Mobile health service adoption in China. Integration of theory of planned behavior, protection motivation theory and personal health differences
| Date | 29 August 2019 |
| DOI | https://doi.org/10.1108/OIR-11-2016-0339 |
| Pages | 1-23 |
| Published date | 29 August 2019 |
| Author | Xing Zhang,Shan Liu,Li Wang,Yajun Zhang,Jiayin Wang |
| Subject Matter | Library & information science |
Mobile health service
adoption in China
Integration of theory of planned behavior,
protection motivation theory and personal
health differences
Xing Zhang
School of Management, Wuhan Textile University, Wuhan, China
Shan Liu
School of Management, Xi’an Jiaotong University, Xi’an, China
Li Wang
School of Management, Wuhan Textile University, Wuhan, China
Yajun Zhang
School of Business Administration,
Guizhou University of Finance and Economics, Guiyang, China, and
Jiayin Wang
School of Management, Xi’an Jiaotong University, Xi’an, China
Abstract
Purpose –Mobile health service (MHS) can provide users with convenient health services and information to
reduce their medical costs from aging or other health issues. Previous studies confirm the underdevelopment
of the Chinese MHS. The purpose of this paper is to analyze the factors that affect the intention to use MHS.
Design/methodology/approach –This paper develops a rese arch model that integra tes personal
health differences wit h theory of planned beha vior (TPB) and protecti on motivation theory (P MT).
This model is empirically tested using data from 49 4 valid questionnaires. Structura l equation modeling is
used to test the hypotheses.
Findings –Perceived vulnerability to disease, perceived severity of disease, response efficacy and
self-efficacy positively affect attitude, thereby exerting a positive influence on the behavioral intention to use
MHS. Subjective norms also influence users’behavioral intention. Personal health status and personal health
value have quasi-moderating effects on the relationship between attitude and behavioral intention.
Originality/value –This paper presents an ea rly attempt to conceptualize and valid ate a research model
of MHS acceptance by integratin g TPB and PMT in a complementary manner. Th e integrated
model provides a holistic view o f people’s intention to use MH S by considering healt h threat beliefs,
individual role (i.e. at titude and self-efficacy) and soc ial influences (i.e. subjective n orms). Furthermore, this
research highlights t he role of two individual health ch aracteristics (i.e. person al health status and personal
health value) in MHS ad option. These new findi ngs are beneficial t oward an in-depth under standing of
technology adoption i n the MHS context.
Keywords Behavioral intention, The theory of planned behavior, Health differences,
Mobile health service, Protection motivation theory
Paper type Research paper
1. Introduction
In China, 280m patients suffer from chronic diseases, with the annual health costs
constantly increasing. Accordingly, the major concerns that require urgent solutions include
alleviating the lack of medical resources and addressing the continued increase in healthcare
costs. The rapid development of wearable smart devices and the manifold data technologies
has ushered the field of health services into the era of mobile internet. Mobile health service
(MHS) is an application program on mobile terminals. People use MHS to avail of relevant
Online Information Review
Vol. 44 No. 1, 2020
pp. 1-23
© Emerald PublishingLimited
1468-4527
DOI 10.1108/OIR-11-2016-0339
Received 30 November 2016
Revised 5 January 2017
6 February 2018
Accepted 3 June 2019
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/1468-4527.htm
1
Mobile health
service
adoption
in China
medical health service and information; actively improve their own behavior, lifestyles and
work patterns; and enhance their physical quality or improve work efficiency (Sun et al.,
2013; Deng et al., 2014). Unlike the electronic health service environment in computers,
MHS transcends time and space limitations and significantly enhances the self-health
management efficiency of users. Through MHS, patients can even monitor their vital sign
data, actively participate in health management and focus on prevention instead of
treatment (Junglas and Watson, 2006).
However, the Chinese mobile health applications remain embryonic in terms of
development time and technical level. Therefore, attracting and retaining potential MHS
users are particularly important. A substantial understanding of MHS-related user behavior
could assuage the lack of medical resources and address the continued increase in
healthcare costs. Thus, the current study addresses this issue by investigating the
determinants of MHS use intention. Technology adoption has long been an important
research issue in the field of information systems (IS) (Lin, 2006). However, prior research on
MHS adoption exhibits three gaps.
First, most prior research interpreted MHS adoption behavior from the perspective of
technology acceptance. These studies substantially emphasized on technological factors,
such as perceived usefulness, perceived ease of use, perceived compatibility and technology
design (Wu et al., 2007; Mohamed et al., 2011; Shareef et al., 2014). Relatively limited attention
was provided to the health behavior aspects (Sun et al., 2013). However, focusing on
technological progress does not guarantee the success of mobile health (Lee and Han, 2015).
The use of health services is generally dependent on whether an individual perceives illness
or the possibility of its occurrence (Andersen and Newman, 2005). Therefore, technological
factors and health protection issues must be considered in the study of MHS adoption.
Second, salient behavioral beliefs (i.e. beliefs on the consequences of performing
particular behavior) are extensively adopted as major determinants of an individual ’s
attitude toward the behavior (Ajzen, 1991). A few studies identified several behavioral
beliefs on MHS adoption from the perspective of health protection (Sun et al., 2013;
Guo et al., 2015). However, these studies proffered contradictory results on the effects
of these salient behavioral beliefs on attitude toward MHS. For example, one research
learned that an individual’s belief on his/her capabilities to complete a behavior
(i.e. self-efficacy) has been determined to positively influence attitude toward MHS
(Guo et al., 2015). By contrast, another study suggested the insignificant effectiveness of
self-efficacy (Deng, 2013). Therefore, further empirical evidence is required for an
improved understanding of this issue.
Third, the relationship between individual characteristics and MHS use intention is
marginally analyzed. These limited studies focused chiefly on age characteristic factors
(Guo et al., 2013; Deng et al., 2014). Given that MHS is used voluntarily for the protection
and maintenance of health, the personal health differences of users may play a critical role
in the adoption of this emerging technology. Moreover, health characteristics may alter
the planned behavior of individuals because behavioral beliefs and attitudes vary among
individuals of different health status. Thus, health characteristic factors still require
further analysis.
In summary, the current study attempts to build a framework by integrating theory of
planned behavior (TPB) with protection motivation theory (PMT) and personal health
differences to analyze the aforementioned issues. TPB is one of the extensively accepted
theories that explain the behavior of technology adoption by considering the individual role
and social influence (Wu et al., 2011; Deng et al., 2014). TPB postulates that three main
constructs (i.e. attitudes, subjective norms and perceived behavioral control or self-efficacy)
can predict a wide range of behaviors, including technology adoption behavior (Venkatesh
et al., 2003; Deng et al., 2014). However, TPB does not provide the antecedents of attitudes;
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