Background
Literature review
Theory | Dependent variable | Findings | Reference |
---|---|---|---|
TAM, integrated model (IM), motivational model (MM), | eHealth behavioural intention | ▪ Users’ perceived technology usefulness (PU), users’ perceived ease of use (PEOU), intrinsic motivation (IM), and extrinsic motivation (MM) have significant positive influence on behavioural intention. | [34] |
▪ IM does not have a better performance than TAM or than MM when predicting behavioural intention. | |||
Elaboration likelihood model (ELM), concern for information privacy (CFIP) | EHR behavioural intention | ▪ Privacy concern (CFIP) is negatively associated with likelihood of adoption. | [5] |
▪ Positively framed arguments and issue involvement create more favourable attitudes toward EHR behavioural intention. | |||
TAM (qualitative research) | eHealth services behavioural intention | ▪ PU seemed to be relevant. | [37] |
▪ PEOU did not seem to be an issue. | |||
▪ Although experience is not a TAM construct, it seemed to have influenced behavioural intention. | |||
TAM, plus several other constructs | Internet use behaviour as a source of information | ▪ PU, concern for personal health, importance given to written media in searches for health information, importance given to the opinions of physicians and other health professionals, and the trust placed in the information available are the major predictors of use behaviour. | [38] |
Personal empowerment | Internet use behaviour as a source of information | ▪ There are three types of attitudes encouraging internet use to seek health information: consumer, professional, and community logic. | [39] |
Extended TAM in health information technology (HIT) | HIT behavioural intention | ▪ PEOU, PU, and perceived threat significantly influenced health consumer’s behavioural intention. | [35] |
UTAUT2 extended model | Behavioural intention and use behaviour in EHR portals | ▪ Effort expectancy, performance expectancy, habit, and self-perception are predictors of behavioural intention. | [3] |
▪ Habit and behavioural intention are predictors of use behaviour. | |||
TAM, Trust and Privacy | Intention to adopt e-Health | ▪ PEOU, PU and trust are significant predictors. | [12] |
Research model
UTAUT core constructs
-
H1. Performance expectancy will positively influence behavioural intention to use
-
H2. Effort expectancy will positively influence behavioural intention to use.
-
H3. Social influence will positively influence behavioural intention to use
-
H4(a). Facilitating conditions will positively influence behavioural intention to use
-
H4(b) Facilitating conditions will positively influence use behaviour.
UTAUT2 consumer specific constructs
-
H5. Hedonic motivation will have a negative influence on behavioural intention to use.
-
H6 (a). Price value will positively influence behavioural intention to use
-
