Investigating factors influencing the adoption of e-Health in developing countries: A patient’s perspective

ABSTRACT Purpose: The aim of the study was to investigate factors that influence the adoption and use of e-Health applications in Bangladesh from citizens’ (patients’) perspectives by extending the technology acceptance model (TAM) to include privacy and trust. Methods: A structured questionnaire survey was used to collect data from more than 350 participants in various private and public hospitals in Dhaka, the capital city of Bangladesh. The data were analyzed using the partial least-squares (PLS) method, a statistical analysis technique based on structural equation modeling (SEM). Results: The study determined that perceived ease of use and perceived usefulness and trust (p < 0.05) were significant factors influencing the intention to adopt e-Health. Privacy (p > 0.05) was identified as a less significant factor in the context of e-Health in Bangladesh. The findings also revealed that gender was strongly associated with the adoption and use of e-Health services. Conclusions: The findings of the present study contribute to the development of strategies and policies to enhance e-Health services in Bangladesh. Furthermore, as a result of the generic approach used in this study, the acceptance model developed can be easily modified to investigate the adoption of e-Health in other developing countries.

[1]  Elizabeth Sillence,et al.  A framework for understanding trust factors in web-based health advice , 2006, Int. J. Hum. Comput. Stud..

[2]  Richard P. Bagozzi,et al.  The Legacy of the Technology Acceptance Model and a Proposal for a Paradigm Shift , 2007, J. Assoc. Inf. Syst..

[3]  Zhongyi Hu,et al.  Exploring Gender Differences on General and Specific Computer Self-Efficacy in Mobile Learning Adoption , 2013, ArXiv.

[4]  P. Briggs,et al.  Trust in Online Advice , 2002 .

[5]  I. Ajzen,et al.  Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research , 1977 .

[6]  David W. Bates,et al.  A Consensus Action Agenda for Achieving the National Health Information Infrastructure , 2004, Journal of the American Medical Informatics Association.

[7]  Donald R. Cooper,et al.  Business Research Methods , 1980 .

[8]  Syed Masud Ahmed,et al.  Harnessing pluralism for better health in Bangladesh , 2013, The Lancet.

[9]  Henry Been-Lirn Duh,et al.  A study on Singaporean women's acceptance of using mobile phones to seek health information , 2011, Int. J. Medical Informatics.

[10]  P. Pavlou,et al.  Perceived Information Security, Financial Liability and Consumer Trust in Electronic Commerce Transactions , 2002 .

[11]  Roger W. Harris,et al.  Technology Leapfrogging in Developing Countries – An Inevitable Luxury? , 2000, Electron. J. Inf. Syst. Dev. Ctries..

[12]  G. Zaltman,et al.  Factors affecting trust in market research relationships. , 1993 .

[13]  Prodromos D. Chatzoglou,et al.  Using a modified technology acceptance model in hospitals , 2009, Int. J. Medical Informatics.

[14]  Jan Marco Leimeister,et al.  Determinants of physicians' technology acceptance for e-health in ambulatory care , 2012, Int. J. Medical Informatics.

[15]  Su-Chao Chang,et al.  An extension of trust and TAM model with IDT in the adoption of the electronic logistics information system in HIS in the medical industry , 2008, Int. J. Medical Informatics.

[16]  M. Siegrist.  The Influence of Trust and Perceptions of Risks and Benefits on the Acceptance of Gene Technology , 2000, Risk analysis : an official publication of the Society for Risk Analysis.

[17]  Fred D. Davis,et al.  Toward preprototype user acceptance testing of new information systems: implications for software project management , 2004, IEEE Transactions on Engineering Management.

[18]  David Ansic,et al.  Gender differences in risk behaviour in financial decision-making: An experimental analysis. , 1997 .

[19]  Martina Ziefle,et al.  Privacy and data security in E-health: Requirements from the user’s perspective , 2012, Health Informatics J..

[20]  Ali Shah,et al.  E-health futures in Bangladesh , 2013 .

[21]  Alec Holt,et al.  Consumers are ready to accept the transition to online and electronic records if they can be assured of the security measures. , 2007, MedGenMed : Medscape general medicine.

[22]  H. Ono,et al.  Gender and the Internet , 2003 .

[23]  P. Appelbaum.  Privacy in psychiatric treatment: threats and responses. , 2002, The American journal of psychiatry.

