张敏
, 罗梅芬
Zhang Min, Luo Meifen
中图分类号: F49
通讯作者:
收稿日期: 2016-12-7
修回日期: 2017-02-21
网络出版日期: 2017-04-25
版权声明: 2017 《数据分析与知识发现》编辑部 《数据分析与知识发现》编辑部
基金资助:
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摘要
【目的】探究影响移动医疗APP持续使用意愿的因素及其内在作用机理。【方法】从信息生态的研究视角出发, 分析信息、信息人、信息技术和信息环境4类影响因素, 并基于期望确认模型提出研究假设构建研究模型。【结果】选取多个移动医疗APP用户为实验者, 采用“日志追踪实验+调查问卷”的方式收集288份有效数据并利用SmartPLS2.0对模型进行检验。结果表明, 期望确认模型中的关系在移动医疗情境下均成立; 信息准确性和一致性、信息人的感知健康威胁、信息技术的易用性和响应性、信息环境的直接和间接网络外部性均会正向促进移动医疗APP的期望确认和感知有用性; 而信息人的电子健康素养则会正向促进期望确认, 负向抑制感知有用性。【局限】实验样本数量有待扩充, 得出的结论有待进一步推广。【结论】用户的移动医疗APP持续使用行为是信息、信息人、信息技术和信息环境共同作用的结果。
关键词：
Abstract
[Objective] This paper aims to explore the factors affecting the continuance intention of mobile health application users. [Methods] From the perspective of information ecology, we first analysed information, users, technology and information environment factors. Then we proposed a new research hypotheses model based on the expectation confirmation model (ECM). [Results] We collected user behaviour data from server logs of multiple mobile health applications and questionnaires. A total of 288 valid samples were obtained and examined with SmartPLS2.0. We found that, all original relationships from the ECM existed in the mobile environment. The accuracy and consensus of information, perceived health threats, responding time and ease of use, as well as the direct / indirect network externality of the environment all positively correlated to the confirmation and perceived usefulness of mobile health applications. The eHealth literacy of users increased confirmation but restrained perceived usefulness. [Limitations] The sample size needed to be expanded, and the conclusions should to be promoted. [Conclusions] User’s continuance behaviour of mobile health APP is influenced by the information, users, technology and environment.
Keywords：
随着移动信息技术的发展、亚健康人群的增加、慢性疾病年轻化趋势的出现及人口老龄化的加剧, 移动医疗近年来成为学界和产业界的关注热点。移动医疗指运用无线移动通信技术提供医疗健康服务[1], 它可以提高医疗服务效率, 极大地降低医疗成本[2]。《2016年中国移动医疗市场年度研究分析报告》[3]表明, 截至2015年底, 我国移动医疗市场规模达到48.8亿人民币, 移动医疗总用户规模超过1 700万, 其中移动医疗APP是移动医疗最主要的表现形式。
国内外关于移动医疗采纳与使用行为的研究可以归纳为以下几个方面:
(1) 移动医疗信息服务质量研究。Akter等提出移动医疗服务质量模型, 从系统质量、交互质量和信息质量三个维度对移动医疗服务质量进行验证和评估[4]; 刘咏梅等研究发现信息质量会显著促进消费者对移动医疗服务的初始信任[5];
(2) 个体层面的影响因素研究。Zhang等结合理性行为理论, 发现性别能显著调节便利条件、使用态度和主观规范对移动医疗采纳意愿的影响[6]; Guo等基于保护动机理论, 验证感知易感性、感知严重性、反应效能和自我效能对移动医疗使用态度的显著影响和年龄与性别的调节作用[7]; Rai等验证服务创新性、感知健康状况、人口统计变量和社会经济状况对移动医疗使用意愿的影响[8];
(3) 技术层面的影响因素研究。Hung等基于技术接受模型探讨感知有用性和感知易用性对移动医疗管理服务采纳态度和采纳意愿的显著影响[9]; Cho整合技术接受模型和期望确认模型, 探讨健康APP的持续使用问题[10];
(4) 群体层面的影响因素研究。Hsiao等证实主观规范对移动医疗技术接受意愿的影响[11]; 殷猛等发现群体影响能显著促进用户的健康APP使用意愿[12]。
在对文献进行主题分析后发现, 本领域的研究还可从两个方面深入探索:
(1) 基于信息生态视角的系统性研究。现有文献大多基于TAM等信息系统领域的经典理论模型, 从移动医疗的信息服务特征、移动医疗用户个体特征、移动医疗技术特征及移动医疗使用环境特征的某一视角出发, 着重从单一层面探讨移动医疗用户使用行为的影响因素。这种单一层面的探讨有助于促进移动医疗用户行为的细化研究, 但有时会忽略其他因素以及各个因素之间的相互作用的影响。实际上, 移动医疗这种新兴健康信息服务和技术的采纳行为是信息服务质量、医疗APP系统、用户个体特性以及平台用户环境等各方综合作用的结果, 因此需要从信息生态的整体视角出发展开研究, 以得到更普适性的结论;
(2) 基于“实验+问卷”的样本收集方法。现有的实证研究文献中的样本数据多数来自于单一的调查问卷, 样本偏差会带来研究结论的局限性。本文从在线医疗社区和线下渠道招募实验者, 运用实验和问卷结合的方式收集样本数据, 数据来源尽量体现真实性和可靠性, 得出更为通用和完整的结论。
基于上述分析, 本文从信息生态的视角出发, 在消费者特性、产品特性分析的基础上提取信息、信息人、信息技术和信息环境4类影响因素, 结合期望确认模型提出研究假设, 并构建研究模型探索移动医疗APP的用户持续使用意愿。通过招募移动医疗用户为实验对象, 采用实验与问卷结合的方法收集样本数据, 利用SmartPLS2.0验证假设和模型, 根据研究结论为移动医疗APP开发者、运营者和管理者提供可供参考的建议。
期望确认理论(Expectation-Confirmation Theory, ECT)由Oliver于1980年首次提出, 指消费者通过比较购买前的期望和产品使用时的绩效表现来判断是否对产品或服务感到满意[13]。它广泛应用于消费行为研究领域并被许多学者进行扩展和修改, 2001年Bhattacherjee提出针对信息系统特定情境的期望确认模型(Expectation- Confirmation Model, ECM), 用来解释信息系统持续使用行为[14]。ECM认为感知有用性和使用信息系统时的期望确认程度会影响满意度, 进而促进信息系统持续使用意愿, 而感知有用性会被确认程度影响, 还会直接促进持续使用意愿。
1999年, Nardi和O’Day提出“信息生态系统”这一概念, 并将其定义为“由人、实践、价值和技术在特定环境中所组成的有机系统”。它是研究人、信息、信息技术和信息环境协调发展的理论, 是一定范围内信息资源及其相互关系的总和[15]。王晰巍等指出, 信息生态指在特定空间中, 基于信息技术手段, 为达到一种均衡状态, 信息人与信息环境在信息资源支持下的传递与反馈活动, 并将信息、信息人、信息技术和信息环境视为信息生态系统的4个关键因素[16-17]。移动医疗APP可视为一个独立完整的信息系统, 具有显著的健康信息传播特性。在移动互联网等信息技术的支持下, 医疗APP和该平台上的医护人员能为用户提供健康信息服务。同时, 移动医疗APP上的健康社区等功能为用户营造了一个与其他用户进行信息共享和交流的信息环境。因此, 医疗APP传播的健康信息、医疗APP的支撑技术、医疗APP上的用户和医疗APP的信息环境, 各个信息生态因子之间相互作用, 共同形成一个完整复杂的信息生态系统。用户的移动医疗APP使用行为不仅受到用户自身特性的影响, 还会受到APP上的信息特性、技术特性和信息环境的影响。如何促进用户、信息、信息技术和信息环境的协调发展, 更好地满足用户的使用需求, 提高用户满意度, 成为移动医疗APP在未来发展中需要解决的信息生态问题。
本文通过整合期望确认模型和信息生态系统理论, 将期望确认、感知有用性和满意作为影响持续使用意愿的变量, 将信息、信息人、信息技术和信息环境4个信息生态因子作为影响期望确认和感知有用性的外部因素, 通过实证研究方法探索信息生态因子对移动医疗APP持续使用意愿的影响。