H6 (b). Price value will positively influence behavioural intention to use in the US group and there will be a statistically significantly higher difference when compared with the Portuguese group.
-
H7(a). Habit will positively influence behavioural intention to use
-
H7(b). Habit will positively influence use behaviour.
-
H8. Behavioural intention will positively influence use behaviour.
CFIP framework
Methods
Measurement
Data collection
Data analysis
Results
Sample characteristics
Average | Standard Deviation | ||
---|---|---|---|
Age | |||
Total | 33.34 | 10.97 |
P <0.01
a
|
US | 36.42 | 11.17 | |
Portugal | 30.80 | 10.13 | |
Frequency | Percentage | ||
Gender | |||
Male Total | 257 | 43.05% |
P = 0.587
b
|
Female Total | 340 | 56.95% | |
Male US | 120 | 44.44% | |
Male Portugal | 137 | 41.90% | |
Female US | 150 | 55.56% | |
Female Portugal | 190 | 58.10% | |
Frequency | Percentage | ||
Education | |||
Undergraduate Total | 192 | 32.16% |
P <0.01
b
|
Bachelor's Total | 194 | 32.50% | |
Higher than Bachelor's Total | 211 | 35.34% | |
Undergraduate US | 92 | 34.07% | |
Undergraduate Portugal | 100 | 30.58% | |
Bachelor's US | 107 | 39.63% | |
Bachelor's Portugal | 87 | 26.61% | |
Higher than Bachelor's US | 71 | 26.30% | |
Higher than Bachelor's Portugal | 140 | 42.81% |
Usage results
Average | Median | ||
---|---|---|---|
UB1 | |||
Total | 3.58 | 4.00 |
P <0.01
a
|
US | 4.77 | 5.00 | |
Portugal | 2.60 | 1.00 | |
UB2 | |||
Total | 3.97 | 4.00 |
P <0.01
a
|
US | 4.84 | 5.00 | |
Portugal | 3.25 | 2.00 | |
UB3 | |||
Total | 3.61 | 3.00 |
P <0.01
a
|
US | 5.19 | 6.00 | |
Portugal | 2.31 | 1.00 | |
UB4 | |||
Total | 3.72 | 4.00 |
P <0.01
a
|
US | 5.31 | 6.00 | |
Portugal | 2.41 | 1.00 | |
UB5 | |||
Total | 3.23 | 3.00 |
P <0.01
a
|
US | 4.52 | 5.00 | |
Portugal | 2.17 | 1.00 |
Measurement model
Construct | AVE | Composite Reliability | Cronbach’s Alpha | ||||||
---|---|---|---|---|---|---|---|---|---|
Total | US | Portugal | Total | US | Portugal | Total | US | Portugal | |
Behavioural Intention | 0.85 | 0.89 | 0.83 | 0.95 | 0.96 | 0.94 | 0.91 | 0.94 | 0.90 |
Collection | 0.74 | 0.85 | 0.87 | 0.92 | 0.96 | 0.96 | 0.95 | 0.94 | 0.95 |
Effort Expectancy | 0.83 | 0.88 | 0.79 | 0.95 | 0.97 | 0.94 | 0.93 | 0.95 | 0.91 |
Errors | 0.85 | 0.85 | 0.68 | 0.94 | 0.94 | 0.86 | 0.93 | 0.91 | 0.95 |
Facilitating Conditions | 0.65 | 0.69 | 0.62 | 0.88 | 0.90 | 0.86 | 0.81 | 0.85 | 0.79 |
Habit | 0.62 | 0.70 | 0.67 | 0.83 | 0.87 | 0.86 | 0.74 | 0.82 | 0.75 |
Hedonic Motivation | 0.88 | 0.88 | 0.88 | 0.96 | 0.96 | 0.96 | 0.93 | 0.93 | 0.93 |
Performance Expectancy | 0.85 | 0.89 | 0.83 | 0.94 | 0.96 | 0.94 | 0.91 | 0.94 | 0.90 |
Price Value | 0.90 | 0.90 | 0.89 | 0.96 | 0.97 | 0.96 | 0.94 | 0.95 | 0.94 |
Secondary Use | 0.71 | 0.78 | 0.73 | 0.91 | 0.93 | 0.92 | 0.89 | 0.90 | 0.88 |
Social Influence | 0.95 | 0.93 | 0.96 | 0.98 | 0.98 | 0.98 | 0.97 | 0.96 | 0.98 |
