Research Article |
Corresponding author: Aldo Alvarez-Risco ( c27408@utp.edu.pe ) Academic editor: Danka Obreshkova
© 2024 Jorge Anibal Schlottke, Aldo Alvarez-Risco, Ezequiel Leandro Bertiche, Rocío Belén López, Carla Vanesa Torletti, Facundo Yamil del Hoyo, Shyla Del-Aguila-Arcentales, Christian R. Mejia, Mercedes Rojas-Osorio, Neal M. Davies, Jaime A. Yáñez.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Schlottke JA, Alvarez-Risco A, Bertiche EL, López RB, Torletti CV, del Hoyo FY, Del-Aguila-Arcentales S, Mejia CR, Rojas-Osorio M, Davies NM, Yáñez JA (2024) Acceptance factors of telemedicine in times of COVID-19: Case Argentina. Pharmacia 71: 1-10. https://doi.org/10.3897/pharmacia.71.e113509
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We performed an analytical, cross-sectional study of 285 consumers to assess the influence of social influence, resistance to use, facilitators to use, perceived ease of use and perceived usefulness of telemedicine on the intention to use telemedicine of citizens of Argentina in times of the pandemic by COVID-19. The proposed research model was analyzed using partial least square structural equation modeling (PLS-SEM). Perceived ease of use had a positive effect (0.624) on perceived usefulness; facilitating conditions had a positive effect (0.476) on usage intention; perceived risk (-0.062) and social influence (0.072) did not have an effect on usage intention. Bootstrapping showed that the beta coefficients were statistically significant. The outcomes may provide ideas to healthcare managers to know what an expectation about telemedicine is and develop new services directed to patients.
Argentina, telemedicine, telehealth, social influence, resistance to use, facilitators to use, perceived to use, perceived usefulness, COVID-19, pandemic
Health needs have changed dramatically due to the COVID-19 pandemic, generating the development of different services for patients. The COVID-19 pandemic reached 241 million confirmed cases and more than 6.6 million deaths worldwide on November 24, 2022 (
The current and future interests of the students about their contribution to the fulfillment of the Sustainable Development Goals have been evaluated since the personal and economic demands of the countries change in a VUCA (volatile, uncertain, complex, ambiguous) world, so to know in detailing student preferences is strategic to generate new training and professional development policies. New services have been generated based on disruption to solve problems generated in the pandemic, such as food e-commerce and those reported in some countries. Globally, tourism changed due to the isolation of people, which generated the bankruptcy of airlines and tourism companies, which have been strongly affected by the absence of customers. Because tourism has been restricted worldwide, hotel services have been very strongly impacted since there were no tourists, and hotels lost their customers, generating a massive loss of jobs. Other impacts include product and service prices.
Due to the large number of patients arriving at hospitals to be treated for COVID-19, patients with other diseases, such as hypertension or diabetes, have seen their access to medical care limited, generating a lack of control of chronic diseases, leading to the worsening of the patients and finally to increase the death in these patients (
The current study was carried out in Argentina, a developing country with different characteristics compared to countries that have provided telemedicine since many years ago. The research aims to evaluate the influence of social influence, resistance to use, facilitators to use, perceived ease of use and perceived usefulness of telemedicine on the intention to use telemedicine during the COVID-19 pandemic.
Globally, telemedicine has been increasing its implementation and its application in the treatment of various diseases such as cancer (
The use of telemedicine has increased, even in countries where it was already in operation, such as the UK (
People may have different reasons to accept a new service; however, when this acceptance is linked to the use of technology, this construct is called acceptance of technology. Because the development of science constantly presents users with different technological products, the acceptance of technology is an aspect that constantly has relevance in purchasing a product or service. The evolution of mobile phones (
The intention to use a specific technology is a changing element over time. The different technological gadgets that are used daily have evolved rapidly. For this reason, it can be expected that the change in the intention of a particular technology is influenced by its greater availability, accessible price, more people in the environment using said technology, ease of use, and benefit of using it, among others. There is evidence of evaluation of intention to use healthcare technology in different types of patients (
A central component of TAM is perceived ease of use, that is, how easy it can be for the person to use the technology offered. There are differences between people regarding the level of digital literacy (
It is the extent to which a person thinks deeply that using a system help in enhancing their performance. For the current study, perceived usefulness must be understood as how much technology can provide a concrete utility, in this case, to replace the usual health care. The usefulness inside the person may be based on saving time by not attending the appointment in person, saving the transfer to the place of the face-to-face appointment, the comfort of the house, and even getting better outcomes for their health. Previous studies have evaluated perceived usefulness in the healthcare system as acceptance of to use of electronic health records (
With the expansion of the Internet, information between people is easily and quickly distributed, often without any filter, which allows the environment, friends and family to have an important influence on the decision of daily activities, from the simplest ones such as where to tale lunch (
Several studies have described the resistance to technology (
Personal communication devices such as mobile phones, tablets and laptops are increasingly available to people in economic terms. However, there is a group of people who still have limitations, accessing these technologies but of low range, which makes functions difficult more complete communication systems such as video calls or access to meeting rooms with other participants (
H1: SOC has a positive and significant effect on the IUT
H2: PEOU has a positive and significant effect on PU
H3: PU has a positive and significant effect on IUT
H4: RES has a negative and significant effect on the IUT
H5: FAC has a positive and significant effect on the IUT
H6: PEOU has a positive and significant effect on IUT
The methodology for this research includes a correlational design. The aim is to describe the factors explaining the intention to use the telemedicine service.
