The role of perceived e-health literacy in users’ continuance intention to use mobile healthcare applications: an exploratory empirical study in China

ABSTRACT

In recent years, mobile healthcare applications (MHAs) have boomed, providing several new kinds of health services and methods of information transmission. However, MHA vendors face a significant challenge in attracting users to adopt software continuously. Some recent studies recognized users’ perceived e-health literacy (PEHL) as a critical factor in continuance intention, but its influence was still unclear. In this paper, based on the elaboration likelihood model (ELM), we investigated how the users’ PEHL affects their continuance intention when adopting MHAs. We distributed convenience sample questionnaires by Wechat (similar to WhatsApp) in China, where hundreds of MHAs can be downloaded, and 273 valid samples were collected. The result shows that ELM works well in this model, with six of the eight hypotheses supported. The moderating effect of PEHL is largely significant for the peripheral route but not significant for the central route. The most interesting finding is that, with regard to continuance adoption, PEHL has a positive relationship with users’ satisfaction. Possible reasons are discussed, such as there could be a moderator on this relationship. Limitations, future studies and implications for theory, practice and policy are also given.     

Understanding Chinese users’ continuance intention toward online social networks: an integrative theoretical model

This study explores users’ continuance intention in online social networks by synthesizing Bhattacherjee’s IS continuance theory with flow theory, social capital theory, and the unified theory of acceptance and use of technology (UTAUT) to consider the special hedonic, social and utilitarian factors in the online social network environment. The integrated model was empirically tested with 320 online social network users in China. The results indicated that continuance intention was explained substantially by all hypothesized antecedents including perceived enjoyment, perceived usefulness, usage satisfaction, effort expectancy, social influence, tie strength, shared norms and trust. Based on the research findings, we offer discussions of both theoretical and practical implications.     

Determinants of students’ continuance intention to use blogs to learn: an empirical investigation

This study examines factors influencing students’ continuance intention to use blogs to learn in an undergraduate-level course. The research uses constructs from relevant theoretical frameworks, including the technology acceptance model, social cognitive theory, innovation diffusion theory, and expectation–confirmation model. A survey administered to 108 university students in a Canadian university was analysed using the partial least squares technique. The results show that perceived usefulness and perceived compatibility have positive effects on students’ attitudes towards blog use; perceived ease of use did not. Perceived compatibility, perceived self-efficacy, and perceived support for enhancing social ties with blogs have significant effects on the positive impacts of learning with such tools. Attitude and positive impacts of learning with blogs influence satisfaction with blog use. Both attitude and satisfaction are determinants of students’ continuance intention to use blogs to learn. Satisfaction with blog use is the main predictor of continued use intention.     

Understanding consumers’ continuance intention towards mobile advertising: a theoretical framework and empirical study

While issues regarding mobile advertising have captured the interest and attention of both practitioners and academics, in practice success stories are rare. An understanding of the continuance intention to use such services can provide insights into failed mobile marketing campaigns, and help to improve the implementation of future ones. Therefore, it is important to examine the underlying drivers of loyalty with regard to mobile advertising. This study uses the expectation–confirmation model in conjunction with the perspectives of value and trust to derive an integrated model to better understand the motivations behind consumers’ continued use of mobile advertising. We conducted an empirical study consisting of an online survey of 508 consumers who had experience with mobile advertising. The results show that perceived value, perceived usefulness, and satisfaction all directly influence continuance intention. Furthermore, consumer satisfaction has a crucial intervening role in the relationships that perceived value, perceived usefulness, and confirmation have with continuance intention. The theoretical and practical implications of the findings are discussed. One key limitation of this research is that the majority of respondents were students, although this group is the chief user of mobile advertising. Future research could be extended to consider other drivers of loyalty in this context, such as cultural differences and personal behavioural characteristics.     