在移动医疗情境下, 用户通过比较使用移动医疗APP付出的努力和随之获得的报酬来形成满意或不满意的情绪。期望确认是形成满意的重要前因, 它取决于用户使用前的期望与使用后的绩效表现间的差距。感知有用性由Davis在1989年首次提出, 本研究将其定义为用户对移动医疗APP对其健康状况的提升及健康管理的促进程度的感知[18]。Cho通过整合技术接受模型和期望确认模型探索医疗APP的采纳后使用行为, 发现原始期望确认模型中的假设均成立[10]。因此, 提出如下假设:
H1: 满意正向影响移动医疗APP的持续使用意愿;
H2: 期望确认正向影响移动医疗APP的满意;
H3: 期望确认正向影响移动医疗APP的感知有用性;
H4: 感知有用性正向影响移动医疗APP的满意;
H5: 感知有用性正向影响移动医疗APP的持续使用意愿。
本研究的信息因素包括信息准确性和信息一致性。基于Johnson等的研究将信息准确性定义为用户对移动医疗APP发布的健康资讯的正确程度的感知[19]; 基于Chou等的研究将信息一致性定义为用户对移动医疗APP提供的信息与其他信息源提供的同一话题的信息相似性或一致性程度的感知[20]。Gudigantala等发现信息准确性会促进系统的感知有效性[21]; Chou等发现感知知识一致性会促进虚拟社区中的知识采纳行为[20]。本研究认为, 用户对移动医疗APP提供的健康资讯信息准确性和一致性的感知越高, 对移动医疗APP的期望确认程度也会越高, 对感知有用性的感知也会越强。基于以上分析, 提出如下假设:
H6(a): 信息准确性正向影响移动医疗APP的期望确认;
H6(b): 信息准确性正向影响移动医疗APP的感知有用性;
H6(c): 信息一致性正向影响移动医疗APP的期望确认;
H6(d): 信息一致性正向影响移动医疗APP的感知有用性。
本研究的信息人因素包含感知健康威胁和电子健康素养。其中, 感知健康威胁来自保护动机理论(Protection Motivation Theory, PMT), 该理论从健康威胁评估和健康应对评估两方面来解释用户的健康技术和健康服务采纳行为[22]。即当用户认为不久将会遇到健康方面的威胁或此威胁对自身健康的危害较大时, 会倾向于采纳相关的健康技术或服务来减轻健康威胁。本研究认为, 用户的健康威胁感知越强, 其避免威胁的愿望会越强烈, 对移动医疗APP的期望确认和有用性感知也越强。
电子健康素养指用户在互联网环境中搜寻、找到、评估、整合和应用所需要的信息来解决健康问题的能力, 它包含传统素养、健康素养、信息素养、科学素养、媒体素养和计算机素养6个核心素养[23]。与线下医疗服务模式相比, 利用互联网查找健康信息和接受健康服务效果相似但效率更高[24-25]。电子健康素养较高的人, 对计算机、社交媒体、在线医疗平台等医疗服务支持技术和工具更熟悉, 其搜寻、评估健康信息和健康服务、解决健康问题的能力也越强, 对移动医疗APP产品和服务的期望能得到很好的满足。但电子健康素养较高的人, 能够熟练运用多种工具和平台解决健康问题, 对移动医疗APP的依赖性会减弱, 对有用性的感知会降低。
基于上述分析, 提出如下假设:
H7(a): 感知健康威胁正向影响移动医疗APP的期望确认;
H7(b): 感知健康威胁正向影响移动医疗APP的感知有用性;
H7(c): 电子健康素养正向影响移动医疗APP的期望确认;
H7(d): 电子健康素养负向影响移动医疗APP的感知有用性。
本研究的信息技术因素包括响应性与易用性。本文的响应性定义为移动医疗APP能积极响应用户的需求且能为用户提供即时的服务[26]。基于1989年Davis提出的技术接受模型将易用性定义为用户相信通过使用移动医疗APP减少精力浪费的程度。Du等发现响应性会正向影响SaaS的感知有用性[27]; Wu等在探索医疗专家对移动医疗系统的采纳意愿时发现, 系统的感知易用性会正向影响其感知有用性[28]。本研究认为, 用户对移动医疗APP的响应性和易用性的感知越好, 其期望满足程度和有用性感知会越强。基于上述分析, 提出如下假设:
H8(a): 响应性正向影响移动医疗APP的期望确认;
H8(b): 响应性正向影响移动医疗APP的感知有用性;
H8(c): 易用性正向影响移动医疗APP的感知有用性。
本文用网络外部性这一因素来研究平台信息环境, 它指单个用户从产品或服务中获得的价值随着使用人数的增加而增长的现象, 包括直接网络外部性和间接网络外部性[29]。在移动医疗的情境下, 直接网络外部性指用户感知的医疗APP的普通用户和医生数量, 间接网络外部性指用户认为该医疗APP提供了补充性的工具或服务。Zhou的研究表明, 直接网络外部性和间接网络外部性均会正向影响感知有用性[30]。本研究认为, 移动医疗APP上的医生数量和用户数量越多则形成的用户价值也越大, 同时用户的期望确认和有用性感知也会越强。此外, 补充性的功能或服务(如健康管理工具、健康讨论社区)也会极大地增强用户的期望确认程度和感知有用性。基于上述分析, 提出如下假设:
H9(a): 直接网络外部性正向影响移动医疗APP的期望确认;
H9(b): 直接网络外部性正向影响移动医疗APP的感知有用性;
H9(c): 间接网络外部性正向影响移动医疗APP的期望确认;
H9(d): 间接网络外部性正向影响移动医疗APP的感知有用性。
根据上述研究假设, 本文构建的研究模型如图1所示。
采取日志追踪实验和调查问卷结合的方法以保证实证研究的数据真实、可靠。通过查阅大量文献资料和市场调研, 最终选择“春雨医生”作为实验素材, 主要原因如下:
(1) “春雨医生”是目前中国移动医疗APP市场中用户数较多的产品[3];
(2) “春雨医生”虽以在线轻问诊和自诊功能为主, 但同时兼顾健康资讯的普及、自我健康管理辅助和在线预约挂号等功能。因此, 其具有较好的代表性, 符合本研究对实验素材的要求。
在实验设计部分, 研究团队设计并编辑实验说明文档、实验任务文档及实验日志文档, 并将其发布在国内在线调研平台。其中, 实验说明文档简要向实验者介绍实验目的、实验流程等, 实验者通过阅读实验说明文档能详细了解国内外移动医疗发展现状, 并在各自的手机上安装和注册“春雨医生”APP; 每天早上由研究者向实验者定时发送实验任务文档, 文档内容是使实验者对“春雨医生”APP的特定功能进行深度体验的实验任务书, 实验者必须在当天结束之前完成当日的任务; 实验日志文档由实验者每天晚上填写来记录当日的任务完成情况。实验任务涉及移动医疗APP健康资讯的浏览、健康管理辅助工具的使用、疾病自诊、在线轻问诊等, 实验时长为5天, 实验者在实验结束后会收到一定的经济报酬。
问卷设计包括人口统计量和变量问项两个部分。为保证量表的信度和效度, 问卷中的所有问项均是在分析国内外相关文献基础上结合本研究特定的情境进行提取和改编获得。表1显示了问卷变量及问项的相关信息。
表1 问卷变量设计
| 变量名 | 问项数 | 问项来源 |
|---|---|---|
| 持续使用意愿(Continuance Intention, CONI) | 3 | Dağhan & Akkoyunlu (2016)[ 31] |
| 满意(Satisfaction, SATI) | 3 | Dağhan & Akkoyunlu (2016)[31] |
| 期望确认(Expectation Confirmation, EXPE) | 3 | Dağhan & Akkoyunlu (2016)[31] |
| 感知有用性(Perceived Usefulness, PU) | 3 | Davis(1989)[18] |
| 准确性(Accuracy, ACCU) | 3 | Shin, et al. (2016)[32] |
| 一致性(Consensus, CONS) | 3 | Chou, et al. (2015)[20] |
| 感知健康威胁(Perceived Health Threat, PHT) | 6 | Johnston & Warkentin (2010)[33]; Sun, et al. (2013)[34] |
| 电子健康素养(eHealth Literacy, EHLI) | 8 | Norman, et al. (2006)[35] |
| 响应性(Responsiveness, RESP) | 4 | Parasuraman, et al. (1988)[26] |
| 易用性(Perceived Ease of Use, PEOU) | 4 | Davis(1989)[18] |
| 直接网络外部性(Direct Network Externalities, DNE) | 3 | Zhou (2015)[30] |
| 间接网络外部性(Indirect Network Externality, INE) | 3 | Zhou (2015)[30] |
变量问项均采用Likert7点量表进行测量, 1-7依次代表“非常不同意”到“非常同意”的各个程度。为保证数据的准确性和科学性, 在正式进行大规模问卷发放前选取30名移动医疗APP的大学生用户完成相关实验并进行问卷前测。随后将前测结果反馈至移动医疗相关研究领域的三名专家进行问卷修订, 并重复测试直至反馈结果在控制范围内, 再进行大规模实验和问卷调查。
实验者的招募主要通过线上和线下两种渠道进行。线上通过各大在线医疗网站和论坛、线下通过实地访谈公开招募。为尽可能保证实验样本的代表性和有效性, 在确定实验者被纳入实验对象之前会通过电子邮件或当面访谈的形式询问其是否有使用移动医疗的健康需求或经验, 将健康需求较高或有移动医疗使用经验的人作为本研究的实验样本。同时, 由于本文研究的是用户的持续使用意愿, 因此为保证实验数据的真实可靠, 在正式发放调查问卷之前, 让实验者对实验选取的医疗APP进行为期5天的使用体验, 并通过实验任务和日志文档的形式确保其如期完成实验。最终共招募实验志愿者320名并向其发放实验说明文档, 在确保各实验者了解实验流程并同意参与实验后开始正式实验。实验结束之后, 研究者向每位实验者发放最终的调查问卷, 剔除回答不完整及回答具有明显错误的无效问卷后, 最终获得288份有效问卷。
