Predictors of Health Care Practitioners' Intention to Use AI-Enabled Clinical Decision Support Systems: Meta-Analysis Based on the Unified Theory of Acceptance and Use of Technology.

BACKGROUND: Artificial intelligence-enabled clinical decision support systems (AI-CDSSs) offer potential for improving health care outcomes, but their adoption among health care practitioners remains limited. OBJECTIVE: This meta-analysis identified predictors influencing health care practitioners' intention to use AI-CDSSs based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Additional predictors were examined based on existing empirical evidence. METHODS: The literature search using electronic databases, forward searches, conference programs, and personal correspondence yielded 7731 results, of which 17 (0.22%) studies met the inclusion criteria. Random-effects meta-analysis, relative weight analyses, and meta-analytic moderation and mediation analyses were used to examine the relationships between relevant predictor variables and the intention to use AI-CDSSs. RESULTS: The meta-analysis results supported the application of the UTAUT to the context of the intention to use AI-CDSSs. The results showed that performance expectancy (r=0.66), effort expectancy (r=0.55), social influence (r=0.66), and facilitating conditions (r=0.66) were positively associated with the intention to use AI-CDSSs, in line with the predictions of the UTAUT. The meta-analysis further identified positive attitude (r=0.63), trust (r=0.73), anxiety (r=-0.41), perceived risk (r=-0.21), and innovativeness (r=0.54) as additional relevant predictors. Trust emerged as the most influential predictor overall. The results of the moderation analyses show that the relationship between social influence and use intention becomes weaker with increasing age. In addition, the relationship between effort expectancy and use intention was stronger for diagnostic AI-CDSSs than for devices that combined diagnostic and treatment recommendations. Finally, the relationship between facilitating conditions and use intention was mediated through performance and effort expectancy. CONCLUSIONS: This meta-analysis contributes to the understanding of the predictors of intention to use AI-CDSSs based on an extended UTAUT model. More research is needed to substantiate the identified relationships and explain the observed variations in effect sizes by identifying relevant moderating factors. The research findings bear important implications for the design and implementation of training programs for health care practitioners to ease the adoption of AI-CDSSs into their practice.

Factors Associated with Intention to Use Telerehabilitation for Children with Special Needs: A Cross-Sectional Study.

Background: Children with special health care needs (CSHCN) require long-term and ongoing rehabilitation interventions supporting their development. Telerehabilitation can provide continuous rehabilitation services for CSHCN. However, few studies have explored the intention of CSHCN and their caregivers to use telerehabilitation and its impact on them. Objective: The objective of this study was to identify factors that influence the intention to use telerehabilitation among CSHCN and their caregivers. Methods: This study was a cross-sectional study. Based on the unified theory of acceptance and use of technology, extended with additional predictors (trust and perceived risk [PR]), this study developed a research model and proposed 10 hypotheses. A structured questionnaire was distributed to 176 caregivers. Data were analyzed and research hypotheses were tested using partial least squares structural equation modeling to better understand the factors influencing the use of telerehabilitation. Results: A total of 164 valid questionnaires were collected. CSHCN and their caregivers were overall satisfied with this telerehabilitation medical service. The results of the structural model analysis indicated that social influence (SI), facilitating conditions (FC), and trust had significant effects on behavioral intention (BI) to use telerehabilitation, while the paths between performance expectancy (PE), effort expectancy (EE), and PR and BI were not significant. PE, EE, and SI had a significant effect on trust. Moreover, EE and SI had indirect effects on BI, with trust as the mediator. Conclusions: The results indicated that SI, FC, and trust are significant factors influencing CSHCN and their caregivers' use of telerehabilitation. Trust is also an important mediator for the intention and highly influenced by PE, EE, and SI.

Investigating Factors Influencing Medical Practitioners' Resistance to and Adoption of Internet Hospitals in China: Mixed Methods Study.