Unauthorized access | 0.83 | 0.82 | 0.89 | 0.94 | 0.93 | 0.96 | 0.92 | 0.89 | 0.94 |
BI | CL | EE | ER | FC | HT | HM | PE | PV | SU | SI | UA | UB | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
BI | 0.92 | ||||||||||||
CL | −0.06 | 0.86 | |||||||||||
EE | 0.45 | −0.17 | 0.91 | ||||||||||
ER | 0.04 | 0.00 | 0.23 | 0.92 | |||||||||
FC | 0.40 | −0.11 | 0.68 | 0.26 | 0.81 | ||||||||
HT | 0.53 | 0.07 | 0.26 | −0.10 | 0.23 | 0.79 | |||||||
HM | 0.27 | −0.04 | 0.39 | 0.08 | 0.27 | 0.47 | 0.94 | ||||||
PE | 0.57 | −0.08 | 0.50 | 0.24 | 0.42 | 0.38 | 0.39 | 0.92 | |||||
PV | 0.49 | −0.03 | 0.39 | 0.09 | 0.35 | 0.44 | 0.33 | 0.41 | 0.95 | ||||
SU | 0.09 | −0.03 | 0.28 | 0.51 | 0.37 | −0.12 | 0.03 | 0.22 | 0.11 | 0.84 | |||
SI | 0.51 | 0.08 | 0.19 | −0.11 | 0.20 | 0.57 | 0.28 | 0.36 | 0.37 | −0.10 | 0.97 | ||
UA | 0.11 | 0.03 | 0.31 | 0.69 | 0.38 | −0.10 | 0.06 | 0.25 | 0.12 | 0.65 | −0.14 | 0.91 | |
UB | 0.56 | 0.06 | 0.20 | −0.07 | 0.23 | 0.43 | 0.05 | 0.33 | 0.36 | −0.03 | 0.49 | −0.05 | F |
BI | CL | EE | ER | FC | HT | HM | PE | PV | SU | SI | UA | UB | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
BI | 0.94 | ||||||||||||
CL | −0.19 | 0.92 | |||||||||||
EE | 0.61 | −0.18 | 0.94 | ||||||||||
ER | 0.23 | −0.07 | 0.23 | 0.92 | |||||||||
FC | 0.63 | −0.20 | 0.79 | 0.33 | 0.83 | ||||||||
HT | 0.46 | 0.01 | 0.29 | −0.07 | 0.19 | 0.83 | |||||||
HM | 0.29 | −0.08 | 0.31 | −0.02 | 0.18 | 0.56 | 0.94 | ||||||
PE | 0.68 | −0.25 | 0.55 | 0.31 | 0.62 | 0.37 | 0.35 | 0.95 | |||||
PV | 0.58 | −0.16 | 0.48 | 0.27 | 0.48 | 0.41 | 0.34 | 0.50 | 0.95 | ||||
SU | 0.32 | −0.12 | 0.36 | 0.55 | 0.51 | −0.15 | −0.08 | 0.34 | 0.31 | 0.88 | |||
SI | 0.45 | −0.04 | 0.24 | 0.04 | 0.24 | 0.55 | 0.48 | 0.43 | 0.30 | −0.04 | 0.96 | ||
UA | 0.33 | −0.04 | 0.37 | 0.64 | 0.51 | −0.11 | −0.10 | 0.34 | 0.32 | 0.76 | −0.07 | 0.91 | |
UB | 0.62 | −0.07 | 0.47 | 0.27 | 0.45 | 0.47 | 0.30 | 0.54 | 0.42 | 0.19 | 0.35 | 0.26 | F |
BI | CL | EE | ER | FC | HT | HM | PE | PV | SU | SI | UA | UB | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
BI | 0.91 | ||||||||||||
CL | 0.00 | 0.93 | |||||||||||
EE | 0.42 | −0.17 | 0.89 | ||||||||||
ER | 0.05 | −0.02 | 0.20 | 0.82 | |||||||||
FC | 0.30 | −0.07 | 0.56 | 0.17 | 0.79 | ||||||||
HT | 0.63 | 0.14 | 0.29 | −0.03 | 0.28 | 0.82 | |||||||
HM | 0.44 | −0.02 | 0.45 | 0.07 | 0.34 | 0.50 | 0.94 | ||||||
PE | 0.50 | 0.03 | 0.46 | 0.19 | 0.27 | 0.44 | 0.48 | 0.91 | |||||
PV | 0.36 | 0.00 | 0.35 | 0.05 | 0.27 | 0.47 | 0.44 | 0.33 | 0.86 | ||||
SU | −0.02 | 0.07 | 0.16 | 0.38 | 0.23 | −0.09 | 0.08 | 0.12 | −0.02 | 0.86 | |||
SI | 0.44 | 0.14 | 0.25 | −0.07 | 0.25 | 0.57 | 0.32 | 0.32 | 0.34 | −0.06 | 0.98 | ||
UA | −0.11 | −0.08 | −0.23 | −0.63 | −0.25 | −0.01 | −0.13 | −0.22 | −0.08 | −0.52 | 0.02 | 0.94 | |
UB | 0.42 | 0.10 | 0.16 | −0.06 | 0.22 | 0.41 | 0.16 | 0.22 | 0.21 | −0.06 | 0.41 | −0.04 | F |
Indicators | VIF a
| T value (Weights) b
| Outer Loadings |