[24]  Allen S. Lee.  Integrating Positivist and Interpretive Approaches to Organizational Research , 1991 .

[25]  Sung-joon Yoon,et al.  The antecedents and consequences of trust in online-purchase decisions , 2002 .

[26]  Viswanath Venkatesh,et al.  Consumer Acceptance and Use of Information Technology: Extending the Unified Theory of Acceptance and Use of Technology , 2012, MIS Q..

[27]  Yukun Bao,et al.  Can Online MBA Programmes Allow Professional Working Mothers to Balance Work, Family, and Career Progression? A Case Study in China , 2014, ArXiv.

[28]  Olivia R. Liu Sheng,et al.  Examining the Technology Acceptance Model Using Physician Acceptance of Telemedicine Technology , 1999, J. Manag. Inf. Syst..

[29]  Robert W. Shaw,et al.  The strategic management of technology , 1983 .

[30]  S. Cotten,et al.  Characteristics of online and offline health information seekers and factors that discriminate between them. , 2004, Social science & medicine.

[31]  Gordon B. Davis,et al.  User Acceptance of Information Technology: Toward a Unified View , 2003, MIS Q..

[32]  Ji-Young An,et al.  Theory Development in Nursing and Healthcare Informatics: A Model Explaining and Predicting Information and Communication Technology Acceptance by Healthcare Consumers , 2007, ANS. Advances in nursing science.

[33]  M. Gagnon,et al.  Evaluation of teledermatology adoption by health-care professionals using a modified Technology Acceptance Model , 2011, Journal of telemedicine and telecare.

[34]  Heshan Sun,et al.  The role of moderating factors in user technology acceptance , 2006, Int. J. Hum. Comput. Stud..

[35]  Mark Vandenbosch,et al.  Research Report: Richness Versus Parsimony in Modeling Technology Adoption Decisions - Understanding Merchant Adoption of a Smart Card-Based Payment System , 2001, Inf. Syst. Res..

[36]  Fred D. Davis.  Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology , 1989, MIS Q..

[37]  T. Busch.  Gender Differences in Self-Efficacy and Attitudes toward Computers , 1995 .

[38]  P. Korgaonkar.  A Multivariate Analysis of Web Usage , 1999 .

[39]  Lukas Furst,et al.  Multivariate Data Analysis With Readings , 2016 .

[40]  Susan Greener,et al.  Business Research Methods , 2008 .

[41]  M. E. Herselman,et al.  E-health in Rural Areas: Case of Developing Countries , 2008 .

[42]  Giedrius Vanagas,et al.  Factors affecting electronic health information needs in primary care patients. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[43]  John Doucette,et al.  Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries , 2009, Int. J. Medical Informatics.

[44]  Ritu Agarwal,et al.  Adoption of Electronic Health Records in the Presence of Privacy Concerns: The Elaboration Likelihood Model and Individual Persuasion , 2009, MIS Q..

[45]  A. Bhattacharya,et al.  Situation analysis of care and support for rape survivors at first point of contact in India and Bangladesh , 2010, Injury Prevention.

[46]  A. Chetley,et al.  Improving health, connecting people : the role of ICTs in the health sector of developing countries - a framework paper , 2006 .

[47]  Wenhong Luo,et al.  Trust-building measures: a review of consumer health portals , 2004, CACM.

[48]  Paul Jen-Hwa Hu,et al.  Investigating healthcare professionals' decisions to accept telemedicine technology: an empirical test of competing theories , 2002, Inf. Manag..

[49]  Peter A. Todd,et al.  Assessing IT usage: the role of prior experience , 1995 .

[50]  E. Vance Wilson,et al.  Modeling patients' acceptance of provider-delivered e-health. , 2004, Journal of the American Medical Informatics Association : JAMIA.

[51]  J. Sankaranarayanan,et al.  Rural patients' access to mobile phones and willingness to receive mobile phone-based pharmacy and other health technology services: a pilot study. , 2014, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[52]  S. Ozawa,et al.  How do you measure trust in the health system? A systematic review of the literature. , 2013, Social science & medicine.

[53]  A. Bandura.  Social cognitive theory of self-regulation☆ , 1991 .

[54]  I. Ajzen.  The theory of planned behavior , 1991 .