Exploring users’ switching intention and behavior on social networking sites: Linear and nonlinear perspectives

The increasing integration of computers and networks into society has profoundly affected our lives in recent years. In Taiwan, use of SNSs – especially Facebook – has become the main action for the Internet users; accordingly, a number of scholars have explored people's intention to use, or actual use of, SNSs. However, few studies have investigated how and why users stop using one SNS and begin using another from the linear perspective. The findings are incomplete for the human behaviors which are complex and nonlinear systems. The purpose of this study is therefore to explore the relationship between SNS users’ switching intention and switching behavior based on structural equation modeling (SEM) and cusp catastrophe model (CCM). The key factors for the switching intentions and behaviors of SNS users were examined through empirical research, and a structural model was established. The model, which involved habits as a mediating factor, was used to conduct a qualitative and quantitative analysis on the switching behaviors of SNS users from a nonlinear perspective. This model will provide a new method for future researchers to analyze nonlinear behaviors as well as a dynamic decision support model for service providers to improve their business operation.     

How to unite the power of the masses? Exploring collective stickiness intention in social network sites from the perspective of knowledge sharing

This study aims to investigate users’ knowledge-sharing intention and collective stickiness intention towards social network sites (SNS). SNS offer an opportunity for users to interact and form relationships, while knowledge is accrued by integrating users’ information, experience, and practice. However, there have been few systematic studies that question why people use SNS to share knowledge. We adopt social capital theory, social identity theory, as well as use and gratification theory, to explore the determinants of members’ knowledge-sharing intention in using SNS. The survey was conducted on two education virtual communities (VCs) on Facebook, of which most members were teachers and educators. Data analysis was executed to validate our research model, and SmartPLS was used to analyse users’ collective stickiness intention. The results show that social capital and social identity have an impact on teachers’ knowledge-sharing intention, which, in turn, influences collective stickiness intention towards SNS. Our findings can not only help researchers interpret why members share their knowledge in VCs, but can assist practitioners in developing better SNS strategies as well.     

Identify predictors of university students’ continuance intention to use online carbon footprint calculator

An online carbon footprint calculator (CFC) is a Green Information System, which enables individuals to self-estimate carbon footprints, self-manage behaviour, and accordingly self-control carbon emissions. Individuals’ persistent CFC use may help to slow down global warming. Thus, it is vital to establish a model to investigate the motivational predictors of CFC continuance intention. We formulated a model by integrating Expectation-Confirmation Model (ECM) and Theory of Planned Behaviour (TPB), with the former measuring continuance intention and the latter measuring low-carbon behavioural intention. To validate the model and identify significant predictors, a survey was conducted on undergraduate students. The survey results revealed that ECM accounted for 50% of the variance in continuance intention, that TPB accounted for 35% in low-carbon behavioural intention, and that the integrated model accounted for 64% in CFC continuance intention. Plus, direct and significant predictors of CFC continuance intention included low-carbon attitude, low-carbon behavioural intention, low-carbon subjective norm, satisfaction, and usefulness. Findings, implications, and suggestions are accordingly offered.     

Exploring consumers’ intention to accept smartwatch

With the growing smartwatch market over the past few years, smartwatch acceptance in consumer markets has become an important topic for both researchers and designers. Identification of factors that influence consumers to accept a smartwatch can improve user-centered design. This study explores the intentions of using a smartwatch from the consumer perspective, combining innovation diffusion theory (IDT), the technology acceptance model (TAM), the unified theory of acceptance and use of technology (UTAUT), and perceived enjoyment. It presents an integrated method empirically tested with data from 212 participants in Taiwan. Partial lease squares (PLS) were used for models and hypotheses tests. We find several interesting results greatly different from previous studies: (1) Attitude, often identified as a weak mediator, is significant; (2) Ease of use was not significant, which implies that it should be the basic specification of smartwatches; (3) Gender has no significant effect on acceptance of smartwatches; and (4) Individuals 35–54 years old exhibit a significant demand for enjoyment in their use of smartwatch. This study contributes to the technology acceptance research field, and identifies the characteristics that influence smartwatch acceptance. Our methods and results should benefit both academics and managers with useful suggestions for research directions and product strategies.     