---|---|---|---|
Total | |||
UB1 | 3.41 | 3.64** | 0.94 |
UB2 | 2.10 | 2.70** | 0.81 |
UB3 | 3.17 | 3.65** | 0.93 |
UB5 | 2.52 | 0.89 | 0.74 |
US | |||
UB1 | 2.45 | 23.41** | 0.89 |
UB2 | 2.37 | 14.21** | 0.79 |
UB3 | 1.98 | 25.59** | 0.91 |
UB5 | 1.85 | 8.43** | 0.61 |
Portugal | |||
UB1 | 2.72 | 16.72** | 0.95 |
UB2 | 1.70 | 7.86** | 0.81 |
UB3 | 3.26 | 7.74** | 0.79 |
UB5 | 2.52 | 5.54** | 0.68 |
Structural model
Dependent variables | Independent variables |
\( \widehat{\beta} \)
total
|
\( \widehat{\beta} \)
PT
a
|
\( \widehat{\beta} \)
US
|
t
otal
b
|
t
PT
b
|
t
US
b
|
\( \widehat{\beta} \)
(
US –PT
)
|
t (
US- PT
)
b
| R2
Total
| R2
PT
| R2
US
|
---|---|---|---|---|---|---|---|---|---|---|---|---|
BI | PE | 0.285 | 0.190 | 0.292 | 6.61** | 3.29** | 3.86** | 0.102 | 1.07 | 0.53 | 0.49 | 0.64 |
EE | 0.160 | 0.177 | 0.163 | 3.17** | 2.61** | 1.99* | −0.014 | 0.13 | ||||
SI | 0.198 | 0.083 | 0.149 | 5.42** | 1.57 | 2.91** | 0.066 | 0.89 | ||||
FC | 0.062 | 0.001 | 0.181 | 1.51 | 0.02 | 2.15* | 0.180 | 1.87 | ||||
HM | −0.141 | 0.026 | −0.138 | 3.63** | 0.44 | 2.66** | −0.164 | 2.10* | ||||
PV | 0.152 | −0.004 | 0.196 | 3.62** | 0.08 | 3.24** | 0.200 | 2.46* | ||||
HT | 0.255 | 0.436 | 0.188 | 6.74** | 7.57** | 3.60** | −0.248 | 3.20** | ||||
UB | FC | 0.052 | 0.103 | 0.106 | 1.19 | 2.09* | 1.26 | 0.003 | 0.04 | 0.36 | 0.23 | 0.47 |
HT | 0.145 | 0.209 | 0.276 | 2.96** | 2.59** | 4.55** | 0.067 | 0.67 | ||||
CL | 0.088 | 0.073 | 0.027 | 1.49 | 1.26 | 0.45 | −0.046 | 0.56 | ||||
ER | −0.018 | −0.115 | 0.174 | 0.36 | 1.21 | 2.63** | 0.289 | 2.50* | ||||
SU | 0.000 | −0.066 | −0.091 | 0.00 | 0.76 | 1.16 | −0.025 | 0.22 | ||||
UA | −0.098 | −0.085 | 0.064 | 1.47 | 0.76 | 0.70 | 0.149 | 1.03 | ||||
BI | 0.480 | 0.249 | 0.395 | 10.57** | 3.30** | 4.36** | 0.146 | 1.26 |
Discussion
Theoretical implications
Path | Beta | t-value | Hypothesis | Result |
---|---|---|---|---|
PE → BI | 0.285 | 6.61** | H1 | supported |
EE → BI | 0.160 | 3.17** | H2 | supported |
SI → BI | 0.198 | 5.42** | H3 | supported |
FC → BI | 0.062 | 1.51 | H4(a) | not supported |
FC → UB | 0.052 | 1.19 | H4(b) | not supported |
HM → BI | −0.141 | 3.63** | H5 | supported |
PV → BI | 0.152 | 3.62** | H6(a) | supported |
(PVUS → BIUS) - (PVPT → BIPT) | 0.200 | 2.46* | H6(b) | supported |
HT → BI | 0.255 | 6.74** | H7(a) | supported |
HT → UB | 0.145 | 2.96** | H7(b) | supported |
BI→ UB | 0.480 | 10.57** | H8 | supported |
CL→ UB | 0.088 | 1.49 | H9(a) | not supported |
(CLUS → UBUS) - (CLPT → UBPT) | −0.046 | 0.56 | H9(b) | not supported |
ER→ UB | −0.018 | 0.36 | H10(a) | not supported |
(ERUS → UBUS) - (ERPT → UBPT) | 0.289 | 2.50* | H10(b) | not supported |
UA→ UB | −0.098 | 1.47 | H11(a) | not supported |
(UAUS → UBUS) - (UAPT → UBPT) | 0.149 | 1.03 | H11(b) | not supported |
SU→ UB | 0.000 | 0.00 | H12(a) | not supported |
(SUUS → UBUS) - (SUPT → UBPT) | −0.025 | 0.22 | H12(b) | not supported |