由表2可知, 在288份有效问卷中, 男性占比53.8%, 女性占比46.2%。在年龄分布上, 25岁及以下的人占比最大, 达到85%以上, 26-45岁人群约占10%, 46岁及以上的人群共占4.5%。受教育程度方面, 本科占比最大为64.9%, 大专及以下样本占比31.0%, 硕士及以上占比为4.1%。
表2 样本描述统计
| 类别 | 选项 | 人数 | 比例(%) |
|---|---|---|---|
| 性别 | 男 | 155 | 53.8 |
| 女 | 133 | 46.2 | |
| 年龄 | 18岁以下 | 17 | 5.9 |
| 18-25岁 | 228 | 79.2 | |
| 26-35岁 | 18 | 6.3 | |
| 36-45岁 | 12 | 4.2 | |
| 46-60岁 | 11 | 3.8 | |
| 60岁以上 | 2 | 0.7 | |
| 教育程度 | 初中及以下 | 8 | 2.8 |
| 高中或高职高专 | 52 | 18.1 | |
| 大专 | 29 | 10.1 | |
| 本科 | 187 | 64.9 | |
| 硕士 | 9 | 3.1 | |
| 博士及以上 | 3 | 1.0 |
模型验证包括测量模型检验和结构模型检验, 采用SmartPLS2.0软件进行分析。该软件基于偏最小二乘法, 对样本数量要求较少且对样本数据的分布要求较低。首先运行PLS Algorithm算法验证测量模型, 然后运行Bootstrapping算法分析结构模型。
测量模型的检验包括信度和效度检验。信度用来判断量表的结果是否可信, 可通过复合信度(CR)值和变量的$\alpha $值进行观测。效度包括聚合效度和区别效度, 聚合效度检验问项与所对应的变量间的相关程度, 可通过平均提取方差(AVE)的值来观测; 区别效度检验问项与所对应的变量的相关度是否高于该问项与其他变量的相关度, 可通过比较各变量AVE值的平方根与变量之间的相关系数来衡量。
表3和表4分别显示模型的信度、聚合效度以及区别效度结果。由表3可知, 所有变量的因子负载均大于0.7, CR值都大于0.7, $\alpha $值在0.8896和0.9588之间, 说明模型具有较好的信度。所有变量的AVE值在0.6443与0.9000之间, 说明模型聚合效度较好。由表4可知, 各变量的AVE值的平方根(对角线的值)大于变量之间的相关系数(对角线下方各列的值), 说明模型的区别效度较好。
表3 测量模型信度和聚合效度相关指标
| 变量 | 问项 | 因子负载 | AVE | CR | $\alpha $值 |
|---|---|---|---|---|---|
| 持续使用意愿CONT | CONT1 | 0.9559 | 0.9000 | 0.9643 | 0.9444 |
| CONT2 | 0.9468 | ||||
| CONT3 | 0.9434 | ||||
| 电子健康素养EHLI | EHLI1 | 0.8604 | 0.7765 | 0.9653 | 0.9588 |
| EHLI2 | 0.8970 | ||||
| EHLI3 | 0.8987 | ||||
| EHLI4 | 0.8986 | ||||
| EHLI5 | 0.8922 | ||||
| EHLI6 | 0.8926 | ||||
| EHLI7 | 0.8426 | ||||
| EHLI8 | 0.8655 | ||||
| 期望确认EXPE | EXPE1 | 0.9343 | 0.8587 | 0.9480 | 0.9177 |
| EXPE2 | 0.9165 | ||||
| EXPE3 | 0.9291 | ||||
| 一致性CONS | CONS1 | 0.9156 | 0.8269 | 0.9348 | 0.8953 |
| CONS2 | 0.8972 | ||||
| CONS3 | 0.9152 | ||||
| 准确性ACCU | ACCU1 | 0.9152 | 0.8634 | 0.9499 | 0.9208 |
| ACCU2 | 0.9341 | ||||
| ACCU3 | 0.9381 | ||||
| 间接网络外部性INE | INE1 | 0.9165 | 0.8316 | 0.9368 | 0.8988 |
| INE2 | 0.9052 | ||||
| INE3 | 0.9142 | ||||
| 易用性PEOU | PEOU1 | 0.8935 | 0.8420 | 0.9552 | 0.9373 |
| PEOU2 | 0.9192 | ||||
| PEOU3 PEOU4 | 0.9420 0.9151 | ||||
| 感知健康 威胁PHT | PHT1 | 0.7830 | 0.6443 | 0.9156 | 0.8896 |
| PHT2 | 0.8553 | ||||
| PHT3 | 0.7964 | ||||
| PHT4 | 0.7723 | ||||
| PHT5 | 0.7805 | ||||
| PHT6 | 0.8252 | ||||
| 感知有用性PU | PU1 | 0.9053 | 0.8367 | 0.9389 | 0.9024 |
| PU2 | 0.9273 | ||||
| PU3 | 0.9114 | ||||
| 响应性RESP | RESP1 | 0.8894 | 08117 | 0.9452 | 0.9226 |
| RESP2 | 0.9058 | ||||
| RESP3 | 0.9230 | ||||
| RESP4 | 0.8851 | ||||
| 直接网络外部性DNE | DNE1 | 0.8782 | 0.8341 | 0.9378 | 0.9006 |
| DNE2 | 0.9331 | ||||
| DNE3 | 0.9277 | ||||
| 满意SATI | SATI1 | 0.9184 | 0.8532 | 0.9458 | 0.9139 |
| SATI2 | 0.9174 | ||||
| SATI3 | 0.9352 |
表4 测量模型区别效度指标
| CONT | EHLI | EXPE | CONS | ACCU | INE | PEOU | PU | RESP | DNE | SATI | PHT | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CONT | 0.9487 | |||||||||||
| EHLI | 0.5584 | 0.8812 | ||||||||||
| EXPE | 0.8428 | 0.6356 | 0.9267 | |||||||||
| CONS | 0.6347 | 0.6877 | 0.7204 | 0.9093 | ||||||||
| ACCU | 0.6761 | 0.6566 | 0.7664 | 0.8001 | 0.9292 | |||||||
| INE | 0.5748 | 0.5718 | 0.6408 | 0.6949 | 0.6845 | 0.9119 | ||||||
| PEOU | 0.5543 | 0.7137 | 0.6504 | 0.7680 | 0.7228 | 0.6295 | 0.9176 | |||||
| PU | 0.7197 | 0.6005 | 0.7677 | 0.8315 | 0.8201 | 0.7306 | 0.7292 | 0.9147 | ||||
| RESP | 0.6319 | 0.6438 | 0.7419 | 0.7841 | 0.7785 | 0.7442 | 0.7135 | 0.7959 | 0.9009 | |||
| DNE | 0.6242 | 0.5182 | 0.6400 | 0.6378 | 0.6173 | 0.6475 | 0.4931 | 0.6532 | 0.6386 | 0.9133 | ||
| SATI | 0.8295 | 0.7095 | 0.9046 | 0.7564 | 0.8236 | 0.7038 | 0.7047 | 0.8101 | 0.7809 | 0.6495 | 0.9237 | |
| PHT | 0.5384 | 0.4538 | 0.5253 | 0.5260 | 0.4729 | 0.5006 | 0.3752 | 0.5341 | 0.5151 | 0.4977 | 0.5142 | 0.8027 |
通过路径系数和显著性水平两个指标判断假设是否成立, 应用Bootstrapping进行路径系数求解, 并进行1 000次抽样检验模型路径的显著性水平, 如图2所示。
从图2可知, 满意正向影响持续使用意愿, 路径系数为0.714; 期望确认正向影响满意和感知有用性, 路径系数分别为0.690和0.159; 感知有用性正向影响满意和持续使用意愿, 路径系数分别为0.280和0.141。因此, 期望确认模型中的变量关系均成立, 即假设H1、H2、H3、H4和H5均成立。信息的准确性显著正向影响期望确认和感知有用性, 路径系数分别为0.349和0.231; 信息的一致性正向影响感知有用性, 但对期望确认无显著影响, 路径系数为0.291和0.049。因此, 假设H6(a)、H6(b)和H6(d)成立, H6(c)不成立。信息人的感知健康威胁正向影响期望确认和感知有用性, 路径系数分别为0.099和0.059; 电子健康素养正向影响期望确认且负向影响感知有用性, 路径系数分别为0.116和-0.142。因此, H7(a)、H7(b)、H7(c)和H7(d)均成立。信息技术中的响应性正向影响期望确认和感知有用性, 易用性正向影响感知有用性, 路径系数分别为0.213、0.116和0.133。因此, H8(a)、H8(b)和H8(c)均成立。信息环境中的直接网络外部性正向影响期望确认和感知有用性, 间接网络外部性正向影响感知有用性, 但不能显著影响期望确认, 路径系数分别为0.151、0.053、0.116和-0.005。因此, 假设H9(a)、H9(b)和H9(d)成立, H9(c)不成立。