BACKGROUND: The swift shift toward internet hospitals has relied on the willingness of medical practitioners to embrace new systems and workflows. Low engagement or acceptance by medical practitioners leads to difficulties in patient access. However, few investigations have focused on barriers and facilitators of adoption of internet hospitals from the perspective of medical practitioners. OBJECTIVE: This study aims to identify both enabling and inhibiting predictors associated with resistance and behavioral intentions of medical practitioners to use internet hospitals by combining the conservation of resources theory with the Unified Theory of Acceptance and Use of Technology and technostress framework. METHODS: A mixed methods research design was conducted to qualitatively identify the factors that enable and inhibit resistance and behavioral intention to use internet hospitals, followed by a quantitative survey-based study that empirically tested the effects of the identified factors. The qualitative phase involved conducting in-depth interviews with 16 experts in China from June to August 2022. Thematic analysis was performed using the qualitative data analysis software NVivo version 10 (QSR International). On the basis of the findings and conceptual framework gained from the qualitative interviews, a cross-sectional, anonymous, web-based survey of 593 medical practitioners in 28 provincial administrative regions of China was conducted. The data collected were analyzed using the partial least squares method, with the assistance of SPSS 27.0 (IBM Corp) and Mplus 7.0 (Muthen and Muthen), to measure and validate the proposed model. RESULTS: On the basis of qualitative results, this study identified 4 facilitators and inhibitors, namely performance expectancy, social influence, work overload, and role ambiguity. Of the 593 medical practitioners surveyed in the quantitative research, most were female (n=364, 61.4%), had a middle title (n=211, 35.6%) or primary title (n=212, 35.8%), and had an average use experience of 6 months every year. By conducting structural equation modeling, we found that performance expectancy (ß=-.55; P<.001) and work overload (ß=.16; P=.005) had the most significant impact on resistance to change. Resistance to change fully mediated the influence of performance expectancy and partially mediated the influences of social influence (variance accounted for [VAF]=43.3%; P=.002), work overload (VAF=37.2%; P=.03), and role ambiguity (VAF=12.2%; P<.001) on behavioral intentions to use internet hospitals. In addition, this study found that the sex, age, professional title, and use experience of medical practitioners significantly moderated the aforementioned influencing mechanisms. CONCLUSIONS: This study investigated the factors that facilitate or hinder medical practitioners' resistance to change and their behavioral intentions to use internet hospitals. The findings suggest that policy makers avoid the resistance and further promote the adoption of internet hospitals by ensuring performance expectancy and social influence and eliminating work overload and role ambiguity.

Applying the UTAUT2 Model to Smart Eyeglasses to Detect and Prevent Falls Among Older Adults and Examination of Associations With Fall-Related Functional Physical Capacities: Survey Study.

BACKGROUND: As people age, their physical capacities (eg, walking and balance) decline and the risk of falling rises. Yet, classic fall detection devices are poorly accepted by older adults. Because they often wear eyeglasses as they go about their daily activities, daily monitoring to detect and prevent falls with smart eyeglasses might be more easily accepted. OBJECTIVE: On the basis of the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), this study evaluated (1) the acceptability of smart eyeglasses for the detection and prevention of falls by older adults and (2) the associations with selected fall-related functional physical capacities. METHODS: A total of 142 volunteer older adults (mean age 74.9 years, SD 6.5 years) completed the UTAUT2 questionnaire adapted for smart eyeglasses and then performed several physical tests: a unipodal balance test with eyes open and closed, a 10-m walk test, and a 6-minute walk test. An unsupervised analysis classified the participants into physical performance groups. Multivariate ANOVAs were performed to identify differences in acceptability constructs according to the performance group. RESULTS: The UTAUT2 questionnaire adapted for eyeglasses presented good psychometric properties. Performance expectancy (ß=.21, P=.005), social influence (ß=.18, P=.007), facilitating conditions (ß=.17, P=.04), and habit (ß=.40, P<.001) were significant contributors to the behavioral intention to use smart eyeglasses (R²=0.73). The unsupervised analysis based on fall-related functional physical capacities created 3 groups of physical performance: low, intermediate, and high. Effort expectancy in the low performance group (mean 3.99, SD 1.46) was lower than that in the other 2 groups (ie, intermediate: mean 4.68, SD 1.23; high: mean 5.09, SD 1.41). Facilitating conditions in the high performance group (mean 5.39, SD 1.39) were higher than those in the other 2 groups (ie, low: mean 4.31, SD 1.68; intermediate: mean 4.66, SD 1.51). CONCLUSIONS: To our knowledge, this study is the first to examine the acceptability of smart eyeglasses in the context of fall detection and prevention in older adults and to associate acceptability with fall-related functional physical capacities. The older adults with higher physical performances, and possibly lower risks of falling, reported greater acceptability of smart eyeglasses for fall prevention and detection than their counterparts exhibiting low physical performances.