Understanding consumers’ continuance intention towards mobile purchase: A theoretical framework and empirical study – A case of China

Although mobile purchase is convenient in the age of mobile commerce, many consumers still do not utilize mobile purchase to its full potential. From the mobile vendor’s perspective, retaining current customers and facilitating their continued purchase are crucial to create profitability and achieve a sustainable development. An understanding of the continuance intention towards mobile purchase can provide insights into mobile vendors’ marketing campaigns. Therefore, it is important to examine the determinants that impact continuance intentions of consumers for mobile purchase. Drawing upon information success model, flow theory and trust, this study proposed and empirically tested an integrated model to better understand the determinants of consumers’ continued intention to purchase on mobile sites. Empirical data from 462 users who had experience with mobile purchase were tested against the proposed research model by using structural equation modelling (SEM). The results indicated that information quality, and privacy and security concerns are the main factors affecting trust, whereas service quality is the main factor affecting flow. System quality, and privacy and security concerns affect satisfaction. Trust affects flow, which in turn affects satisfaction. These three factors together affect continued intention towards mobile purchase. The findings of this study provide several important implications for mobile commerce research and practice.     

Physicians’ motivations to use mobile health monitoring: a cross-country comparison

While mobile device receives increasing attention as a practical tool to remotely check patients’ health, little research has shed light on physicians’ acceptance of this information and communication technology. This study attempts to fill this research gap by examining how Japanese and Spanish physicians perceive a series of factors associated with mobile diabetes monitoring acceptance, and whether any differences exist in these perceptions between the countries due to different levels of physician scarcity, which is operationalised as the number of physicians available per 10,000 population. The hypotheses were tested by empirical surveys in Japan and Spain. In total, 471 and 497 usable responses were obtained from Japanese and Spanish physicians, respectively. In both countries, physicians were likely to embrace clinical expectations (perceived value) and appreciate the ability to check patients’ health remotely (ubiquitous control) as the main benefits of mobile diabetes monitoring. In terms of cross-country comparison, the influence of personal innovativeness on perceived value and ubiquitous control was stronger in Japan (greater physician scarcity), compared with Spain (less physician scarcity).     

How to regulate individuals’ privacy boundaries on social network sites: A cross-cultural comparison

Individuals presently interact with their diverse social circles on social networking sites and may find it challenging to maintain their privacy while deriving pleasure through self-disclosure. Drawing upon the communication privacy management theory, our study examines how boundary coordination and boundary turbulence can influence individuals’ self-disclosure decisions. Further, our study examines how the effects of boundary coordination and boundary turbulence differ across cultures. Our hypotheses are tested with survey data collected from the United States and China. The results strongly support our hypotheses and show interesting cultural differences. The implications for theory and practice are discussed.     

The drivers of consumers’ intention to redeem a push mobile coupon

A modern-day marketing tool that has caught the industry's attention is the use of mobile coupons (m-coupons). Despite the attractiveness of this new marketing tool, a high level of consumer resistance is reported. To therefore ensure the successful implementation of an m-coupon strategy, customer buy-in is a prerequisite. The research on which this article is based, aimed to explore the factors that contribute to consumers’ intention to ultimately redeem m-coupons. A hypothesised model proposes economic benefit, convenience benefit, positive consumer attitude, perceived control and social benefit as constructs that either directly or indirectly influence consumers’ intention to redeem an m-coupon. A survey of 204 respondents revealed that a consumer's positive attitude is the main driving force behind m-coupon redemption intentions. Results reflected that businesses should emphasise convenience and economic benefits in order to assist in the development of a positive attitude amongst potential m-coupon users. Consumers value their privacy and are resistant towards push-based m-coupons. If businesses incorporate these aspects into their m-couponing strategy, it will allow them to reach their audience in an entirely new manner and in doing so, potentially trigger purchase behaviour or increase store foot count.     

Predicting Asian undergraduates’ intention to continue using social network services from negative perspectives

With the maturity of the social network service (SNS) market, the increasing sophistication of its customer or user base, and the growing intensity of competition, SNS success has now become a pressing issue. Understanding the antecedents of continuance intention is the first step to assure the success of an SNS. This study proposed a model to examine the key drivers of users’ intention to continue using SNSs from negative standpoints. The developed research model was empirically validated using the responses from a field survey of 236 Asian undergraduates. The results revealed that normative pressure and fatigue are the main determinants of the users’ intention to continue using SNSs. Moreover, the findings showed that satisfaction is a major determinant of fatigue, whereas negative critical incidents are crucial predictors of satisfaction. The negative critical incidents experienced when undergraduates use services include rumour dissemination, advertising interference, and low ease of use. The implications of the present findings for research and managerial practice were analysed and discussed.     

