A Study of the Middle-aged and Elderly Patients Switching Intention Towards Cloud Healthcare

由於台灣人口老年化之趨勢，加上慢性病的危害，使得電子照護系統的需求提高。台灣遠距照護推動已經有一段時間，近年來雲端運算 (Cloud Computing)的興起，透過醫療雲結合原有的遠距照護，藉由行動裝置，幫助慢性病患者自我健康管理，並在熟悉的社區及居家環境中，就能獲得健康照護與預防保健服務。由於多數中老年人對於新科技的接受度較低，故本研究用以探討中老年病患對於雲端照護的轉換意圖。首先以Push Pull Mooring (PPM) 模型為架構，納入影響變數包含: 「不方便性」、「隱私及安全性」、「習慣性」、「不確定性」、「無所不在的照護」、「回應性」，並根據此六因素設計問卷。本研究針對有使用過遠距照護之病患為受訪對象，依據他們以往的使用經驗與雲端照護之認知，找出真正會影響他們意圖轉換使用雲端照護之推力、拉力及躊躇因子。透過分析結果顯示，三項因子及躊躇因子與推力效果間對中老年病患轉換使用雲端照護皆有顯著之影響。然而，躊躇因子與拉力效果間對中老年病患轉換意圖卻沒有顯著的影響關係。本研究以傳統醫療之推力、雲端醫療之拉力、病患躊躇因子三項觀點，探討中老年病患轉換使用雲端照護之意圖。雲端醫療可解決偏遠地區病患就醫之不便，對於慢性病患者，也可提供居家及社區型服務，如能廣泛受到病患接受，將能達到更好的醫療成效。預期研究成果可供醫療照護業者多方面的參考，並有助於設計出符合中老年病患需求之醫療模式。Due to the formation of ageing society, the demand of electronic healthcare is rising. “Cloud healthcare” is a system which combines healthcare with cloud computing, it enables older people with chronic illnesses to live independently and have easy access to healthcare services. For middle-aged and elderly people, they are not familiar with most of new technologies because of their acceptance of new technology is low. To investigate their switching intention has assumed a new importance in recent year, this study uses push pull mooring (PPM) model to analyze middle-aged and elderly patients’ switching intention. This PPM model consists of 6 variables: “Inconvenience”, “Low privacy and security”, “Habit”, “Uncertainty”, “Ubiquitous care” and “Responsiveness”. According to these variables, the author develops questionnaires and the respondents are asked to have used telehealthcare. The results show that push effect, mooring effect and pull effect have a significant direct effect on patients’ switching intention. Also, the mooring effect has a significant direct effect on the relationship between push effect and switching intentions. On the other hand, the mooring effect does not have significant direct influence on the relationship between pull effect and switching intentions. It will be convenient for patients, especially in remote areas, to use cloud healthcare. Cloud healthcare can improve medical efficiency and quality, so that the author hopes to find the factors that affect these patients’ switching intention. These findings will serve as a reference for healthcare industry.誌謝…………………...…………………………………………………..i 摘要…………………...………………………………………………….ii ABSTRCT…..…………...………………………………………………iii CONTENT…..…………...……………………………………………...iv LIST OF TABLE…..…………...………………………………………..vi LIST OF FIGURES..…………...……………………………………….vii Chapter 1 Introduction…………….…………………………………...1 1.1. Background and Motivation………….. ………………………..1 1.2. Objectives…………..………………………………….………..2 1.3. Organizations…………………………..………………………..3 Chapter 2 Literature Review…………………………………………...4 2.1. Cloud Computing…………………….. ………………………..4 2.2. The Development of Taiwan Cloud Healthcare……….………..7 2.2.1 Telehealthcare……………………………………………..7 2.2.2 Cloud Healthcare………………………………………….9 2.2.3 Cloud Healthcare Management Model in Taiwan……….10 2.3. Migration……….…………………….. ………………………12 2.4. PPM Model…………………………………………….………12 Chapter 3 Research Model and Hypotheses………………...…….....14 3.1. Introduction…………………………... ………………………14 3.2. Push effects…………………………………………….………14 3.3. Mooring effects………………………………………………...15 3.4. Pull effects…………………………………………….……….17 3.5. Moderating effects of mooring….…………………….……….18 Chapter 4 Research Methodology and Analysis…..………...…….....19 4.1. Research Design……………………… ………………………19 4.2. Data Analysis……….………………………………….………22 4.3. Demographics………………………………………………….22 4.4. Results……...………………………………………………….23 4.4.1 Testing the measurement model………………………….23 4.4.2 Testing the structural model…………..………………….26 Chapter 5 Discussion………………………………..………...…….....28 5.1. Findings and implications……………. ……………………….28 Chapter 6 Conclusions……………………………...………...…….....30 6.1. Conclusions…………………………... ………………………30 6.2. Research Limitations and Future Work….…………….………30 Reference……………………………………………………………….31 Appendix……………………………………………………………….37 LIST OF TABLES Table 1.1: The Top Ten Causes of Death of 2010 in Taiwan………...1 Table 2.1: Bogue’s Push and Pull Factors in Migration……………12 Table 4.1: Questionnaire items………………………………..……20 Table 4.2: Demographics……….……………………………..……23 Table 4.3: Convergent validity………………………………..……24 Table 4.4: Cross loading matrix…..…………………………..……25 Table 4.5: Structural model result...…………………………..……27 LIST OF FIGURES Figure 1.1: Thesis Organization chart……………………...………..3 Figure 2.1: The Cloud Definition Framework……………...………..4 Figure 2.2: The Service Model of Taiwan Pilot Telecare Project..…..8 Figure 2.3: The Cloud Healthcare Model…...……………...………..9 Figure 3.1: Research model………………………………...………14 Figure 4.1: Model testing results…………………………...………26 Figure 4.2: Comparison model: independent direct effect....………27 LIST OF PHOTOS Photo 2.1: Diabetes e Institute in Changhua Christian Hospital...…10 Photo 2.2: e- Care application……………………………...………10 Photo 2.3: Mobile device and Bluetooth blood sugar machine.....…1