R2代表自变量对因变量的解释程度的大小, 用户行为研究领域中R2大于0.20时说明该变量被解释程度较高。从计算结果可知, 期望确认、满意、感知有用性和持续使用意愿的R2分别为0.680、0.851、0.809和0.695, 可见模型拟合程度良好, 具有较高的预测能力。
基于模型验证结果, 从期望确认模型的因素来看, 与前人的研究结论一致[10], 用户的期望确认程度会正向影响用户对移动医疗APP的感知有用性和满意, 且感知有用性会促进满意, 同时感知有用性和满意共同促进移动医疗APP持续使用意愿。
从信息生态的整体视角来看, 用户的移动医疗APP持续使用意愿是信息、信息人、信息技术和信息环境共同作用的结果。Hsiao等[11]从技术、个体和社会三方面探讨老年群体对移动医疗技术的采纳问题; Cho等[36]从个体的健康特性和群体影响上研究大学生群体的手机健康APP的使用意愿。本文在前人基础上, 基于信息生态视角整合四个重要的维度, 发现信息生态的四个核心要素对用户移动医疗持续使用意愿的共同影响, 并将研究样本拓展到各个年龄阶层, 得出更具普适性的结论。
从信息因素来看, 本文在刘咏梅等[5]的研究上进一步发现, 用户对健康信息的正确性的感知会增强其期望确认程度和对APP有用性的感知。此外, 当APP上的健康信息与用户在其他渠道获得的健康信息类似时, 对有用性的感知也更强烈。但在用户期望方面, 获取健康服务和自我健康管理是主要的用户期望, 对信息一致性的要求并不高, 甚至在某些情境下获取区别于其他渠道的健康信息反而更符合对信息多样化的需求, 因此信息一致性不会对用户的期望确认程度产生显著影响。
从信息人因素来看, 在Guo等[2]和Cho等[10]的研究基础上, 本文发现感知疾病威胁和电子健康素养会共同影响用户的期望确认和感知有用性。感知健康威胁是用户对自身疾病易感性与疾病严重性的感知, 用户的感知健康威胁越强, 对移动医疗APP期望确认和有用性感知也越强。另一方面, 电子健康素养高的用户能较轻松地使用APP各项功能及服务, 其期望预期能得到满足, 但越高的电子健康素养使得用户越能通过其他渠道寻找到更好的健康问题解决方案, 其对移动医疗APP的有用性感知会减弱。
从信息技术因素来看, 基于Hung等[9]的研究, 本文发现系统的易用性和响应性会共同影响感知有用性。响应性反映APP系统能否快速响应用户的请求并给予用户服务反馈。系统的响应性越好, 用户的期望确认和感知有用性越强。另一方面, 与原始TAM模型结论一致, 用户能越轻松地学会使用移动医疗APP, 对其有用性的感知也越强。
从信息环境因素来看, Zhang等[6]验证了主观规范对移动医疗采纳态度的影响。但是在中国的移动医疗情境下, 移动医疗APP的市场渗透率还比较低, 相比主观规范, 使用者更关心医疗APP上的用户和医生数量是否充足从而为自己择医问诊提供参考和帮助, 同时关注医疗APP是否提供其他辅助性工具帮助自己进行健康管理。因此直接和间接网络外部性这两个信息环境因素在用户的持续使用意愿中起到重要的作用。APP上的医生和用户数增多, 用户能与其他更多用户和医生交流获取更多的收益, 使得其增强对期望确认和有用性的感知。同时, APP其他辅助性健康管理工具的补充, 使得用户的感知有用性也会增强。另一方面, 用户使用APP的主要目的是获取健康信息和服务, 辅助性的功能不会对用户的期望确认程度产生显著影响。
基于研究结论, 移动医疗APP开发者、运营商和管理方可从信息生态的视角得到一些启示和建议。
(1) 移动医疗APP开发者可从信息技术和信息环境两方面入手, 强化用户的易用性、响应性和间接网络外部性的感知。Hung等[9]的研究强调易用性和有用性的作用, 但在移动医疗APP开发时, 开发者还应在充分调研分析用户的健康信息服务需求、找准自己的产品定位的前提下, 开发出满足不同用户需求的功能模块和辅助性健康管理工具, 通过“个性化”的功能服务增强用户的期望确认、有用性和满意度感知。同时, 还需关注系统的响应性和易用性, 根据用户使用习惯开发出用户容易理解、快速掌握的产品, 并尽量避免出现运行不稳定、闪退等现象, 也可将用户常见问题归纳存档并形成Q&A知识库, 根据用户的询问或搜索行为自动回复提问或自动推送健康服务, 有效缩减用户等待时长。
(2) 移动医疗APP运营商可从信息和信息人入手, 充分发挥信息的准确性、一致性和用户感知健康威胁等因素的作用。前人研究中从健康信息方面为移动医疗运营商提供实践建议的较少, 根据本文研究结论, 运营商在日常更新发布健康资讯时, 可以通过标注健康信息的来源、机构、可靠级别等方式增强用户的信息准确性和一致性感知。此外, Guo等[7]的研究指出移动医疗服务提供者可以通过向用户展示其他用户使用移动医疗服务获益或面临健康问题不使用移动医疗服务出现风险的案例来促进用户的使用意愿。本文认为, 运营者还可根据用户的注册、浏览及服务使用等历史记录来鉴别用户对自身健康问题的威胁程度感知, 对于健康威胁感知强烈的用户重点给予关怀和帮助, 有针对性地提供医疗信息或医生推荐, 鼓励其使用APP上的健康服务。
(3) 移动医疗APP管理方可从信息人和信息环境入手, 重视用户的电子健康素养和直接网络外部性的作用。在Cho等[36]的研究中, 电子健康素养对用户易用性的影响不显著, 但是本文的研究发现电子健康素养能促进用户的期望确认。因此管理者可以采取一些积极措施主动培养用户的电子健康素养。如向其普及移动医疗相关产品及知识, 鼓励其参与移动医疗上的社区话题讨论、使用多种媒体工具实现在线疾病咨询等。同时, 应降低移动医疗APP的使用难度, 通过卡通化等形式活泼、有趣的方式录制APP使用指南, 增强电子健康素养较低的用户对平台的期望确认感知。此外, 在Zhou[30]的研究基础上, 本文认为管理者还可以通过增加普通和医师用户数来提升用户的价值收益。
张敏, 罗梅芬: 提出研究思路, 设计研究方案;
罗梅芬, 聂瑞: 进行实验和问卷收集;
罗梅芬: 清洗和分析数据;
罗梅芬: 论文撰写;
张敏, 张艳: 论文最终版本修订。
所有作者声明不存在利益冲突关系。
支撑数据由作者自存储, E-mail: luomeifen@whu.edu.cn。
[1] 张敏, 罗梅芬, 聂瑞, 张艳. Dataset.xls. 移动医疗用户使用行为调查问卷数据.
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Mobile health (mHealth) services have gained increasing attention in recent years; however, few studies have focused on the manner in which customers’ attributes affect acceptance behavior, for instance, personal privacy concerns and personalization concerns; with even fewer studies on the effects on different age groups. To fill this research gap, our research has developed an attribute–perception–intention model, using the privacy–personalization paradox factors as independent variables that affect mHealth acceptance intention, with trust as a mediator. The age differences of participants were then examined. A survey of 650 subjects in China was conducted to test the proposed research model and hypotheses. The results show the following key findings: (1) perceived personalization and privacy concerns are positively and negatively associated with behavior intention; (2) trust mediates the relationships between perceived personalization, privacy concerns and behavior intention; and (3) age differences are examined in the model, which in this respect differ from previous technology acceptance research. Theoretical and practical implications are also discussed.
