field but also offers theoretical insights and practical recommendations for product optimization and promotion to mHealth service providers and designers.

Development and Validation of the Saudi Telehealth Acceptance Scale Based on the Unified Theory of Acceptance and Use of Technology

Background

Telehealth is in early stages in the Kingdom of Saudi Arabia (KSA). Identifying barriers to using telehealth is an essential step prior to its implementation; however, no theoretically based scales exist for the same purpose.

Objective

To design a theory-based scale capable of measuring telehealth users' perceptions of benefits, barriers, and social influence in the KSA.

Methods

The Saudi Telehealth Acceptance Scale (STAS) was constructed based on the Unified Theory of Acceptance and Use of Technology and its content validity was determined by eight experts using the modified Delphi process. Only items with a content validity index score of ≥0.83 were chosen. Finally, the face validity of the questionnaire for healthcare professionals, which was in English, was determined by eight healthcare professionals, and for the patient version, which was in Arabic, by six patients.

Results

Initially, 37 items were identified; however, after Round 1, 29 items remained and after Round 2, 24 items were included in the STAS for both healthcare professionals and patients. In the healthcare professionals scale, there were 7 performance expectancy (PE) items, 6 effort expectancy (EE) items, 3 social influence (SI) items, 4 facilitating conditions (FC) items, and 4 behavioral intention (BI) items, while in the scale for patients, there were 9 PE items, 4 EE items, 3 SI items, 4 FC items, and 4 BI items.

Conclusions

The two new scales showed evidence of content and face validity. The significance of the two scales is that they were both designed in the context of the healthcare system in the KSA and could provide standardized data collection tools to measure the acceptance of telehealth among HCPs and patients.

The Role of Initial Trust in the Behavioral Intention to Use Telemedicine Among Filipino Older Adults

This study investigated the behavioral intention of Filipino older adults toward using telemedicine and the pivotal role of initial trust in influencing this intention. A cross-sectional method was employed, involving a questionnaire administered to 180 participants using convenience sampling. The structural model test results indicate that subjective norm, attitude, and notably, initial trust positively impact the behavioral intention to use telemedicine, whereas perceived behavioral control does not significantly affect intention. This underscores the significance of subjective norm and attitude in shaping behavioral intention, consistent with the Theory of Planned Behavior (TPB), while the extended construct of initial trust played a crucial role in influencing the attitude and intention of older adults, highlighting its importance in technology adoption. The study aligns with the trend of increased telemedicine adoption during the COVID-19 pandemic, emphasizing the need for trust in sensitive healthcare contexts. Establishing initial trust is vital for successful telemedicine implementation among Filipino older adults, enhancing healthcare accessibility and well-being.

Digital Health Innovations in the Battle against COVID-19: A Global Perspective

The COVID-19 pandemic has unleashed unprecedented challenges upon the global population, demanding rapid and innovative solutions [...].

The Use of a Technology Acceptance Model (TAM) to Predict Patients' Usage of a Personal Health Record System: The Role of Security, Privacy, and Usability

Personal health records (PHR) systems are designed to ensure that individuals have access and control over their health information and to support them in being active participants rather than passive ones in their healthcare process. Yet, PHR systems have not yet been widely adopted or used by consumers despite their benefits. For these advantages to be realized, adoption of the system is necessary. In this study, we examined how self-determination of health management influences individuals' intention to implement a PHR system, i.e., their ability to actively manage their health. Using an extended technology acceptance model (TAM), the researchers developed and empirically tested a model explaining public adoption of PHRs. In total, 389 Saudi Arabian respondents were surveyed in a quantitative cross-sectional design. The hypotheses were analysed using structural equation modelling-partial least squares (SEM-PLS4). Results indicate that PHR system usage was influenced by three major factors: perceived ease of use (PEOU), perceived usefulness (PU), and security towards intention to use. PHR PEOU and PHR intention to use were also found to be moderated by privacy, whereas usability positively moderated PHR PEOU and PHR intention to use and negatively moderated PHR PU and PHR intention to use. For the first time, this study examined the use of personal health records in Saudi Arabia, including the extension of the TAM model as well as development of a context-driven model that examines the relationship between privacy, security, usability, and the use of PHRs. Furthermore, this study fills a gap in the literature regarding the moderating effects of privacy influence on PEOU and intention to use. Further, the moderating effects of usability on the relationship between PEOU, PU, and intention to use. Study findings are expected to assist government agencies, health policymakers, and health organizations around the world, including Saudi Arabia, in understanding the adoption of personal health records.