Modeling the adoption of personal health record (PHR) among individual: the effect of health-care technology self-efficacy and gender concern

Figures & data

Figure 1. Research Framework.

Table 1. Sample demographics.

Item	Option	Count	Percentage %
Gender	Male	120	51.28
	Female	114	48.72
Age	20–29	98	41.88
	30–39	69	29.49
	40–49	32	13.68
	50–59	20	8.54
	≥ 60	15	6.41
Education Level	High School or under	30	12.82
	College	137	58.55
	Master or above	67	28.63
Experienced of using health-care information system (HIS)	Yes	199	85.04
	No	35	14.96

Table 2. Descriptive statistics of the study dimensions.

Constructs	Item	Loadings	No. of items	Composite Reliability	Standardized Cronbach’s α	AVE
PU	PU1	0.806	4	0.84	0.82	0.78
	PU2	0.834
	PU3	0.817
	PU4	0.883
PEOU	PEOU1	0.856	4	0.87	0.84	0.76
	PEOU2	0.827
	PEOU3	0.784
	PEOU4	0.841
ATT	ATT1	0.892	4	0.95	0.92	0.83
	ATT2	0.865
	ATT3	0.821
	ATT4	0.874
INT	INT1	0.862	3	0.91	0.89	0.81
	INT2	0.872
	INT3	0.892
HTSE	HTSE1	0.912	4	0.92	0.87	0.72
	HTSE2	0.894
	HTSE3	0.861
	HTSE4	0.868

Note. PU = perceived usefulness; PEOU = perceived ease of use; ATT = attitude toward using PHR; INT = intention to use PHR; HTSE = health-care technology self-efficacy.

Table 3. Average variance extracted and discriminant validity.

	PU	PEOU	ATT	INT	HTSE	AVE
PU	0.88					0.78
PEOU	0.42**	0.87				0.76
ATT	0.51**	0.54**	0.91			0.83
INT	0.47*	0.52*	0.53**	0.90		0.81
HTSE	0.54**	0.57**	0.43*	0.65**	0.85	0.72

Note. PU = perceived usefulness; PEOU = perceived ease of use; ATT = attitude toward using PHR; INT = intention to use PHR; HTSE = health-care technology self-efficacy.

Diagonal in Bold: square root of the average variance extracted (AVE) from observed items; Off-diagonal: correlations between constructs. *p < 0.05; **p < 0.01

Table 4. Goodness-of-fit measures of the research model.

Goodness-of-fit measure	Recommended value (a)	Model Value
χ^2/degree of freedom	≤3.00	2.17
Goodness-of-fit index (GFI)	≥0.90	0.94
Adjusted goodness-of-fit index (AGFI)	≥0.80	0.86
Normed fit index (NFI)	≥0.90	0.91
Non-normed fit index (NNFI)	≥0.90	0.92
Comparative fit index (CFI)	≥0.90	0.95
Root mean square residual (RMSR)	≤0.10	0.07

Note. a: Bagozzi and Yi [47]; Hair et al. [49].

Table 5. Two group comparisons of paths for men and women users.

		χ^2	Df	Δχ^2 from base model
Unconstrained base model ^a		256.158	127
Constrained paths ^b	HTSE → PU	264.212		7.626*
	HTSE → PEOU	264.048		7.502**
	HTSE → ATT	268.181		10.232**
	PU → ATT	268.166		0.121^ns
	PU → INT	256.321		0.164^ns
	PEOU → ATT	259.264		0.051^ns
	PEOU → INT	256.219		0.072^ns
	ATT → INT	256.297		0.172^ns

Note. PU = perceived usefulness; PEOU = perceived ease of use; ATT = attitude toward using PHR; INT = intention to use PHR; HTSE = health-care technology self-efficacy.

^aPaths for the two groups were allowed to be freely estimated.

^bThe path specified was constrained to be equal across the two groups.

*p < 0.05; **p < 0.01; ns = not significant.

Table 6. Hypothesis results.