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The role of service quality in fostering the growth of mHealth services has gained much attention in the academic and practitioner communities. However, empirical research in this area has been beset by inadequate conceptualization and the lack of a validated scale. This study addresses these limitations by theoretically conceptualizing and empirically validating a multidimensional service quality scale in the mHealth context. The findings show that mHealth service quality is a hierarchical, multidimensional, and reflective construct, which consists of three primary dimensions and eight subdimensions. The results also confirm that the mHealth service quality scale is more effective at predicting satisfaction and continuance in a nomological network.
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消费者对移动医疗的初始信任研究 [J].
借鉴已有移动商务的初始信任模型,本文考虑移动医疗的特殊情境,加入技术焦虑以及信任倾向的调节效应,考察医院的声誉、信任倾向、技术焦虑、结构保证和信息质量等因素对消费者对移动医疗的初始信任的影响,本文利用问卷调查的方法,以204名消费者为样本,验证初始信任模型,研究结果表明医院的声誉、结构保证和信息质量显著增加消费者的初始信任,而个人信任倾向除了正面的直接效应之外,还调节结构保证、信息质量与初始信任之间的关系。
Research on Consumers’ Initial Trust for Mobile Health [J].
借鉴已有移动商务的初始信任模型,本文考虑移动医疗的特殊情境,加入技术焦虑以及信任倾向的调节效应,考察医院的声誉、信任倾向、技术焦虑、结构保证和信息质量等因素对消费者对移动医疗的初始信任的影响,本文利用问卷调查的方法,以204名消费者为样本,验证初始信任模型,研究结果表明医院的声誉、结构保证和信息质量显著增加消费者的初始信任,而个人信任倾向除了正面的直接效应之外,还调节结构保证、信息质量与初始信任之间的关系。
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| [6] |
Understanding Gender Differences in m-Health Adoption: A Modified Theory of Reasoned Action Model [J].https://doi.org/10.1089/tmj.2013.0092 URL PMID: 24161004 [本文引用: 2] 摘要
ABSTRACT Background: Mobile health (m-health) services are becoming increasingly popular in healthcare, but research on m-health adoption is rare. This study was designed to obtain a better understanding of m-health adoption intention. Materials and methods: We conducted an empirical research of a 481-respondent sample consisting of 44.7% women and 55.3% men and developed a modified theory of reasoned action (TRA) model by incorporating the nonlinearities between attitude and subjective norms and the moderating effect of gender. Results: The results indicate that, based on the study population in China: (1) facilitating conditions, attitude, and subjective norms are significant predictors of m-health adoption intention; (2) the model including the nonlinearities enhances its explanatory ability; (3) males enjoy a higher level of m-health adoption intention compared with females; (4) the modified TRA model can predict men's behavior intention better than that of women; and (5) males have an Edgeworth-Pareto substitutability between attitude and subjective norms in predicting m-health adoption intention. Conclusions: Thus, we found gender differences in m-health adoption from the perspective of social psychology.
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| [7] |
Investigating m-Health Acceptance from a Protection Motivation Theory Perspective: Gender and Age Differences [J].https://doi.org/10.1089/tmj.2014.0166 URL PMID: 25919800 [本文引用: 2] 摘要
ABSTRACT Mobile health (m-health) services are becoming increasingly important and widely accepted. However, empirical studies on potential users' m-health acceptance behavior remain underexplored. Indeed, m-health adoption is not only a technology acceptance behavior, but also a health-related behavior. Based on the Protection Motivation Theory, this article explores users' m-health adoption behavior from the perspectives of threat appraisal and coping appraisal, and also examines the moderating role of gender and age through a survey of potential users. The survey was conducted among 500 potential m-health service participants. Our results show that threat appraisal and coping appraisal factors influence adoption intention through attitude. It is also found that gender and age play different moderating roles with threat appraisal and coping appraisal factors. Gender and age play different roles between threat appraisal and coping appraisal factors in the acceptance of m-health. Implications for research and practice are discussed.
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| [8] |
Understanding Determinants of Consumer Mobile Health Usage Intentions, Assimilation, and Channel Preferences [J].https://doi.org/10.2196/jmir.2635 URL PMID: 3742412 [本文引用: 1] 摘要
Consumer use of mobile devices as health service delivery aids (mHealth) is growing, especially as smartphones become ubiquitous. However, questions remain as to how consumer traits, health perceptions, situational characteristics, and demographics may affect consumer mHealth usage intentions, assimilation, and channel preferences.We examine how consumers' personal innovativeness toward mobile services (PIMS), perceived health conditions, health care availability, health care utilization, demographics, and socioeconomic status affect their (1) mHealth usage intentions and extent of mHealth assimilation, and (2) preference for mHealth as a complement or substitute for in-person doctor visits.Leveraging constructs from research in technology acceptance, technology assimilation, consumer behavior, and health informatics, we developed a cross-sectional online survey to study determinants of consumers' mHealth usage intentions, assimilation, and channel preferences. Data were collected from 1132 nationally representative US consumers and analyzed by using moderated multivariate regressions and ANOVA.The results indicate that (1) 430 of 1132 consumers in our sample (37.99%) have started using mHealth, (2) a larger quantity of consumers are favorable to using mHealth as a complement to in-person doctor visits (758/1132, 66.96%) than as a substitute (532/1132, 47.00%), and (3) consumers' PIMS and perceived health conditions have significant positive direct influences on mHealth usage intentions, assimilation, and channel preferences, and significant positive interactive influences on assimilation and channel preferences. The independent variables within the moderated regressions collectively explained 59.70% variance in mHealth usage intentions, 60.41% in mHealth assimilation, 34.29% in preference for complementary use of mHealth, and 45.30% in preference for substitutive use of mHealth. In a follow-up ANOVA examination, we found that those who were more favorable toward using mHealth as a substitute for in-person doctor visits than as a complement indicated stronger intentions to use mHealth (F69,656860=20.14, P<.001) and stronger assimilation of mHealth (F69,656860=41.866, P<.001).Multiple predictors are shown to have significant associations with mHealth usage intentions, assimilation, and channel preferences. We suggest that future initiatives to promote mHealth should shift targeting of consumers from coarse demographics to nuanced considerations of individual dispositions toward mobile service innovations, complementary or substitutive channel use preferences, perceived health conditions, health services availability and utilization, demographics, and socioeconomic characteristics.
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| [9] |
The Adoption of Mobile Health Management Services: An Empirical Study [J].https://doi.org/10.1007/s10916-010-9600-2 URL PMID: 20878452 Magsci [本文引用: 3] 摘要
As their populations age, many countries are facing the increasing economic pressure of providing healthcare to their people. In Taiwan, this problem is exacerbated by an increasing rate of obesity and obesity-related conditions. Encouraging the adoption of personal health management services is one way to maintain current levels of personal health and to efficiently manage the distribution of healthcare resources. This study introduces Mobile Health Management Services (MHMS) and employs the Technology Acceptance Model (TAM) to explore the intention of students in Executive Master of Business Management programs to adopt mobile health management technology. Partial least squares (PLS) was used to analyze the collected data, and the results revealed that "perceived usefulness" and "attitude" significantly affected the behavioral intention of adopting MHMS. Both "perceived ease of use" and "perceived usefulness," significantly affected "attitude," and "perceived ease of use" significantly affected "perceived usefulness" as well. The results also show that the determinants of intention toward MHMS differed with age; young adults had higher intention to adopt MHMS to manage their personal health. Therefore, relevant governmental agencies may profitably promote the management of personal health among this population. Successful promotion of personal health management will contribute to increases in both the level of general health and the efficient management of healthcare resources.
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| [10] |
The Impact of Post-Adoption Beliefs on the Continued Use of Health Apps [J].https://doi.org/10.1016/j.ijmedinf.2015.12.016 URL PMID: 26806714 [本文引用: 4] 摘要
Main findings from this present study contribute to developing and empirically testing a model of explaining the basic process of motivating health app users to keep using those apps. This model will be helpful for researchers to further examine health-related technologies, particularly mHealth-oriented ones.
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| [11] |
Examining a Model of Mobile Healthcare Technology Acceptance by the Elderly in Taiwan [J].https://doi.org/10.1080/1097198X.2015.1108099 URL [本文引用: 2] 摘要
“Graying of the globe” is an increasing phenomenon worldwide, accompanied with the expanding healthcare costs of long-term care and hospitalization. To deal with this issue, previous medical literature has suggested that the ultimate success of telemedicine depends not only on the technology itself but also on users’ acceptance of the technology. Differing from past healthcare studies which focused on physicians’ viewpoints, the current study investigates the use intention of mobile healthcare devices from the perspectives of elderly people in Taiwan. Meanwhile, this study proposes a model of mobile healthcare technology acceptance, and provides a theoretical and empirical assessment including sociological, technological, and individual variables. To achieve the research purpose, elderly people in the community were invited to participate in the study, with 338 effective questionnaires eventually collected for analysis using the structural equation modeling technique. The empirical results support the inclusion of perceived ubiquity, personal health knowledge, and perceived need for healthcare in the technology acceptance model. In sum, the mobile healthcare technology acceptance model provides researchers and practitioners with in-depth understanding of the introduction of new mobile healthcare technology devices. Further discussion is provided.