Intentions of Patients With Cancer and Their Relatives to Use a Live Chat on Familial Cancer Risk: Results From a Cross-Sectional Web-Based Survey.

BACKGROUND: An important prerequisite for actively engaging in cancer prevention and early detection measures, which is particularly recommended in cases of familial cancer risk, is the acquisition of information. Although a lot of cancer information is available, not all social groups are equally well reached because information needs and communicative accessibility differ. Previous research has shown that a live chat service provided by health professionals could be an appropriate, low-threshold format to meet individual information needs on sensitive health topics such as familial cancer risk. An established German Cancer Information Service is currently developing such a live chat service. As it is only worthwhile if accepted by the target groups, formative evaluation is essential in the course of the chat service's development and implementation. OBJECTIVE: This study aimed to explore the acceptance of a live chat on familial cancer risk by patients with cancer and their relatives (research question [RQ] 1) and examine the explanatory power of factors associated with their intentions to use such a service (RQ2). Guided by the Extended Unified Theory of Acceptance and Use of Technology (UTAUT2), we examined the explanatory power of the following UTAUT2 factors: performance expectancy, effort expectancy, social influence, facilitating conditions, and habit, supplemented by perceived information insufficiency, perceived susceptibility, perceived severity, and cancer diagnosis as additional factors related to information seeking about familial cancer. METHODS: We conducted a cross-sectional survey via a German web-based access panel in March 2022 that was stratified by age, gender, and education (N=1084). The participants are or have been diagnosed with cancer themselves (n=144) or have relatives who are or have been affected (n=990). All constructs were measured with established scales. To answer RQ1, descriptive data (mean values and distribution) were used. For RQ2, a blockwise multiple linear regression analysis was conducted. RESULTS: Overall, 32.7% of participants were (rather) willing, 28.9% were undecided, and 38.4% were (rather) not willing to use a live chat on familial cancer risk in the future. A multiple linear regression analysis explained 47% of the variance. It revealed that performance expectancy, social influence, habit, perceived susceptibility, and perceived severity were positively associated with the intention to use a live chat on familial cancer risk. Effort expectancy, facilitating conditions, information insufficiency, and cancer diagnosis were not related to usage intentions. CONCLUSIONS: A live chat seems promising for providing information on familial cancer risk. When promoting the service, the personal benefits should be addressed in particular. UTAUT2 is an effective theoretical framework for explaining live chat usage intentions and does not need to be extended in the context of familial cancer risk.

Exploring factors that influence the behavioural intention of medical students to use 3D gastroscopic model to learn how to operate gastroscope using UTAUT Model.