The data collection was performed from citizens in Argentina through a non-probabilistic sampling. Participation was completing an online questionnaire between June 28 – July 14, 2021. It was completed 285 questionnaires. The questionnaire was share by Internet. The collection of the questionnaire was using an online distribution by via emails and WhatsApp, that is, snowball technique.
“Informed consent was obtained from all individual participants included in the study. The participants received the following information: “The online questionnaire is for scientific purposes. If after you start answering the questions, you do not want to go ahead for different reasons, feel free to do so”. The participants answered yes/no to statements “I have freely decided to participate in this study”, “I understand that my participation is voluntary,” and “I received information about the objectives of the present investigation”. For this research, it was used a questionnaire that consisted of a 5-point Likert scale based and adapted from instruments developed to assess PU (
The data was analyzed using SmartPLS statistical package version 3.3.2. The questionnaire was validated using partial least square structural equation modeling (PLS-SEM); it also determined the construct and discriminant validity and internal consistency through composite reliability. Cronbach’s alpha reliability coefficient evaluated each subscale’s internal consistency. Finally, the questionnaire’s discriminant validity was established by applying the Fornell–Larcker criterion (
285 participants from Argentina completed the survey. Most respondents were women [169 (59.29%)], ranging between 18 and 47 years.
Table
Internal consistency analysis using partial least square structural equation modeling (PLS-SEM).
Scale | N° of items | Cronbach’s Alpha | Range of relations item – scale |
---|---|---|---|
Perceived ease of use | 3 | 0.813 | 0.841–0.867 |
Perceived usefulness | 3 | 0.82 | 0.839–0.878 |
Social influence | 2 | 0.627 | 0.820–0.884 |
Resistance to use | 3 | 0.876 | 0.830–0.932 |
Facilitating to use | 3 | 0.822 | 0.820–0.893 |
Intention to use telemedicine | 3 | 0.821 | 0.765–0.910 |
The model was analyzed using PLS-SEM, which included the reliability analysis of each indicator, the internal consistency of each dimension (composite reliability), the analysis of the average variance extracted and the discriminant validity.
The coefficients of sub-scale reliability were between 0.842 and 0.924 (Table
Scale – Items | Loading | Composite Reliability | AVE |
---|---|---|---|
PU | 0.893 | 0.735 | |
Using TM would improve the quality of my healthcare | 0.839 | ||
Using TM would improve my access to healthcare services | 0.855 | ||
Using TM would be useful in my daily routine. | 0.878 | ||
PEOU | 0.889 | 0.728 | |
I would find learning to use TM would not be very difficult for me | 0.841 | ||
I would find it easy for myself to interact with doctors using TM | 0.851 | ||
Interacting with TM systems would be clear and understandable for me | 0.867 | ||
SOC | 0.842 | 0.727 | |
People around me who mean to me a lot would prefer if I would use TM services | 0.820 | ||
I am forced to change habits to adapt to new developments in social media | 0.884 | ||
RES | 0.924 | 0.802 | |
I wouldn’t want TM to alter my traditional way of using healthcare services | 0.932 | ||
I wouldn’t want TM to interfere or change the way I interact with doctors. | 0.921 | ||
I don’t want TM services to change the way I deal with my health problems and choices | 0.830 | ||
FAC | 0.894 | 0.737 | |
I would be able to have all the necessary resources for using the TM | 0.820 | ||
I would acquire sufficient knowledge to use the TM service | 0.893 | ||
TM suite well with my healthcare routine | 0.861 | ||
IUT | 0.895 | 0.740 | |
Assuming that I was given a chance to access TM, I intend to use telemedicine services | 0.910 | ||
Whenever I would need remote medical care from professionals, I would gladly use TM services | 0.898 | ||
I intend to inform my relatives and friends about TM | 0.765 |
The Fornell-Larcker criterion was used (
The criterion used was 5000 resamples. The original value is expected to be similar to the average obtained value (
Scale | Original sample | Mean sample | Standard deviation | t-statistic | p-value | Hypothesis Test |
---|---|---|---|---|---|---|
SOC → IUT | 0.111 | 0.131 | 0.124 | 0.899 | 0.042 | Accepted |
PEOU → PU | 0.622 | 0.625 | 0.055 | 11.315 | 0 | Accepted |
PU → IUT | 0.256 | 0.244 | 0.092 | 2.782 | 0.005 | Accepted |
RES → IUT | -0.046 | -0.047 | 0.052 | 0.883 | 0.377 | Rejected |
FAC → IUT | 0.482 | 0.482 | 0.071 | 6.825 | 0.758 | Rejected |