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基于保护动机理论的健康APP用户使用研究 [J].https://doi.org/10.3969/j.issn.1008-0821.2016.07.012 URL [本文引用: 1] 摘要
移动医疗发展迅速，医疗健康管理成为研究热点，为了研究用户对健康 APP 的采纳意愿及影响因素。本文从技术视角和健康行为改变视角，基于 UTAUT 理论和 PMT 理论构建用户使用意愿研究模型，通过调查问卷收集数据，并利用 SPSS和 AMOS 进行统计分析和结构方程建模。研究发现：绩效期望、信任感知、社会影响和努力期望依次显著正向影响用户的使用意愿；信任感知正向影响用户的自我效能和反应效能；用户的自我效能和反应效能分别正向影响用户的绩效期望、努力期望和社会影响；并为医疗健康服务商及 APP 开发运维商提供建议。
An Empirical Study on the Intention of Healthcare Application Usage Based on the PMT [J].https://doi.org/10.3969/j.issn.1008-0821.2016.07.012 URL [本文引用: 1] 摘要
移动医疗发展迅速，医疗健康管理成为研究热点，为了研究用户对健康 APP 的采纳意愿及影响因素。本文从技术视角和健康行为改变视角，基于 UTAUT 理论和 PMT 理论构建用户使用意愿研究模型，通过调查问卷收集数据，并利用 SPSS和 AMOS 进行统计分析和结构方程建模。研究发现：绩效期望、信任感知、社会影响和努力期望依次显著正向影响用户的使用意愿；信任感知正向影响用户的自我效能和反应效能；用户的自我效能和反应效能分别正向影响用户的绩效期望、努力期望和社会影响；并为医疗健康服务商及 APP 开发运维商提供建议。
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| [13] |
A Cognitive Model of the Antecedents and Consequences of Satisfaction Decisions [J].https://doi.org/10.2307/3150499 URL [本文引用: 1] 摘要
Abstract A model is proposed which expresses consumer satisfaction as a function of expectation and expectancy disconfirmation. Satisfaction, in turn, is believed to influence attitude change and purchase intention. Results from a two-stage field study support the scheme for consumers and nonconsumers of a flu inoculation.
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| [14] |
Understanding Information Systems Continuance: An Expectation-Confirmation Model [J].https://doi.org/10.2307/3250921 URL [本文引用: 1] 摘要
This paper examines cognitive beliefs and affect influencing one's intention to continue using (continuance) information systems (IS). Expectation-confirmation theory is adapted from the consumer behavior literature and integrated with theoretical and empirical findings from prior IS usage research to theorize a model of IS continuance. Five research hypotheses derived from this model are empirically validated using a field survey of online banking users. The results suggest that users' continuance intention is determined by their satisfaction with IS use and perceived usefulness of continued IS use. User satisfaction, in turn, is influenced by their confirmation of expectation from prior IS use and perceived usefulness. Post-acceptance perceived usefulness is influenced by users' confirmation level. This study draws attention to the substantive differences between acceptance and continuance behaviors, theorizes and validates one of the earliest theoretical models of IS continuance, integrates confirmation and user satisfaction constructs within our current understanding of IS use, conceptualizes and creates an initial scale for measuring IS continuance, and offers an initial explanation for the acceptance-discontinuance anomaly.
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| [15] |
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| [16] |
微信用户信息共享行为影响因素模型及实证研究——基于信息生态视角的分析 [J].https://doi.org/10.13266/j.issn.0252-3116.2016.15.001 URL [本文引用: 1] 摘要
[目的／意义]针对移动社交媒体的典型工具微信的信息共享行为进行研究，以帮助企业或相关组织更好地利用社交媒体工具开展相关的业务及公共服务。[方法／过程]基于信息生态视角，构建微信用户信息共享行为的影响因素模型，并通过实证研究方法对模型的适用性进行检验。[结果／结论]数据分析结果表明，感知信息有用性、自我效能、信息技术创新性、信息环境交互性四个变量对微信用户信息共享态度产生正向影响，微信用户的信息共享态度对共享行为也产生正向影响。
An Empirical Study of Influence Factors on WeChat User Information Sharing Behavior: Based on the Perspective of Information Ecology [J].https://doi.org/10.13266/j.issn.0252-3116.2016.15.001 URL [本文引用: 1] 摘要
[目的／意义]针对移动社交媒体的典型工具微信的信息共享行为进行研究，以帮助企业或相关组织更好地利用社交媒体工具开展相关的业务及公共服务。[方法／过程]基于信息生态视角，构建微信用户信息共享行为的影响因素模型，并通过实证研究方法对模型的适用性进行检验。[结果／结论]数据分析结果表明，感知信息有用性、自我效能、信息技术创新性、信息环境交互性四个变量对微信用户信息共享态度产生正向影响，微信用户的信息共享态度对共享行为也产生正向影响。
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| [17] |
企业信息生态系统的要素及评价指标构建研究 [J].
<html dir="ltr"><head><title></title></head><body><font style="BACKGROUND-COLOR: #cce8cf">基于生态系统理论分析企业信息生态系统的内涵及特征，从系统构成角度分析企业信息生态系统的基本要素及支撑要素，并给出要素之间的相互作用关系。从企业信息生态系统建设过程角度构建企业信息生态的评价指标，应用群决策方法，结合LWD算子和LOWA算子构建新的综合评价方法，并对企业信息生态评价指标的应用进行算例分析。</font></body></html>
Research of the Elements and Evaluation Index Construction of Enterprise Information Ecological System [J].
<html dir="ltr"><head><title></title></head><body><font style="BACKGROUND-COLOR: #cce8cf">基于生态系统理论分析企业信息生态系统的内涵及特征，从系统构成角度分析企业信息生态系统的基本要素及支撑要素，并给出要素之间的相互作用关系。从企业信息生态系统建设过程角度构建企业信息生态的评价指标，应用群决策方法，结合LWD算子和LOWA算子构建新的综合评价方法，并对企业信息生态评价指标的应用进行算例分析。</font></body></html>
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Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology [J].https://doi.org/10.2307/249008 URL [本文引用: 3] 摘要
Abstract Valid measurement scales for predicting user acceptance of computers are in short supply. Most subjective measures used in practice are unvalidated, and their relationship to system usage is unknown. The present research develops and validates new scales for two specific variables, perceived usefulness and perceived ease of use, which are hypothesized to be fundamental determinants of user acceptance. Definitions for these two variables were used to develop scale items that were pretested for content validity and then tested for reliability and construct validity in two studies involving a total of 152 users and four application programs. The measures were refined and streamlined, resulting in two six-item scales with reliabilities of .98 for usefulness and .94 for ease of use. The scales exhibited high convergent, discriminant, and factorial validity. Perceived usefulness was significantly correlated with both self-reported current usage (r=.63, Study 1) and self-predicted future usage (r =.85, Study 2). Perceived ease of use was also significantly correlated with current usage (r=.45, Study 1) and future usage (r=.59, Study 2). In both studies, usefulness had a significantly greater correlation with usage behavior than did ease of use. Regression analyses suggest that perceived ease of use may actually be a causal antecedent to perceived usefulness, as opposed to a parallel, direct determinant of system usage. Implications are drawn for future research on user acceptance.
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Effort and Accuracy in Choice [J]. |
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Exploring the Determinants of Knowledge Adoption in Virtual Communities: A Social Influence Perspective [J].https://doi.org/10.1016/j.ijinfomgt.2015.02.001 URL [本文引用: 3] 摘要
This study aims to explore the determinants of online knowledge adoption with respect to informational and normative social influences. Existing studies on online knowledge adoption have primarily focused on the perspective of knowledge provider. Knowledge recipients, however, also play a fundamental role in knowledge adoption. Informational and normative social influence theory is utilized as the theoretical foundation to investigate the influences of informational and normative factors on online knowledge adoption. Based on the theories and previous literature, this study proposes a theoretical model of knowledge adoption, in which knowledge quality and source credibility serve as informational determinants, whereas knowledge consensus and knowledge rating serve as normative determinants. In addition, time pressure is hypothesized to be a moderator that impacts the dual evaluation process toward knowledge adoption. Data collected from 510 respondents was tested against the research model using the partial least squares approach. The findings demonstrate that both informational and normative determinants had positive effects on knowledge adoption, while the moderating test indicates that time pressure exerted influences with different directions on the two evaluation processes of adopting behavior. Theoretical and practical contributions are also outlined.