BACKGROUND: The application of virtual reality (VR) in gastroscopic operation teaching can be safe and effective, but the advantages can be realized only when students accept and use it. This study aims to identify the factors influencing Chinese clinical medical postgraduates on their intention to use the 3D gastroscopic model constructed based on VR technology using Unified Theory of Acceptance and Use of Technology (UTAUT) model. Students' demographic factors are also taken into consideration. METHODS: All methods were carried out in accordance with relevant guidelines. Data were collected from clinical medical postgraduates students in China using stratified sampling. A total of 292 questionnaires including valid responses were used in this study. Data were processed using Amos 24.0 and SPSS 26.0 software and the statistical analysis technique was based on structural equation modeling (SEM). RESULTS: The results showed that different from the mediator of home location and year of clinical learning, mediator of gender, university kind and graduate degree did not affect the behavioral intention. In addition, performance expectancy, facilitating condition, and social influence directly and indirectly have effect on behavioral intention. Also, the significance between social influence and performance expectancy, social influence and effort expectancy were verified. CONCLUSIONS: This study manifested that the proposed framework based on the UTAUT had explanatory power to identify the factors influencing the students' behavioral intention to use the 3D gastroscopic model constructed based on VR technology. Whereas, an important variable of effort expectancy in the frame of the SEM were not certified, thereby indicating that particular attention should be paid to this variable by universities and teachers before applying 3D gastroscopic model constructed based on VR technology in teaching. Added preparatory work is required such as explaining the basic knowledge of the operating steps of VR model and make students adequately understand its accessibility, which can probably improve the intentions of them to use it. The positive effects of social influence on performance expectancy and effort expectancy we proposed was also verified in this study, which provided a direction for future research.

Evaluation of the psychometric properties of the Youth Psychopathic Traits Inventory-Short Version among young people in South Africa and the relationship of high scale scores to reported offending or similar deviant behaviour.

BACKGROUND: While there is empirical evidence to support associations between psychopathy scale ratings and offending or deviant behaviours, suggested as support for a unified theory of crime, evidence to date has been mainly from countries with high economic ratings and Western philosophies. In countries with a wide range of cultural groups and languages and a complex history of colonisation and apartheid, such scale ratings and correlations may differ. AIMS: To explore the psychometric properties of the Youth Psychopathic Traits Inventory-Short Version (YPI-S) and its applicability and relationship to deviant and actual or potential criminal behaviour among young adults in South Africa. METHODS: 18- to 20-year-olds from poor socio-economic backgrounds were recruited by a fieldworker with an existing relationship with community-based youth centres. Consenting participants completed the Deviant Behaviour Variety Scale, reflecting criminal or similar behaviours in the 12 months prior to rating and the YPI-S. Reliability measurements, principal factor analysis, Spearman's Rho correlations, chi square and multiple regression were used to explore performance of the YPI-S in this sample and relationship of YPI-S scores to deviancy. RESULTS: Of the 213 participants recruited, 176 completed all data points and were entered into analyses. The YPI-S was found to have generally good psychometric properties; however, in factor analysis, while items mapped well into an emotional subscale and quite well into an interpersonal scale, as in the original, behavioural items did not. Emotional, interpersonal and total YPI-S scores were significantly associated with reported deviant behaviour scores. CONCLUSION: The findings of this study suggest value in using the YPI-S with young people in South Africa to help identify those vulnerable to committing criminal acts. Among these disadvantaged young people, however, caution should be used in interpreting scores on its behavioural dimension. It is interesting that the emotional dimension, which incorporates perhaps the most personal features such as 'callous and unemotional traits' (albeit probably better considered as difficulty in recognising emotions in others), seemed most robust, suggesting that there may be core problems in a pathway to crime-or theory of crime-that transcend culture. This possibility, likely to be remediable through personal interventions, would benefit from further investigation.

The adoption of remote work platforms after the Covid-19 lockdown: New approach, new evidence.

With the aim of providing further insights into the driving factors influencing behavioral intentions and expectations to use remote work after the Covid-19 lockdown, this study draws on an enhanced version of the technology acceptance model to analyze the determinants and moderating factors of remote work platform use. From an analysis of quantitative data collected from questionnaires and qualitative data from interviews with employees of Chinese firms in the service sector, we conclude that post-lockdown adoption of remote work is explained by three main variables: behavioral intention, behavioral expectation and facilitating conditions, but demographic characteristics and factors related to the specific features of remote work all nevertheless moderate the relationships in our model. In addition to gender, the generational gap and behavioral tendency should be taken into consideration to improve employee acceptance rates.

Customer perception and acceptance of autonomous delivery vehicles in the State of Kuwait during COVID-19.