	Path	Hypothesis	Results
Relationship
H1a	PU → ATT	Positive	Supported
H1b	PU → INT	Positive	Supported
H2a	PEOU → PU	Positive	Supported
H2b	PEOU → ATT	Positive	Not supported
H2c	PEOU → INT	Positive	Supported
H3	ATT → INT	Positive	Supported
H4a	HTSE → PU	Positive	Supported
H4b	HTSE → PEOU	Positive	Supported
H4c	HTSE → ATT	Positive	Supported
Gender difference
H5a	HTSE → PU	Men > Women	Not supported (women > men)
H5b	HTSE → PEOU	Men > Women	Not supported (women > men)
H5c	HTSE → ATT	Men > Women	Not supported (women > men)
H6a	PU → ATT	Men > Women	Not supported (no difference)
H6b	PU → INT	Men > Women	Not supported (no difference)
H7a	PEOU → ATT	Women > Men	Not supported (no difference)
H7b	PEOU → INT	Women > Men	Not supported (no difference)
H8	ATT → INT	Men > Women	Not supported (no difference)

Note. PU = perceived usefulness; PEOU = perceived ease of use; ATT = attitude toward using PHR; INT = intention to use PHR; HTSE = health-care technology self-efficacy.

Table B1. Results of confirmatory factor analysis and reliability analysis.

Constructs	Item	Loadings	Standardized Cronbach’s α
Perceived usefulness (PU)	PU1	0.792	0.79
	PU2	0.813
	PU3	0.806
	PU4	0.862
Perceived ease of use (PEOU)	PEOU1	0.834	0.82
	PEOU2	0.812
	PEOU3	0.762
	PEOU4	0.814
Attitude toward using EMR (ATT)	ATT1	0.871	0.87
	ATT2	0.854
	ATT3	0.812
	ATT4	0.845
Health-care technology self-efficacy (HTSE)	HTSE1	0.851	0.84
	HTSE2	0.842
	HTSE3	0.865
	HTSE4	0.874
Intention to use PHR (INT)	INT1	0.894	0.86
	INT2	0.867
	INT3	0.858

NOTE. PU = perceived usefulness; PEOU = perceived ease of use; ATT = attitude toward using PHR; INT = intention to use PHR; HTSE = health-care technology self-efficacy

Table D1. Direct, indirect and total effects of research model.

		Standardized estimates
Predictor Variables	Outcome Variables	R^2	Direct	Indirect	Total
HTSE	PU	0.578	0.261	0.218	0.479aa
PEOU	PU		0.523	-	0.523aa
HTSE	PEOU	0.321	0.426	-	0.426^aa
HTSE	ATT	0.527	0. 461	0.297	0.758a
PU	ATT		0.492	-	0.492^aa
PEOU	ATT		0.151	0.254	0.405aa
HTSE	INT	0.406	-	0.653	0.653a
PU	INT		0.513	0.142	0.655aa
PEOU	INT		0.362	0.382	0.744a
ATT	INT		0.297	-	0.297^aa

NOTE. PU = perceived usefulness; PEOU = perceived ease of use; ATT = attitude toward using PHR; INT = intention to use PHR; HTSE = health-care technology self-efficacy.

ap < 0.05; **p < 0.01

Figure 2. Standardized path coefficients for the male and female users.

Note. Coefficients for male users are in the shaded boxes.*p < 0.05;**p < 0.01; ns = not significant.

Table A1. Measurement Items.

Dimension		Items	Sources
Perceived Usefulness (PU)	PU1	Using PHR, I can improve my health quality.	Davis [31]
	PU2	Using PHR, I can make my life more convenient.
	PU3	Using PHR, I can understand my physical condition.
	PU4	Overall, I find PHR to be useful for my health.
Perceived ease of use (PEOU)	PEOU1	Learning to operate PHR will be easy for me.	Davis [31]
	PEOU2	I can easily become skillful at using PHR.
	PEOU3	I can get PHR to do what I want to do.
	PEOU4	Overall, I think using PHR is very easy to use.
Attitude toward using PHR (ATT)	ATT1	Using PHR is a good idea.	Davis [31]; Sun et al. [40]
	ATT2	Using PHR is pleasant.
	ATT3	Using PHR is beneficial.
	ATT4	Overall, I like the idea of using PHR.
Intention to use PHR (INT)	INT1	I intend to use PHR in the near future to manage my health.	Venkatesh et al. [12]; Sun et al [40].
	INT2	I plan to use PHR in the near future to manage my health.
	INT3	My willingness to use PHR is high.
Health-care technology Self-efficacy (HTSE)	HTSE1	It is easy for me to use health technology.	Rahman et al. [20]
	HTSE2	I have the capability to use health technology.
	HTSE3	I do not feel comfortable using health technology.
	HTSE4	While using health technology, I am worry that I might press the wrong button and risk my health.

Figure C1. standardized structural path analysis.

NOTE. * Significant at p < 0.05 level, ** Significant at p < 0.01 level, ns not significant at p < 0.05 level.

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