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User Satisfaction with Web-based DSS: The Role of Cognitive Antecedents [J].https://doi.org/10.1016/j.ijinfomgt.2010.10.009 URL Magsci [本文引用: 1] 摘要
Websites play a critical role in attracting customers and providing information to assist Web customers in decision making. Despite the importance of such systems providing a satisfactory experience, as per our knowledge no effort has been made to systematically examine the underlying causal structure among important decision related variables such as perceived effort, perceived information accuracy, perceived effectiveness, and satisfaction using Web-based decision support systems (Web-based DSS) that provide information to potential customers. In this study, we develop a conceptual model for investigating cognitive antecedents to Web users' satisfaction in the context of Web-based DSS. The empirical examination of the research model using structural equations modeling indicates that perceived effectiveness is influenced by perceived information accuracy and effort, and in turn, has positive impact on satisfaction in using Web-based DSS. The implications of this study suggest to information managers that providing customers with highly accurate information from web sites requiring lower effort is perceived as an effective system and such perception leads to increased satisfaction. (C) 2010 Elsevier Ltd. All rights reserved.
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A Protection Motivation Theory of Fear Appeals and Attitude Change [J].https://doi.org/10.1080/00223980.1975.9915803 URL PMID: 28136248 [本文引用: 1] 摘要
Abstract A protection motivation theory is proposed that postulates the three crucial components of a fear appeal to be (a) the magnitude of noxiousness of a depicted event; (b) the probability of that event's occurrence; and (c) the efficacy of a protective response. Each of these communication variables initiates corresponding cognitive appraisal processes that mediate attitude change. The proposed conceptualization is a special case of a more comprehensive theoretical schema: expectancy-value theories. Several suggestions are offered for reinterpreting existing data, designing new types of empirical research, and making future studies more comparable. Finally, the principal advantages of protection motivation theory over the rival formulations of Janis and Leventhal are discussed.
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| [23] |
eHealth Literacy: Essential Skills for Consumer Health in a Networked World [J].https://doi.org/10.2196/jmir.8.2.e9 URL PMID: 1550701 [本文引用: 1] 摘要
Electronic health tools provide little value if the intended users lack the skills to effectively engage them. With nearly half the adult population in the United States and Canada having literacy levels below what is needed to fully engage in an information-rich society, the implications for using information technology to promote health and aid in health care, or for eHealth, are considerable. Engaging with eHealth requires a skill set, or literacy, of its own. The concept of eHealth literacy is introduced and defined as the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. In this paper, a model of eHealth literacy is introduced, comprised of multiple literacy types, including an outline of a set of fundamental skills consumers require to derive direct benefits from eHealth. A profile of each literacy type with examples of the problems patient-clients might present is provided along with a resource list to aid health practitioners in supporting literacy improvement with their patient-clients across each domain. Facets of the model are illustrated through a set of clinical cases to demonstrate how health practitioners can address eHealth literacy issues in clinical or public health practice. Potential future applications of the model are discussed.
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| [24] |
A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions [J].https://doi.org/10.1080/15228830802094429 URL PMID: 0026877 [本文引用: 1] 摘要
Internet-based psychotherapeutic interventions have been used for more than a decade, but no comprehensive review and no extensive meta-analysis of their effectiveness have been conducted. We have collected all of the empirical articles published up to March 2006 (n = 64) that examine the effectiveness of online therapy of different forms and performed a meta-analysis of all the studies reported in them (n = 92). These studies involved a total of 9,764 clients who were treated through various Internet-based psychological interventions for a variety of problems, whose effectiveness was assessed by different types of measures. The overall mean weighted effect size was found to be 0.53 (medium effect), which is quite similar to the average effect size of traditional, face-to-face therapy. Next, we examined interacting effects of various possible relevant moderators of the effects of online therapy, including type of therapy (self-help web-based therapy versus online communication-based etherapy), type of outcome measure, time of measurement of outcome (post-therapy or follow-up), type of problem treated, therapeutic approach, and communication modality, among others. A comparison between face-to-face and Internet intervention as reported on in 14 of the studies revealed no differences in effectiveness. The findings of this meta-analysis, and review of additional Internet therapy studies not included in the meta-analysis, provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity and suggest several insights in regard to its application. Limitations of the findings and recommendations concerning Internet-based therapy and future research are discussed.
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| [25] |
Cost- Effectiveness of Computerised Cognitive-Behavioural Therapy for Anxiety and Depression in Primary Care: Randomised Controlled Trial [J].https://doi.org/10.1192/bjp.185.1.55 URL PMID: 15231556 [本文引用: 1] 摘要
ABSTRACT Cognitive-behavioural therapy (CBT) is effective for treating anxiety and depression in primary care, but there is a shortage of therapists. Computer-delivered treatment may be a viable alternative. To assess the cost-effectiveness of computer-delivered CBT. A sample of people with depression or anxiety were randomised to usual care (n=128) or computer-delivered CBT (n=146). Costs were available for 123 and 138 participants, respectively. Costs and depression scores were combined using the net benefit approach. Service costs were 40 British pounds (90% CI - 28 British pounds to 148 British pounds) higher over 8 months for computer-delivered CBT. Lost-employment costs were 407 British pounds (90% CI 196 British pounds to 586 British pounds) less for this group. Valuing a 1-unit improvement on the Beck Depression Inventory at 40 British pounds, there is an 81% chance that computer-delivered CBT is cost-effective, and it revealed a highly competitive cost per quality-adjusted life year. Computer-delivered CBT has a high probability of being cost-effective, even if a modest value is placed on unit improvements in depression.
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| [26] |
SERVQUAL: A Multiple-Item Scale for Measuring Consumer Perceptions of Service Quality [J].https://doi.org/10.1016/0737-6782(88)90045-8 URL [本文引用: 2] 摘要
The article presents information on the development of SERVQUAL, a 22-item instrument, for assessing customer perceptions of service quality in service and retailing organizations. The conceptual foundation for the SERVQUAL scale was derived from the works of a handful of researchers who have examined the meaning of service quality and from a comprehensive qualitative research study that defined service quality and illuminated the dimensions along which consumers perceive and evaluate service quality. The construct of quality as conceptualized in the services literature and as measured by SERVQUAL, the scale that is the focus of this study, involves perceived quality. Perceived quality is the consumer's judgment about an entity's overall excellence or superiority. It differs from objective quality. It is a form of attitude, related but not equivalent to satisfaction and results from a comparison of expectations with perceptions of performance. SERVQUAL is most valuable when it is used periodically to track service quality trends and when it is used in conjunction with other forms of service quality measurement.
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| [27] |
User Acceptance of Software as a Service: Evidence from Customers of China’s Leading E-Commerce Company, Alibaba [J].https://doi.org/10.1016/j.jss.2013.03.012 URL [本文引用: 1] 摘要
This paper proposes a model with which to analyze the user acceptance of Software as a Service (SaaS). To develop this model, empirical surveys were conducted through four rounds of questionnaires obtained from customers of China's leading e-commerce company, Alibaba. Firstly, based on the data from the first three rounds (1399 respondents), a SaaSQual of operationalizing perceived e-service quality of SaaS was developed, and its four dimensions (ease of use, security, reliability and responsiveness) were identified. Secondly, based on the data from the fourth round (1532 respondents), it was found that the level of three user perceptions (e-service quality, usefulness, and social influence) were predictive of the users behavioral intention to use SaaS, and their direct and indirect influences were tested. This study recommends engineering improvements to SaaS based upon a better understanding of the level of user acceptance of this service.
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| [28] |
Mobile Computing Acceptance Factors in the Healthcare Industry: A Structural Equation Model [J].https://doi.org/10.1016/j.ijmedinf.2006.06.006 URL PMID: 16901749 [本文引用: 1] 摘要
This paper presents a revised technology acceptance model to examine what determines mobile healthcare systems (MHS) acceptance by healthcare professionals.Conformation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique was used to evaluate the causal model.The results indicated that compatibility, perceived usefulness and perceived ease of use significantly affected healthcare professional behavioral intent. MHS self-efficacy had strong indirect impact on healthcare professional behavioral intent through the mediators of perceived usefulness and perceived ease of use. Yet, the hypotheses for technical support and training effects on the perceived usefulness and perceived ease of use were not supported.This paper provides initial insights into factors that are likely to be significant antecedents of planning and implementing mobile healthcare to enhance professionals' MHS acceptance. The proposed model variables explained 70% of the variance in behavioral intention to use MHS; further study is needed to explore extra significant antecedents of new IT/IS acceptance for mobile healthcare. Such as privacy and security issue, system and information quality, limitations of mobile devices; the above may be other interesting factors for implementing mobile healthcare and could be conducted by qualitative research.