[55]  Mohammad Reza Gerami,et al.  E-health Challenges, Opportunities and Experiences of Developing Countries , 2010, 2010 International Conference on e-Education, e-Business, e-Management and e-Learning.

[56]  France Bélanger,et al.  Gender differences in perceptions of web-based shopping , 2002, CACM.

[57]  Martina Ziefle,et al.  Perception of privacy and security for acceptance of E-health technologies: Exploratory analysis for diverse user groups , 2011, 2011 5th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth) and Workshops.

[58]  English Only.  THE PEOPLE'S REPUBLIC OF BANGLADESH , 2006 .

[59]  Gad Saad,et al.  Applications of evolutionary psychology in marketing , 2000 .

[60]  Nilmini Wickramasinghe,et al.  A Framework For Assessing E-Health Preparedness , 2005, AMCIS.

[61]  Patricia Flatley Brennan,et al.  Factors affecting home care patients' acceptance of a web-based interactive self-management technology , 2011, J. Am. Medical Informatics Assoc..

[62]  Rudolf R. Sinkovics,et al.  The Use of Partial Least Squares Path Modeling in International Marketing , 2009 .

[63]  Ulku Yaylacicegi,et al.  Differential Impacts of Four Types of EHR Implementation on Small, Medium, and Large Hospitals , 2012, AMCIS.

[64]  Eun Kyoung Yun,et al.  The impact of user's perceived ability on online health information acceptance. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[65]  Jackie Fenn,et al.  Mastering the Hype Cycle: How to Choose the Right Innovation at the Right Time , 2008 .

[66]  Alejandro R Jadad,et al.  Examination of instruments used to rate quality of health information on the internet: chronicle of a voyage with an unclear destination , 2002, BMJ : British Medical Journal.

[67]  Frank M. Bass,et al.  A New Product Growth for Model Consumer Durables , 2004, Manag. Sci..

[68]  Paul A. Pavlou,et al.  Predicting E-Services Adoption: A Perceived Risk Facets Perspective , 2002, Int. J. Hum. Comput. Stud..

[69]  Xitong Guo,et al.  Understanding gender differences in m-health adoption: a modified theory of reasoned action model. , 2014, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[70]  George Demiris,et al.  Older adults' acceptance of a community-based telehealth wellness system , 2013, Informatics for health & social care.

[71]  Arik Ragowsky,et al.  Establishing Trust in Electronic Commerce Through Online Word of Mouth: An Examination Across Genders , 2008, J. Manag. Inf. Syst..

[72]  M. Kenward,et al.  An Introduction to the Bootstrap , 2007 .

[73]  Yukun Bao,et al.  Perceptions of International Female Students toward E-Learning in Resolving High Education and Family Role Strain , 2014, ArXiv.

[74]  Fred D. Davis,et al.  A Theoretical Extension of the Technology Acceptance Model: Four Longitudinal Field Studies , 2000, Management Science.

[75]  R. Chellappa.  Consumers ’ Trust in Electronic Commerce Transactions : The Role of Perceived Privacy and Perceived Security 1 Introduction , 2007 .

[76]  Alan D. Smith,et al.  Exploring the trust factor in e-medicine , 2004, Online Inf. Rev..

[77]  Jen-Her Wu,et al.  Mobile computing acceptance factors in the healthcare industry : A structural equation model , 2006 .

[78]  S. Ek,et al.  Use of and trust in health information on the Internet: A nationwide eight-year follow-up survey , 2013, Informatics for health & social care.

[79]  Peter Williams,et al.  Health information on the Internet: a qualitative study of NHS Direct Online users , 2003, Aslib Proc..

[80]  Thomas A. Horan,et al.  Personal health records , 2011, Health Informatics J..

[81]  M. Eric Johnson,et al.  Information security and privacy in healthcare: current state of research , 2010, Int. J. Internet Enterp. Manag..

[82]  Manish Latthe,et al.  Accuracy of information on apparently credible websites: survey of five common health topics , 2002, BMJ : British Medical Journal.

[83]  D. Müller,et al.  Assistive Technology: Matching Device and Consumer for Successful Rehabilitation , 2003 .

[84]  José Manuel Ortega Egea,et al.  Explaining physicians' acceptance of EHCR systems: An extension of TAM with trust and risk factors , 2011, Comput. Hum. Behav..

