From health to e-health : understanding citizens' acceptance of online health care

In light of the challenges arising from an ageing population and runaway health-care costs, e-health offers tremendous opportunities for public and private health-care providers worldwide to optimize service delivery and enhance the quality of care being provided to patients. Even though the potential of e-health is acknowledged in academia as well as among practitioners, its application has proven to be remarkably difficult. In order for e-health to be successful, it is imperative that it offers services which address the needs of citizens and patients. Academia has recognized the importance of research on e-health adoption, but it focused mainly on organizational adoption and technological advances while it neglected the perspectives of health-care consumers. The purpose of this study was to investigate citizens' acceptance of e-health services by identifying the determinants of their intention to use e-health in the future. This knowledge of citizens' attitudes and needs is crucial to health-care managers who wish to pursue successful e-health initiatives. Through an extensive review of the literature and some initial exploratory fieldwork, factors relevant to citizens' acceptance of e-health were identified. Based on those determinants, a citizen survey was developed that collected the perceptions and attitudes of Swedish citizens towards the use of two Swedish e-health services: the online health guide and the ask-the-doctor online service. This investigation leads to the proposal of the e-Health Acceptance Model (eHAM), a theoretical framework that helps to understand and predict citizens' acceptance of online health care. This study demonstrates that awareness of the existence of such e-health services among Swedish citizens remains rather low despite the fact that the general attitude towards using e-health is quite positive. This emphasizes the importance of making citizens aware of the e-health alternatives available to them. The study finds that citizens' intention to use e-health is determined primarily by their attitude towards using e- health, which in turn results from the overall compatibility of e-health with citizens' needs, its perceived usefulness, and the risks associated with e-health usage. Offering clarity to the discrepancy and doubt about the role of the attitude construct that persisted in previous research, attitude here constitutes a strong mediator, capturing the majority of the effects of behavioral beliefs on usage intentions. Along with attitude, the perceived accessibility of e-health affects directly citizens' intention to use e-health in the future. In contrast to earlier assumptions and empirical findings, the key TAM determinant perceived ease of use, as well as the social influence construct subjective norm that is regarded as crucial in predicting social behavior, did not demonstrate any major effect on citizens' intention to use e-health. The technological advances required for e-health are available today, and citizens are generally positive about such developments in health-care service delivery. However, the adoption of innovations, new technologies, and services takes time, since changing people's habits is not an easy task. Thus, for the time being, it is important to view e-health as a powerful complement rather than a substitute for traditional channels. Not everyone is e-ready at this point, but the potential is there. The findings of this study highlight the critical role of communication. Citizens must be made aware of the service alternatives available to them as well as the advantages their use can bring. Uncertainty and hesitancy can be mitigated and adoption propelled by implementing risk-reducing measures and design features, and communicating those actions to citizens. The overall effort will be enhanced by ensuring information quality and strengthening provider- citizen relationships.Godkänd; 2008; 20081120 (ysko