Studies On The Adoption And Usage Of Mobile Health Services By Elderly Users:The Role Of Trust

The rapidly aging population presents challenging healthcare service problems including healthcare spending growth,limited medical resources,and declining medical treatment outcomes.Although mobile health(mHealth)services are widely viewed as a viable means to relieve the strain on aging population,the adoption and usage rates of mHealth services still remain at a low level among the elderly.As the diffusion of mHealth is still at the early stage and with low social cognition,the bussiness model,service model and regulatory system are not well-established.To advance knowledge in this unexplored research area,this thesis aims to investigate the antecedents influencing elderly users' adoption and usage of mHealth services from the perspective of trust.Accordingly,three inter-related empirical studies were conducted as follows:Study 1 aims to explore elderly users' intentions to use mHealth services in the pre-adoption stage.Drawing upon the trust transfer theory,this study investigates declining physiological conditions and support from hospitals in an integrated framework to explain the adoption intentions of mobile health services by elderly users,and empirically examine the trust transfer mechanism.Study 2 aims to investigate elderly users' continuance intentions to use mHealth services in the post-adoption stage.Based on trust theory,this study examines how elderly users' specific characteristics(e.g.,technology anxiety and health anxiety)and two trust dimensions(e.g.,cognitive and affective trust)affect their continuance use intentions of mHealth services.Study 3 aims to underline antecedents of routine use intentions of mHealth services by elderly users in the post-adoption stage.This study investigates the interaction effects of trust,personal innovativeness in information technology(PIIT),and perceived health severity on routine use intentions of mHealth services by elderly users.Three questionnaire-based surveys were conducted among the sample of elderly users in China.The data analysis shows the following:(1)trust can directly influence elderly users' use intentions,continuance use intentions,and routine use intentions of mHealth services;(2)trust in offline health services canindirectly influence use intentions via trust in mHealth services;(3)health anxiety strengthens the positive effect of cognitive trust,but weakens the positive effect of affective trust,on the continuance intention;(4)technology anxiety strengthens the positive effects of affective trust,but not that of cognitive trust,on the continuance intention;(5)in situations of high perceived health severity,trust related less positively to routine use intention than PIIT;however,in situations of low perceived health severity,trust related more positively to routine than PIIT.This thesis contributes to the existing literature in several ways and provides a foundation for future research.First,our work bridges the gap in trust research by examining the impacts of inter-channel trust transfer on building initial trust in mHealth services.Second,this study bridges the research gap on trust issue by investigating the effect of personality traits(e.g.,elderly users' specific characteristics)on trust in mHealth services.Third,our study provides new sights into other contexts of adoption and usage of health information technology by investigating a combination effect of variables of the IS,health informatics,and gerontology literature on elderly users' behavior towards mHealth services.Practically,mHealth service providers can better develop and adapt their marketing strategies to not only increase elderly users' adoption and usage of mHealth services use,but also customized services catering to elderly users' specific characteristics.