| BackgroundDiabetes and its complications have become a major public health problem in the twenty-first Century.China has the largest number of diabetes,accounting for about 1/3 of the total number of patients with diabetes and nearly 2/3 of patients haven't got a reasonable diagnosis and treatment.Diabetes prevention and treatment still have a long way to go.Driven by the upsurge of "Internet plus",the internet industry began to combine with the medical services industry.The global challenges of diabetes prevention and control provide a breakthrough for the development of mobile health service.Mobile health of Diabetes has been widely developed in the world.Welldoc as a pioneer of mobile health service in diabetes has achieved great success abroad.Domestic APP,such as Micro Sugar,Sugar Nurses,Sugar Doctors,Palm Sugar,U Sugar,have sprung up in recent years.Compared with the traditional mode of diabetes management,mobile health service can realize the interaction of medical information at anytime,anywhere,with better convenience and flexibility,and is not limited by time and region.China,which has the world's largest and fastest growing group of patient with diabetes,has the huge potential demand for mobile health services and pregnant with a mobile health revolution.However,most people have not fully accepted,used,or even do not know about this new type of diabetes management mode at present.To achieve the development of mobile health in diabetes,we must first get the acceptance of patient with diabetes.In recent years,researches on mobile health in diabetes were mainly focused on platform or system design,evaluation of intervention effect and APP analysis while seldom focused on the usage acceptance of patients with diabetes.Therefore,it is very important to study the willingness to use and its influencing factors of mobile health services of patient with diabetic,so as to accurately grasp the needs of patients,better exert the value of mobile health service,finally improve the self-management of patients with diabetes.ObjectiveTake mobile health services of diabetes as an example,this paper aims to constructs the patient usage intention model of mobile health service of diabetes and explore the usage willingness of mobile health services and its influencing factors from the aspect of patient with diabetes,so as to provide reference for the development of mobile health service industry.MethodOn the basis of reading and sorting out relevant literature,this paper integrated the Unified Theory of Acceptance and Use of Technology(UTAUT),Health Belief Model(HBM)and Perceived Risk Theory(PR)to construct the patient usage intention model of mobile health service of diabetes,which combined eight latent:performance expectation,effort expectancy,social influence,behavior attitude,willingness to use,perceived threat,health beliefs,perceived risk.In addition,the demographic variables and patient condition were included as control variables.In this study,a self-designed questionnaire was used to conduct a questionnaire survey.Diabetic outpatients and inpatients in the Department of endocrinology of a large general hospital in Guangzhou were randomly sampled and surveyed.A total of 380 questionnaires were issued,362 valid questionnaires were collected with the rate of 95.26%.Using Epidata3.1 to create database,SPSS20.0 to perform descriptive analysis,reliability and validity analysis,variance analysis,AMOS21.0 to perform structural equation model validation.Take P<0.05 as significant difference.ResultResults 21.3%of patients had the awareness of mobile health,14.4%knew that diabetes can be managed through mobile health and 4.7%had used the services before.Doctors recommendation(66.2%)and network advertising promotion(58.4%)were the two main ways for patients to know about the service.More than half of the patients believed that the diabetes mobile health service should provide the blood sugar record(244/362),the diet management(232/362)and doctor consultation(213/362).The average score of each factor in the willingness model was as follow:3.76/5 in performance expectation.3.44/5 in effort expectation.3.97/5 in social influence,4.27/5 in perceived threat,4.54/5 in health belief,3.21/5 in perceived risk,3.50/5 in behavior attitude and 3.60/5 in usage intention.The Cronbach's alpha coefficient of the willingness to use evaluation scale for diabetes mobile health was 0.842 and the Cronbach's alpha coefficient of each factor was range from 0.887 to 0.982.The generalized least square method was used to explore the factor analysis,8 factors were extracted and the cumulative variance contribution rate was up to 78.91%.Demographic characteristics and prevalence situation influenced differently on each factors of willingness:Different age,education,income,smart-phone mastery,type of diabetes,history of diabetes and complication status patients with diabetes scored significantly different in performance expectation(P<0.05).Different age,education,income,smart-phone mastery,type of diabetes,history of diabetes and complications status patients scored significantly different in effort expectation(P<0.01).Different age,education,income,smart-phone mastery,type of diabetes and complications status patients scored significantly different in social influence(P<0.01).Different gender,smart-phone mastery and history of diabetes patients scored significantly different in perceived threat(P<0.05).Different gender,income,smart-phone mastery and type of diabetes patients scored significantly different in health belief(P<0.05).Different age,education,income,smart-phone mastery,type of diabetes and history of diabetes patients scored significantly different in perceived risk(P<0.05).Different age,education,income,smart-phone mastery,type of diabetes,history of diabetes and complications status patients scored significantly different in behavior attitude(P<0.05).Different age,education,income.smart-phone mastery,history of diabetes and complications status patients scored significantly different in usage intention(P<0.05).Structural equation model validation showed:Effort expectation,performance expectation,and social influence positively affected behavioral attitudes(P<0.001).Effort expectation and social influence positively affected performance expectation(P<0.001).Behavior attitude positively influenced behavioral intention(P<0.001):.Performance expectation had no significant effect on health belief(P>0.05).Health belief and perceive risk had no significant effect on behavioral intention(P>0.05).Hypothesis H1,H2,H3.H4,H5,H6 was established while hypothesis H7.H8,H9,H10 was not.Conclusion(1)The awareness rate of mobile health service is low in patients with diabetes.The promotion channel is single and the promotion effect is not significant may be the important reasons for the low awareness of the mobile medical serv ice.(2)Patient's demands for mobile health services are primarily basic service and value-added services are not favored temporarily except for doctor consultant.Patients value that whether mobile health services can really play a role in disease management or whether it can really improve the convenience and timeliness of medical treatment.(3)Demographic characteristics and prevalence situation influenced differently on each factors of willingness.Patients who are young,highly educated,getting high inconme and can skillfully use smart phones scores significantly higher in performance expectation.effort expectancy,social influence and behavior attitude.lower in perceived risk.The influence of diabetes prevalence was related to the age factors.(4)There are individual differences in willingness to use mobile health services in patients with diabetes.Patients who are young,highly educated,getting high income and can skillfully use smart phones have higher usage intention.(5)The factors that affect the willingness of patients to use mobile health services include effort expectation,performance expectation,social influence and behavior attitude.Effort expectation,performance expectation and social influence positively affect the usage intention of mobile health services for patients with diabetes which mediates by behavior attitude.The easier patients believe in using mobile health service,the more conducive to the management of diabetes,the more strongly friends and doctors are recommended,the higher the patients evaluate the service,the more willing to use diabetes mobile health serv ices.Patients' judgment of complexity of using diabetes mobile health service has the high relevance with their usage intention.Patient' intention was affected by others and especially by doctors.(6)Perceived threat and health belief of patients showed no significant effects on the behavior intention to use mobile health services for patients with diabetes.Patient thought that whether using mobile health services has no relationship with better management of diabetes.(7)Perceived risk showed no significant effects oin the behavior intention to use mobile health services for patients with diabetes.Privacy issues,price issues,and whether it really plays a role in diabetes management are the three most worrying factors.Although it probably has some risk,patient are still willing to use this new and convenient mode of diabetes management. |
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