Understanding the intentions of users to ‘stick’ to social networking sites: a case study in Taiwan

Social networking sites (SNSs) are the most popular social platforms for developing personal networks. They provide multiple interactive functions for users to create and use large social networks. To determine why people exhibit ‘stickiness’ to SNSs, this study uses the uses and gratifications theory as an underlying structure and builds the research model with factors of motivational needs and interactivity. Our results showed that social needs, information needs, human–message interaction, and human–human interaction are crucial factors that affect the ‘stickiness’ of users to SNSs. The implications of these findings are presented in this paper.     

How does social network diversity affect users’ lurking intention toward social network services? A role perspective

With the increase of users’ social connections on social network services, their social circles become more diverse, which make it difficult to maintain their ideal images and thus lead to their lurking behaviors. Based on the self-discrepancy theory, an integrated model was proposed to link role-related constructs to lurking intention. Results based on data from 641 WeChat users show that social interaction anxiety and disappointment positively influence lurking intention. Role conflict and role overload positively influence social interaction anxiety and disappointment. Moreover, role overload positively moderates the relationship between role conflict and disappointment. Lastly, study implications and conclusions are discussed.     

Promoting online learners’ continuance intention: An integrated flow framework

Despite the rapid growth and significant benefits of online learning, retaining students in online courses remains a key challenge. This study empirically tests an integrated model that simultaneously examines factors influencing students’ attainment of flow experience in online learning and the impacts of flow on their online learning continuance intention. The results identified telepresence as the most significant factor influencing students’ flow experience in online learning. Perceived hedonic value played the most important mediating role transmitting the effects of flow on students’ continuance intention. The implications of the study for both research and practice are discussed.     

Book2U and students’ learning styles: the effect of learning styles on intention to use a social media-enabled tool

Universal Access in the Information Society - This study investigated the factors that affect the intention to use social media for learning among students from the higher learning institutions. A...     

When ‘friends’ collide: Social heterogeneity and user vulnerability on social network sites

The present study examines how the use of social network sites (SNS) increases the potential of experiencing psychological, reputational and physical vulnerability online. From our theoretical perspective, concerns over the use of social network sites and online vulnerability stem from the ease with which users can amass large and diverse sets of online social connections and the associated maintenance costs. To date most studies of online vulnerability have relied on self-report measures, rarely combining such information with user's validated digital characteristics. Here, for a stratified sample of 177 UK-based Facebook users aged 13 to 77, digitally derived network data, coded for content and subjected to structural analysis, were integrated with self-report measures of social network heterogeneity and user vulnerability. Findings indicated a positive association between Facebook network size and online vulnerability mediated by both social diversity and structural features of the network. In particular, network clustering and the number of non-person contacts were predictive of vulnerability. Our findings support the notion that connecting to large networks of online ‘friends’ can lead to increasingly complex online socialising that is no longer controllable at a desirable level.     

Middle-aged adults’ attitudes toward health app usage: a comparison with the cognitive-affective-conative model

Universal Access in the Information Society - Middle-aged adults have a stronger sense of urgency about health apps that not only enhance their health management but also help them administer...     

Exploring users’ social responses to computer counseling interviewers’ behavior

We explore the effect of behavioral realism and reciprocal self-disclosure from computer interviewers on the social responses of human users in simulated psychotherapeutic counseling interactions. To investigate this subject, we designed a 3 × 3 factorial between-subjects experiment involving three conditions of behavioral realism: high realism, low realism, and audio-only (displaying no behavior at all) and three conditions of reciprocal self-disclosure: high disclosure, low disclosure, and no disclosure. We measured users’ feelings of social presence (Copresence, Social Attraction, and Emotional Credibility), rapport, perception of the quality of users’ own responses (Embarrassment and Self-Performance), emotional state (PANAS), perception of an interaction partner (Person Perception), self-reported self-disclosure, speech fluency (Pause Fillers and Incomplete Words), and Verbal Self-Disclosure. We observed some contradictory outcomes in users’ subjective reports. However, the results of objective data analysis demonstrated that users disclosed greater Verbal Self-Disclosure (medium level of intimacy) when interacting with computer interviewers that displayed high behavioral realism and high self-disclosure. Users also delivered more fluent speech when interacting with computer interviewers that displayed high behavioral realism.