COVID-19 is one of the most important dilemmas that took place during the last few years. Logisticians worked hard to present a new mechanism called Autonomous Delivery Vehicles (ADVs) by which they afford help making life easier for people during pandemic while trying to reduce pollution on road as well. This work mainly aimed to explore Unified Theory of Acceptance and Use of Technology (UTAUT2) and the convenience of users - according to gender - to the idea of using Autonomous Delivery Vehicles (ADVs). A survey-based method was applied and presented. It was distributed online where a total of 450 participants had taken part to express their ideas. Structural Equation Modeling (SEM) was used to analyze the data and the results were discussed thoroughly. The model was conducted according to nine hypotheses. Results showed that all of them were supported except hypothesis 7, which is the trust in technology that negatively influenced the perceived risk leading to rejecting the hypothesis that supposes the validity of H7. It was concluded that the perceived risk and behavioral intention relationship were only significant for males while the perceived risk and trust in technology relationship were only significant for females.

Acceptability of Health Information Exchange and Patient Portal Use in Depression Care Among Underrepresented Patients.

BACKGROUND: Depression is often untreated or undertreated, particularly among underrepresented groups, such as racial and ethnic minorities, and individuals of lower socioeconomic status. Electronic health information exchange (HIE) is a recommended practice to improve care coordination and encourage patient engagement in services, but it remains underutilized in depression care. Understanding factors affecting acceptance and adoption of this technology among underrepresented patient populations is needed to increase dissemination of HIE within mental health treatment. OBJECTIVE: The present study aims to identify patient barriers and facilitators towards the acceptance of HIE within the context of depression treatment and to examine how HIE impacts depression-related care coordination and patient activation. DESIGN: Semi-structured qualitative interviews were conducted with 27 patients. PARTICIPANTS: Respondents were English-speaking adults (> 18) receiving depression treatment within a large, safety-net primary care clinic. APPROACH: A grounded theory approach was used to code and analyze data for emergent themes. Thematic analysis was guided by the Unified Theory of Acceptance and Use of Technology, a leading informatics theory used to predict end-user adoption of technology. KEY RESULTS: Respondents reported that HIE made depression care more convenient, transparent, and trustworthy. Though respondents desired greater access to their health records, stigma surrounding depression inhibited acceptance of electronic communication and information sharing. Confusing electronic interface also diminished perceived benefits of HIE. CONCLUSION(S): Respondents desire greater transparency in their depression care. While HIE was perceived to improve the overall quality of depression care, stigma associated with mental illness undermined more robust adoption of this technology among underserved populations.

Hormesis: A General Biological Principle.

Hormesis drives biological modifications from cells to higher levels of biological organization and emerges as a general basic principle of biology, integrating evolution, ecology, medicine, physiology, toxicology, and public health.

Massive open online course adoption amongst newly graduated health care providers.

Massive Open Online Courses (MOOCs) are flexible offerings that deliver content to a large audience in a virtual platform. MOOCs are increasingly accessed by health professionals to support their own professional development. Despite the agreed usefulness of MOOCs, the rates of adoption are still extremely low. This study sought to understand the personal and social factors associated with MOOC adoption. Participants were newly graduated occupational therapists who registered for a leadership skills development MOOC. Qualitative interviews were conducted to understand unique perspectives of participants who did and did not complete the MOOC. Data were analyzed using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. Participants reported they found the MOOC content beneficial in providing a foundational framework on which to develop their leadership skills. Even though MOOC content was organized into multiple small components, participants shared that they would engage with the material once a week for up to two hours. Participants reported a high level of comfort accessing the technology to complete the MOOC, however they reported that they would have preferred more interactive or synchronous learning opportunities. MOOCs are an efficient way to offer a wide variety of educational offerings to health professionals. Despite their asynchronous nature, MOOC developers should consider maximizing opportunities for learner interaction and content application learning opportunities within MOOCs to increase their overall adoption.

Remote learning via video conferencing technologies: Implications for research and practice.