[85]  M. Jung,et al.  Acceptance of Swedish e-health services , 2010, Journal of multidisciplinary healthcare.

[86]  D. McGraw,et al.  Privacy as an enabler, not an impediment: building trust into health information exchange. , 2009, Health affairs.

[87]  Viswanath Venkatesh,et al.  Why Don't Men Ever Stop to Ask for Directions? Gender, Social Influence, and Their Role in Technology Acceptance and Usage Behavior , 2000, MIS Q..

[88]  Detmar W. Straub,et al.  Gender Differences in the Perception and Use of E-Mail: An Extension to the Technology Acceptance Model , 1997, MIS Q..

[89]  Dieter Fink,et al.  Internet banking adoption strategies for a developing country: the case of Thailand , 2005, Internet Res..

[90]  William R. King,et al.  A meta-analysis of the technology acceptance model , 2006, Inf. Manag..

[91]  Maryam Jahanbakhsh,et al.  E-health implementation challenges in Iranian medical centers: a qualitative study in Iran. , 2013, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[92]  Li-Min Lin,et al.  Testing the technology acceptance model for evaluating healthcare professionals' intention to use an adverse event reporting system. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[93]  Don E. Detmer,et al.  Building the national health information infrastructure for personal health, health care services, public health, and research , 2003, BMC Medical Informatics Decis. Mak..

[94]  M. Quaddus,et al.  Examining the Influence of National Culture on Adoption and Use of Information and Communication Technology: A Study from Bangladesh’s SME Perspective , 2013 .

[95]  F. Mair,et al.  Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. , 2012, Bulletin of the World Health Organization.

[96]  Cordula Wagner,et al.  Does inappropriate selectivity in information use relate to diagnostic errors and patient harm? The diagnosis of patients with dyspnea. , 2013, Social science & medicine.

[97]  A. Meyer.  The Health Insurance Portability and Accountability Act. , 1997, Tennessee medicine : journal of the Tennessee Medical Association.

[98]  Ing-Long Wu,et al.  The adoption of mobile healthcare by hospital's professionals: An integrative perspective , 2011, Decis. Support Syst..

[99]  David L. Paul,et al.  A Field of Study of the Effect of Interpersonal Trust on Virtual Collaborative Relationship Performance , 2004, MIS Q..

[100]  Rai-Fu Chen,et al.  An empirical study of physicians' acceptance of hospital information systems in Taiwan. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[101]  Geoffrey S. Hubona,et al.  The effects of gender and age on new technology implementation in a developing country: Testing the theory of planned behavior (TPB) , 2007, Inf. Technol. People.

[102]  Ardion Beldad,et al.  How shall I trust the faceless and the intangible? A literature review on the antecedents of online trust , 2010, Comput. Hum. Behav..

[103]  Christopher Bailey,et al.  A toolkit for e-health partnerships in low-income nations. , 2010, Health affairs.

[104]  Zahraa Shahid,et al.  Hopes and Fears in Implementation of Electronic Health Records in Bangladesh , 2012, Electron. J. Inf. Syst. Dev. Ctries..

[105]  Marko Sarstedt,et al.  Partial least squares structural equation modeling (PLS-SEM): An emerging tool in business research , 2014 .

[106]  Detmar W. Straub,et al.  Trust and TAM in Online Shopping: An Integrated Model , 2003, MIS Q..

[107]  Marion J. Ball,et al.  E-health: transforming the physician/patient relationship , 2001, Int. J. Medical Informatics.

[108]  Gina Green,et al.  Gender Differences in Perceptions and Use of Communication Technologies: A Diffusion of Innovation Approach , 2005, Inf. Resour. Manag. J..

[109]  Yukun Bao,et al.  e-Health in Bangladesh: Current Status, Challenges, and Future Direction , 2014 .

[110]  GuoXitong,et al.  Understanding gender differences in m-health adoption: a modified theory of reasoned action model. , 2014 .

[111]  Richard J. Holden,et al.  The Technology Acceptance Model: Its past and its future in health care , 2010, J. Biomed. Informatics.

[112]  U. Eze,et al.  Factors Affecting Internet Banking Adoption among Young Adults : Evidence from Malaysia , 2022 .

[113]  Rolph E. Anderson,et al.  Multivariate data analysis (4th ed.): with readings , 1995 .