Background
Overview
What are the supporting and constraining factors that influence physicians’ intention to use the telemedical application of online consultations?
The unified theory of acceptance and use of technology
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H1: Performance expectancy has a direct positive effect on the behavioral intention to use telemedicine.
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H2: Effort expectancy has a direct positive effect on the behavioral intention to use telemedicine.
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H3: Social influence has a direct positive effect on the intention to use telemedicine.
Conceptual definitions of drivers of and barriers to conducting online consultations
Compatibility
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H4: Compatibility has a direct positive effect on the intention to use telemedicine
IT anxiety
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H5: IT anxiety has a direct negative effect on the performance expectancy of telemedicine.
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H5*: The relationship between IT anxiety and the intention to use telemedicine is mediated by performance expectancy.
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H6: IT anxiety has a direct negative effect on the effort expectancy of telemedicine.
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H6*: The relationship between IT anxiety and the intention to use telemedicine is mediated by effort expectancy.
Structural conditions regarding data security
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H7: The importance of structural conditions regarding data security has a direct positive effect on the performance expectancy.
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H7*: The relationship between the importance of structural conditions regarding data security and the intention to use telemedicine is mediated by performance expectancy.
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H8: The importance of structural conditions regarding data security has a direct positive effect on the effort expectancy.
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H8*: The relationship between the importance of structural conditions regarding data security and the intention to use telemedicine is mediated by effort expectancy.
Methods
Research context: online consultations
Operationalization of the constructs
Construct | Items | |
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Intention to use (IU) [12] | IU1 | I intend to use online consultations in the future |
IU2 | I plan to use online consultations in the future | |
Performance expectancy (PE) [12] | PE1 | Using online consultations could increase healthcare for patients in old people’s homes and nursing homes |
PE2 | Online consultations would be a useful extension of existing treatment methods | |
Effort expectancy (EE) [12] | EE1 | I expect online consultations to be easy to understand and use |
EE2 | I expect to find online consultations easy to use | |
Social influence (SI) [33] | SI1 | I think my colleagues would support the use of online consultations |
SI2 | I think our patients would support the use of online consultations | |
The importance of structural conditions regarding data security (DS) [16] | DS1 | National security standards for the handling of patients’ medical data are necessary |
DS2 | Committing standards for the handling of patients’ medical data are necessary for my practice | |
DS3 | It’s important to me to be able to extensively inform my patients about the use of their medical data | |
Compatibility (CO) [67] | CO1 | Using online consultations is compatible with the way I want to work with patient data |
CO2 | I think that using online consultations fits well with the way I like to interact with my colleagues | |
CO3 | Using online consultations fits into my work style | |
IT anxiety (IA) [55] | IA1 | Working with a tablet makes me nervous |
IA2 | I feel threatened when others talk about tablets | |
IA3 | Tablets make me feel uncomfortable | |
IA4 | I get a sinking feeling when I think of trying to use a tablet | |
IA5 | Tablets make me feel uneasy |
Data collection
Results
Demographics of the sample
Demographics | Descriptive statistics (n = 127) | |
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Age | Mean 42.24, S.D. 8.44; range 23 to 57 | |
20 to 30 | 07.1% (n = 9) | |
31 to 40 | 30.7% (n = 39) | |
41 to 50 | 45.7% (n = 58) | |
51 to 60 | 12.6% (n = 16) | |
Prefer not to say | 03.9% (n = 5) | |
Gender | Female | 35.4% (n = 45) |
Male | 60.6% (n = 77) | |
Prefer not to say | 03.9% (n = 5) | |
Specification | General medicine | 83.5% (n = 106) |
Medical specialist | 16.5% (n = 21) |
Measurement model
Internal reliability | Convergent and discriminant validity | ||||
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Construct | Item | Cronbach’s α | Factor loading | Composite reliability | AVE |
Intention to use telemedicine (IU) | IU1 | .88 | .94 | .93 | .81 |
IU2 | .95 | ||||
IU3 | .80 | ||||
Performance expectancy (PE) | PE1 | .89 | .95 | .95 | .90 |
PE2 | .96 | ||||
Effort expectancy (EE) | EE1 | .83 | .93 | .92 | .86 |
EE2 | .92 | ||||
Social influence (SI) | SI1 | .69 | .87 | .87 | .77 |
SI2 | .88 | ||||
The importance of structural conditions regarding data security (DS) | DS1 | .72 | .84 | .84 | .64 |
DS2 | .85 | ||||
DS3 | .71 | ||||
IT anxiety (IA) | IA1 | .84 | .76 | .89 | .66 |
IA2 | .85 | ||||
IA3 | .81 | ||||
IA4 | .83 | ||||
Compatibility (CO) | CO1 | .88 | .93 | .92 | .80 |
CO2 | .89 | ||||
CO3 | .96 |
Construct | IU | PE | EE | SI | DS | IA | CO |
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IU | .90 | ||||||
PE | .67 | .95 | |||||
EE | .40 | .38 | .93 | ||||
SI | .65 | .65 | .37 | .88 | |||
DS | .19 | .24 | .34 | .18 | .80 | ||
IA | -.29 | -.37 | -.40 | -.31 | -.14 | .81 | |
CO | -.03 | .02 | .08 | .03 | .12 | .04 | .90 |
Construct | IU | PE | EE | SI | DS | IA | CO |
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IU | |||||||
PE | .76 | ||||||
EE | .47 | .44 | |||||
SI | .83 | .82 | .48 | ||||
DS | .23 | .28 | .43 | .24 | |||
IA | .31 | .38 | .46 | .35 | .21 | ||
CO | .04 | .05 | .11 | .06 | .17 | .08 |
Structural model and testing of the hypotheses
Discussion
Theoretical contribution
Practical contribution
Construct | Key Insights | Derived Recommendations |
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SI | • Colleagues can serve as role models and foster acceptance of online consultations • Governing organizations such as physician associations act as key link for exchange between physicians regarding opinions on online consultations | • Social connections and groups (meetings and networking) among physicians should be built and nurtured • Education and establishment of multipliers allows them to explain the use of telemedical online consultations to reach convergence |
IA | • Fear of change in working practices, impaired performance, increased effort for patient interaction can feed IT anxiety towards online consultations | • Development of familiarity through user training and demonstrations, collaboration, knowledge sharing, involvement in IT design and facilitating monetary incentives or administrative requirements can reduce IT anxiety |
DS | • Physicians have awareness of sensitive patient data and reflect the importance of online consultations’ compliance with data protection guidelines | • Enforcement of national regulations, standards, and low-entry concepts for the implementation of framework conditions builds confidence in adherence of telemedical online consultations |