Following the unprecedented outbreak of the Coronavirus pandemic (COVID-19), educators and students have shifted from conventional face-to-face lectures to fully virtual sessions that were delivered via video conferencing software. This research investigates the facilitating conditions and the students' perceptions toward using these interactive resources to continue their learning journey. The data was gathered through a structured questionnaire among 777 students in tertiary education. The survey instrument comprised valid measures that are frequently utilized in academia, to evaluate the individuals' acceptance of interactive educational technologies. A partial least squares (PLS) approach revealed that there were very significant factors that were predicting the students' dispositions to utilize synchronous learning programs. The findings underlined the importance of providing appropriate facilitating conditions to improve perceptions and attitudes toward interactive conferencing software. These results reflect the latest developments, as COVID-19 has inevitably accelerated the digital transformation in the realms of education. This contribution implies that students adapted well to a new normal. It confirmed that they are willing to participate and engage in virtual meetings through video conferencing programs.

mHealth adoption among primary care physicians in Malaysia and its associated factors: a cross-sectional study.

BACKGROUND: mHealth apps potentially improve health care delivery and patient outcomes, but the uptake of mHealth in primary care is challenging, especially in low-middle-income countries. OBJECTIVE: To measure factors associated with mHealth adoption among primary care physicians (PCPs) in Malaysia. METHODS: A cross-sectional study using a self-administered questionnaire was conducted among PCPs. The usage of mHealth apps by the PCPs has divided into the use of mHealth apps to support PCPs' clinical work and recommendation of mHealth apps for patient's use. Factors associated with mHealth adoption were analysed using multivariable logistic regression. RESULTS: Among 217 PCPs in the study, 77.0% used mHealth apps frequently for medical references, 78.3% medical calculation and 30.9% interacting with electronic health records (EHRs). Only 22.1% of PCPs frequently recommended mHealth apps to patients for tracking health information, 22.1% patient education and 14.3% use as a medical device. Performance expectancy and facilitating conditions were associated with mHealth use for medical references. Family medicine trainees, working in a government practice and performance expectancy were the facilitators for the use of mHealth apps for medical calculation. Internet connectivity, performance expectancy and use by colleagues were associated with the use of mHealth with EHR. Performance expectancy was associated with mHealth apps' recommendation to patients to track health information and provide patient education. CONCLUSIONS: PCPs often used mHealth apps to support their clinical work but seldom recommended mHealth apps to their patients. Training for PCPs is needed on the appraisal and knowledge of the mHealth apps for patient use.

A mixed-method service evaluation of health information exchange in England: technology acceptance and barriers and facilitators to adoption.

BACKGROUND: The need for information exchange and integrated care has stimulated the development of interoperability solutions that bring together patient data across the health and care system to enable effective information sharing. Health Information Exchange (HIE) solutions have been shown to be effective in supporting patient care, however, user adoption often varies among users and care settings. This service evaluation aimed to measure user acceptance of HIE and explore barriers and facilitators to its wider uptake. METHODS: A mixed-method study design was used. A questionnaire was developed using the Unified Theory of Acceptance and Use of Technology and administered to HIE users to assess technology acceptance. Pearson Chi2 tests were used to examine differences in acceptance between user groups and care settings. Web-based, semi-structured interviews were conducted drawing on the Normalisation Process Theory to explore barriers and facilitators to adoption. Interview data were analysed thematically using the Framework Approach. RESULTS: A total of 105 HIE users completed the survey and another 12 participated in the interviews. Significant differences were found in HIE acceptance between users groups and care settings, with high adopters demonstrating higher acceptance and social care users showing lower acceptance. Participants identified several drivers to adoption, including increased information accessibility, better care coordination, informed decision-making, improved patient care, reduced duplication of procedures, and time and cost savings. However, they also highlighted a number of barriers, such as lack of awareness about the solution and its value, suboptimal communication strategies, inadequate training and lack of resources for knowledge dissemination, absence of champions to support the implementation, lack of end-user involvement in the implementation and evaluation of HIE, unclear accountability and responsibility for the overall success of the programme, and patient confidentiality concerns. CONCLUSIONS: Working to better engage stakeholders, considering the needs of users from different care settings, providing users with training resources and support to increase their knowledge and confidence in using the system, developing implementation strategies to seek user feedback and monitor performance, and using communication strategies to increase awareness of the product and its value, can help improve uptake and adoption of HIE.