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| [29] |
Network Externalities, Competition, and Compatibility [J]. |
| [30] |
The Effect of Network Externality on Mobile Social Network Site Continuance [J].https://doi.org/10.1108/PROG-10-2014-0078 URL [本文引用: 4] 摘要
ABSTRACT Purpose – The purpose of this paper is to examine the effect of network externality on users’ continuance of mobile social network sites (SNS). Design/methodology/approach – Based on the 230 valid responses collected from a survey, structural equation modeling was employed to examine the research model. Findings – The results indicated that network externality, which includes referent network size and perceived complementarity, has a significant effect on perceived usefulness and flow. Privacy concern affects perceived usefulness, flow and privacy risk. These three factors determine continued use. Originality/value – Previous research has focussed on the effects of motivations such as perceived value on user adoption of SNS. The effect of network externality on user continuance has seldom been examined. This research tries to fill the gap.
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| [31] |
Modeling the Continuance Usage Intention of Online Learning Environments [J].https://doi.org/10.1016/j.chb.2016.02.066 URL [本文引用: 3] 摘要
This study focused on the continuance usage intention toward online learning environments and also proposed and empirically tested an integrated model to better understand the determinants of students’ continuance intention to use these environments. For this purpose, variables which may have an effect on the continuance usage intention were examined and an “online continuance usage intention model” was revealed. When the variables of the hypothetical model were determined, Technology Continuance Theory, Information Systems Success Model, Cognitive Model and Information Systems Expectation Confirmation Model have been practiced on. Empirical data from 467 public university students who had used an online learning environment for the first time were tested against the proposed research model by using path analysis. The results indicated that, confirmation of the usage of online learning environments could be explained by information quality, system quality and service quality variables. 63% of the variance of the satisfaction variable was explained by information quality, system quality, service quality, confirmation, utilitarian value, outcome expectations and perceived value. Research results confirmed the propounded constructs of Information Systems Success Model and Information Systems Expectation Confirmation Model. In line with the obtained findings and results, some of the various suggestions were provided for the next studies and implementations.
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| [32] |
Examining an Extended Duality Perspective Regarding Success Conditions of IT Service [J].https://doi.org/10.1016/j.ijinfomgt.2015.11.012 URL [本文引用: 1] 摘要
IS research predominantly presumes that the success factors of IT service have one-dimensional influences: the higher (or lower), the better. Sporadic arguments, however, have been made that, depending on the antecedent, such a monolithic premise may not sustainable. Despite the rich evidence of the dichotomous role of success factors on measured consequences in non-IS fields, especially in the marketing discipline, theoretical and empirical efforts to examine this duality have received limited attention in IS research. Especially, no previous IS study took the extended duality position in which the role of success conditions can be any of pure enabler , pure inhibitor , asymmetric bi-directional influencer or symmetric bi-directional influencer . The extended duality becomes the theoretical thesis of this research, setting it apart from the scant IS research that viewed duality through the rather simplified lens of statistical significance in each direction. To test the validity of the extended duality theory in the IT service context, cross-sectional survey data were gathered on post-adoption usage of mobile data services (or MDS), the most prevalent form of IT service. Frequently used success conditions of IT service system quality, information quality, economic value and self-efficacy are chosen as the explanatory variables. The analysis suggests that success conditions of IT service can have a highly divergent and diversified form of duality effects on measured outcomes. The findings have important practical and theoretical implications to practitioners and researchers.
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| [33] |
Fear Appeals and Information Security Behaviors: An Empirical Study [J].https://doi.org/10.1515/libr.2010.017 URL [本文引用: 1] 摘要
ABSTRACT Information technology executives strive to align the actions of end users with the desired security posture of management and of the firm through persuasive communication. In many cases, some element of fear is incorporated within these communications. However, within the context of computer security and information assurance, it is not yet clear how these fear-inducing arguments, known as fear appeals, will ultimately impact the actions of end users. The purpose of this study is to investigate the influence of fear appeals on the compliance of end users with recommendations to enact specific individual computer security actions toward the mitigation of threats. An examination was performed that culminated in the development and testing of a conceptual model representing an infusion of technology adoption and fear appeal theories. Results of the study suggest that fear appeals do impact end user behavioral intentions to comply with recommended individual acts of security, but the impact is not uniform across all end users. It is determined in part by perceptions of self-efficacy, response efficacy, threat severity, and social influence. The findings of this research contribute to information systems security research, human-computer interaction, and organizational communication by revealing a new paradigm in which IT users form perceptions of the technology, not on the basis of performance gains, but on the basis of utility for threat mitigation.
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| [34] |
Understanding the Acceptance of Mobile Health Services: A Comparison and Integration of Alternative Models [J].https://doi.org/10.1108/10662241311331781 URL Magsci [本文引用: 1] 摘要
The advancement of mobile technology and the increasing importance of health promote the boom in mobile health services (MHS) around the world. Although there have been several studies investigating the health technology acceptance behavior from a variety of theoretical perspectives, they have not provided a unified understanding. To fill this research gap, this paper: (1) reviews the health technology acceptance literature and discusses three prominent models (e. g., the technology acceptance model, the theory of planned behavior or the unified theory of use and acceptance of technology, and the protection motivation theory), (2) empirically compares the three models, and (3) formulates and empirically validates the unified model in the context of mobile health services. In the unified model of health technology acceptance, we propose that users' intention to use mobile health services is determined by five key factors: performance expectancy, effort expectancy, social influence, facilitating conditions, and threat appraisals. The results show that the unified model outperforms the three alternative models by significantly improving the R-squares. Finally, the implications for theory and practice are put forward.
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| [35] |
eHEALS: The eHealth Literacy Scale [J].https://doi.org/10.2196/jmir.8.4.e27 URL PMID: 17213046 [本文引用: 1] 摘要
Electronic health resources are helpful only when people are able to use them, yet there remain few tools available to assess consumers' capacity for engaging in eHealth. Over 40% of US and Canadian adults have low basic literacy levels, suggesting that eHealth resources are likely to be inaccessible to large segments of the population. Using information technology for health requires eHealth literacy-the ability to read, use computers, search for information, understand health information, and put it into context. The eHealth Literacy Scale (eHEALS) was designed (1) to assess consumers' perceived skills at using information technology for health and (2) to aid in determining the fit between eHealth programs and consumers.The eHEALS is an 8-item measure of eHealth literacy developed to measure consumers' combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. The objective of the study was to psychometrically evaluate the properties of the eHEALS within a population context. A youth population was chosen as the focus for the initial development primarily because they have high levels of eHealth use and familiarity with information technology tools.Data were collected at baseline, post-intervention, and 3- and 6-month follow-up using control group data as part of a single session, randomized intervention trial evaluating Web-based eHealth programs. Scale reliability was tested using item analysis for internal consistency (coefficient alpha) and test-retest reliability estimates. Principal components factor analysis was used to determine the theoretical fit of the measures with the data.A total of 664 participants (370 boys; 294 girls) aged 13 to 21 (mean = 14.95; SD = 1.24) completed the eHEALS at four time points over 6 months. Item analysis was performed on the 8-item scale at baseline, producing a tight fitting scale with alpha = .88. Item-scale correlations ranged from r = .51 to .76. Test-retest reliability showed modest stability over time from baseline to 6-month follow-up (r = .68 to .40). Principal components analysis produced a single factor solution (56% of variance). Factor loadings ranged from .60 to .84 among the 8 items.The eHEALS reliably and consistently captures the eHealth literacy concept in repeated administrations, showing promise as tool for assessing consumer comfort and skill in using information technology for health. Within a clinical environment, the eHEALS has the potential to serve as a means of identifying those who may or may not benefit from referrals to an eHealth intervention or resource. Further research needs to examine the applicability of the eHEALS to other populations and settings while exploring the relationship between eHealth literacy and health care outcomes.
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| [36] |
Determinants of Adoption of Smartphone Health Apps among College Students [J].https://doi.org/10.5993/AJHB.38.6.8 URL PMID: 25207512 Magsci [本文引用: 2] 摘要
Objective: To examine the effects of cognitive and contingent factors on the adoption of smartphone health apps, focusing on the technology acceptance model (TAM). Methods: American college students (N = 422), who currently owned smartphones but were not using health apps, completed an online survey. Results: Results from a path analysis mostly supported the proposed hypotheses, showing that subjective norm, health consciousness, health information orientation, and Internet health information use efficacy significantly affected the main components of TAM. Conclusion: Study findings provide scholars and practitioners with an empirical model of explaining the cognitive and micro-mechanisms of determining the adoption of health apps, especially among younger populations.
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