PEOU → IUT | 0.03 | 0.021 | 0.097 | 0.308 | 0 | Accepted |
Table
Scale | Original sample | Mean sample | Standard deviation | t-statistic | p-value |
---|---|---|---|---|---|
PEOU → PU → IUT | 0.159 | 0.153 | 0.061 | 2.620 | 0.009 |
Fig.
The present study evaluated the factors that explain the intention to use telemedicine. It was possible to show that the respondents think telemedicine would improve the quality of medical care, which is very striking since this can be a factor for the continuity of use. It could be explained by the more accessible provision of virtual medical appointments, generating the feeling that with any ailment, it is possible to have ease of medical attention, which is usually a problem in developing countries (
Social networks are increasingly present in people’s lives, the opinion of others being of great importance in people’s lives, which could also be explained by the need to validate actions (
The aspects reported as facilitators are also aspects that companies should consider to generate telemedicine services of high acceptance and use. Health is an area that generates many businesses based on products and services, especially those that can have laptops that record and transmit data to a center for medical decision-making. Thus, shoes that record the temperature, weight and distance traveled; lenses, watches, and other devices exist. However, it is not as easy to get people to connect with health remotely as it is with their social topics, which can be seen in the increasing use of social networks to share various material. A recent proof of this difficulty has been seen by Google, which recently had to deactivate Google Health, which was seeking to position itself as a provider of medical services and which will now only be focused on the sale of health products such as exercise controllers or with online recommendations for women subsistence allowance. How has the giant not managed in 15 years (Google Health started in 2006) to find the mechanism to ensure that its clients of general services such as email or map guide can also trust and link with the health offer (
One aspect vital to the success of telemedicine services is based on two types of literacy: technology and health. Health literacy is the level of understanding a person has about the health content communicated by medical personnel or that they can read in medical reports and on the Internet. This literacy level is always explained by the fact that a country or a city dedicates resources to empowering its population through health education from the first years of life.
The current study has limitations as the data was collected in COVID-19 pandemic and need be replied in after pandemic times. The number of participants can be a limitation; however, the PLS-SEM allow make the analysis of the data. Also, the participants were citizens because patients in healthcare facilities were not available by pandemic.
Future research should evaluate the acceptance of the different modes of telemedicine provision, differentiating between the intention to be served by video call, chatbot, synchronous chat, telephone and others. Also, it is necessary to evaluate telemedicine’s intention in patients with specific diseases, such as diabetes and hypertension, as well as patients from urban and rural areas. Another element that is evaluated is to know the perception of the cost of the telemedicine service, answering the question, should I pay the same for a face-to-face and virtual medical appointment? Which health professionals are most needed to offer telemedicine services? Future research should also be aimed at knowing if people are interested in blended services, that is, partial and face-to-face alternately.
The COVID-19 pandemic has created an opportunity for telemedicine to have gained an important role, providing the population with attention to COVID-19 cases; At the same time, it has been a starting point in developing countries to provide services to patients with other diseases that must be controlled and who, due to the lack of places for medical care, received remote care through telemedicine services. The planning of medical services for the post-pandemic period requires information from the potential users of telemedicine services so that it is possible to know who the users would be, what preferences they have regarding medical care and if specific characteristics are required. Health services in developing countries are gradually implementing telemedicine services, which are not for all patients, so it is appropriate to prioritize the types of patients who can obtain the most significant advantage from this service.