Determinants of Fitness App Usage and Moderating Impacts of Education-, Motivation-, and Gamification-Related App Features on Physical Activity Intentions: Cross-sectional Survey Study.

BACKGROUND: Smartphone fitness apps are considered promising tools for promoting physical activity and health. However, it is unclear which user-perceived factors and app features encourage users to download apps with the intention of being physically active. OBJECTIVE: Building on the second version of the Unified Theory of Acceptance and Use of Technology, this study aims to examine the association of the seven determinants of the second version of the Unified Theory of Acceptance and Use of Technology with the app usage intentions of the individuals and their behavioral intentions of being physically active as well as the moderating effects of different smartphone fitness app features (ie, education, motivation, and gamification related) and individual differences (ie, age, gender, and experience) on these intentions. METHODS: Data from 839 US residents who reported having used at least one smartphone fitness app were collected via a web-based survey. A confirmatory factor analysis was performed, and path modeling was used to test the hypotheses and explore the influence of moderators on structural relationships. RESULTS: The determinants explain 76% of the variance in the behavioral intention to use fitness apps. Habit (ß=.42; P<.001), performance expectancy (ß=.36; P<.001), facilitating conditions (ß=.15; P<.001), price value (ß=.13; P<.001), and effort expectancy (ß=.09; P=.04) were positively related to behavioral intention to use fitness apps, whereas social influence and hedonic motivation were nonsignificant predictors. Behavioral intentions to use fitness apps were positively related to intentions of being physically active (ß=.12; P<.001; R2=0.02). Education-related app features moderated the association between performance expectancy and habit and app usage intentions; motivation-related features moderated the association of performance expectancy, facilitating conditions, and habit with usage intentions; and gamification-related features moderated the association between hedonic motivation and usage intentions. Age moderated the association between effort expectancy and usage intentions, and gender moderated the association between performance expectancy and habit and usage intentions. User experience was a nonsignificant moderator. Follow-up tests were used to describe the nature of significant interaction effects. CONCLUSIONS: This study identifies the drivers of the use of fitness apps. Smartphone app features should be designed to increase the likelihood of app usage, and hence physical activity, by supporting users in achieving their goals and facilitating habit formation. Target group-specific preferences for education-, motivation-, and gamification-related app features, as well as age and gender differences, should be considered. Performance expectancy had a high predictive power for intended usage for male (vs female) users who appreciated motivation-related features. Thus, apps targeting these user groups should focus on goal achievement-related features (eg, goal setting and monitoring). Future research could examine the mechanisms of these moderation effects and their long-term influence on physical activity.

A systematic review of theoretical constructs in CDS literature.

BACKGROUND: Studies that examine the adoption of clinical decision support (CDS) by healthcare providers have generally lacked a theoretical underpinning. The Unified Theory of Acceptance and Use of Technology (UTAUT) model may provide such a theory-based explanation; however, it is unknown if the model can be applied to the CDS literature. OBJECTIVE: Our overall goal was to develop a taxonomy based on UTAUT constructs that could reliably characterize CDS interventions. METHODS: We used a two-step process: (1) identified randomized controlled trials meeting comparative effectiveness criteria, e.g., evaluating the impact of CDS interventions with and without specific features or implementation strategies; (2) iteratively developed and validated a taxonomy for characterizing differential CDS features or implementation strategies using three raters. RESULTS: Twenty-five studies with 48 comparison arms were identified. We applied three constructs from the UTAUT model and added motivational control to characterize CDS interventions. Inter-rater reliability was as follows for model constructs: performance expectancy (κ = 0.79), effort expectancy (κ = 0.85), social influence (κ = 0.71), and motivational control (κ = 0.87). CONCLUSION: We found that constructs from the UTAUT model and motivational control can reliably characterize features and associated implementation strategies. Our next step is to examine the quantitative relationships between constructs and CDS adoption.

Usability evaluation of an integrated electronic medication management system implemented in an oncology setting using the unified theory of the acceptance and use of technology.

BACKGROUND: Medication management processes in an Oncology setting are complex and difficult to examine in isolation from interrelated processes and contextual factors. This qualitative study aims to evaluate the usability of an Electronic Medication Management System (EMMS) implemented in a specialised oncology unit using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. METHODS: The study was conducted in a 12-bed outpatient Oncology unit of a major teaching hospital 6 months following implementation of a commercial EMMS. In-depth semi-structured interviews were conducted with doctors, nurses and pharmacists using the system to assess usability. The UTAUT framework was used to analyse the results, which facilitated evaluation of interrelated aspects and provided a structured summary of user experience and usability factors. RESULTS: Direct cross-comparison between user groups illustrated that doctors and pharmacists were generally satisfied with the facilitating conditions (hardware and training), but had divergent perceptions of performance (automation, standardised protocols and communication and documented) and effort (mental and temporal demand) expectancy. In counterpoint, nurses were generally satisfied across all constructs. Prior experience using an alternative EMMS influenced performance and effort expectancy and was related to early dissatisfaction with the EMMS. Furthermore, whilst not originally designed for the healthcare setting, the flexibility of the UTAUT allowed for translation to the hospital environment. CONCLUSION: Nurses demonstrated overall satisfaction with the EMMS, whilst doctors and pharmacists perceived usability problems, particularly related to restricted automaticity and system complexity, which hindered perceived EMMS success. The study demonstrates the feasibility and utility of the UTAUT framework to evaluate usability of an EMMS for multiple user groups in the Oncology setting.

Factors influencing the mobile instant messaging application usage behaviours among home healthcare providers.

AIMS AND OBJECTIVES: To explore the practice related to mobile instant messaging applications usage among home healthcare providers in Taiwan; and based on the unified theory of acceptance and usage of technology and perceived risk theory to examine the influencing factors. BACKGROUND: Previous work has indicated the potential for using mobile instant messaging applications in chronic disease, disasters and public health emergencies. However, few studies have conducted to understand how healthcare professionals use them. DESIGN: A cross-sectional design was used in the study. METHODS: A wide-ranging empirical investigation was conducted in Taiwan. A total of 102 home agencies participated in this study, and 331 valid data were collected. The ODS guideline was followed. RESULTS: 69% of the participants had used mobile instant messaging applications, with high functionality and interesting value can integrate various messages and contribute to adoption. Performance expectancy, effort expectancy, and social influence were significantly positively correlated with behavioral intention. The perceived risk had a significant negative correlation with performance expectancy and use behavior. Among the relevant influencing factors, different types of organization, job position, and institutional policy were related to significant differences in use behaviors. CONCLUSIONS: Our research reported on mobile instant messaging applications usage and behavioral intention among home healthcare providers. This study also highlighted the need to establish regulations within the applications and improve safety and security guidelines. Further research may extend the understanding of the organizations' influencing factors. RELEVANCE TO CLINICAL PRACTICE: This study may help programmers, managers and policymakers improve their strategies for expanding usage of mobile instant messaging applications.

Telemedicine acceptance during the COVID-19 pandemic: User satisfaction and strategic healthcare marketing considerations.

A lot remains unexplored regarding the antecedents and outcomes of telemedicine acceptance from health service marketing perspective. This study addresses this gap by integrating the Health Belief Model and the Unified Theory of Acceptance and Use of Technology model in the context of generation Y and Z's response to the COVID-19 pandemic. Data collected from 293 respondents were analyzed using structural equation modeling. The results confirm theoretical rigor of integrating two models examining the antecedents and user satisfaction as an outcome of telemedicine acceptance. The findings also suggest marketing strategies for implementing telemedicine during pandemic. Future research directions are highlighted.