An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians

doi:10.1016/S1386-5056(03)00094-7

International Journal of Medical Informatics

Volume 71, Issues 2–3, September 2003, Pages 103-115

https://doi.org/10.1016/S1386-5056(03)00094-7 Get rights and content

Abstract

Physicians' acceptance of telemedicine constitutes a prerequisite for its diffusion on a national scale. Based upon the Theory of Interpersonal Behavior, this study was aimed at assessing the predictors of physicians' intention to use telemedicine in their clinical practice. All of the physicians involved in the RQTE, the extended provincial telemedicine network of Quebec (Canada) were mailed a questionnaire to identify the psychosocial determinants of their intention to adopt telemedicine. Confirmatory factor analysis (CFA) was performed to assess the measurement model and structural equation modelling (SEM) was applied to test the theoretical model. The adapted theoretical model explained 81% (P<0.001) of variance in physicians' intention to use telehealth. The main predictors of intentions were a composite normative factor, comprising personal as well as social norms (β=1.08; P<0.001) and self identity (β=−0.33; P<0.001). Thus, physicians who perceived professional and social responsibilities regarding adoption of telehealth in their clinical practice had stronger intention to use this technology. However, it is likely that personal identity had a suppression effect in the regression equation, indicating that physicians' intention to use telemedicine was better predicted if their self-perception as telemedicine users was considered. These results have several implications at the theoretical and practical levels that are discussed in this paper.

Introduction

Over the past years, the adoption of information and communication technologies (ICT) in the health care sector has been the focus of many studies. Telemedicine, defined as the use of information technologies to exchange health information and provide health care services across geographical, time, social, and cultural barriers [1], has the potential to increase quality and access to health care and to lower health expenditures. This technology is considered as a major innovation at the technological, social, and cultural levels. Thus, the introduction of telemedicine as a tool to support the delivery of health care induces numerous changes for professionals, institutions, and for the health care system as a whole that must be accounted for during the implementation process [2]. Telemedicine is expected to impact all levels of health care organisations.

Physicians represent one of the principal groups of telemedicine users and their acceptance of this technology constitutes one of the prerequisites to the emergence and sustainability of telemedicine networks [2]. However, the decision of physicians to adopt a new technology such as telemedicine can be challenged by their relatively low computer literacy, the possible alteration of their traditional routines, and their high professional autonomy. Many studies have investigated physicians' acceptance of various telemedicine applications over the last 10 years [3]. These studies were of exploratory nature and were often limited to the measure of attitudes and perceived barriers. Furthermore, most of these studies were based on small samples and did not use explicit theoretical foundation to test their hypotheses [3].

Section snippets

Theoretical background

Among the studies of telemedicine adoption that were based on a theoretical framework, most employed the Theory of Planned Behaviour (TPB) [4] or the Technology Acceptance Model (TAM) [5]. The validity of the TPB was demonstrated in a study of telemedicine adoption by physicians [6]. This study reported that attitude was the principal determinant of physicians' intention to use telemedicine, while perceived behavioural control had also a lesser but significant effect on intention. However,

Conceptual model and research hypotheses

Among the psychosocial theories developed to understand the adoption of behaviours, Triandis' Theory of Interpersonal Behaviour [10] encompasses many of the behavioural determinants found in other models such as the TPB and the TAM. However, the TIB has a wider scope in that sense that this model also considers cultural, social, and moral factors that are not accounted for in other theories [11].

According to Triandis [10], behaviour is determined by three dimensions: intention, facilitating

Instrument development and validation

As recommended by Davidson et al. [17], an etic–emic approach, inspired from the field of anthropology, was used to develop research instruments according to the TIBs constructs. Firstly, a survey was realised among a convenience sample of physicians attending a conference on telehealth. An open-ended questionnaire, comprising 10 questions, was distributed to a total of 60 physicians. The questions dealt with: (a) physicians' perceived telemedicine pros and cons; (b) barriers and facilitating

Results

Descriptive statistics of the sample are presented in Table 1. The mean age of physicians in the sample was 43.9 years. More males than females participated in the study. Also, specialists accounted for 57% of the sample. These proportions are similar to the ‘College des médecins’ (College of Physicians of Quebec) data on Quebec physicians' profile. However, the practice location of physicians in the sample differed from the provincial average. A majority of respondents was practising in

Discussion

In this study, the TIB was adopted as a basis for examining the predictors of physicians' intention to use telemedicine in their practice. Specifically, normative factors—comprising social as well as personal norms—are the best predictors of intention. In addition, self identity has been found to have a suppression effect in the prediction of physicians' intention to use telemedicine. These findings have several implications, at the theoretical as well as the practical level. Each of these

Conclusion

The rapid advancements in information and communication technologies over the last years have spurred the development of various telemedicine experiments in Canada. However, the diffusion of this technology to the whole healthcare system remains a major challenge. As a professional group, physicians have an important influence on the integration of telemedicine applications in different clinical settings. In the past, models such as the TPB and the TAM have been applied with limited support to

Acknowledgements

The study presented in this paper was substantially supported by a grant from the Canadian Institutes of Health Research (Project No. 49452). The realisation of the research project was also made possible by a doctoral scholarship form the Quebec Fund for Researchers and Research Support (FCAR) to Marie-Pierre Gagnon.

References (32)

I. Ajzen
The theory of planned behaviour
Organizational Behavior and Human Decision Process
(1991)
F. Bergeron et al.
Determinants of EIS use: testing a behavioral model
Decision Support Systems
(1995)
J.J. Dwyer et al.
Internal structure of a measure of self-efficacy in physical activity among high school students
Soc. Sci. Med.
(1998)
J. Reid
A Telemedicine Primer: Understanding the Issues
(1996)
P.J. Hu, P.Y. Chau, O.L. Sheng, Investigation of factors affecting healthcare organization's adoption of telemedicine...
P.J. Hu et al.
Examining the technology acceptance model using physician acceptance of telemedicine technology
Journal of Management Information Systems
(1999)
F.D. Davis
Perceived usefulness, perceived ease of use, and user acceptance of information technology
MIS Quarterly
(1989)
P.J. Hu et al.
Physician acceptance of telemedicine technology: an empirical investigation
Topics in Health Information Management
(1999)
A.-M. Croteau, D. Vieru, Telemedicine adoption by different groups of physicians, 35th Hawaii International Conference...
H. Tanriverdi, N. Venkatraman, Creation of professional networks: an emergent model using telemedicine as a case, 32nd...

M.J. Succi, Z.D. Walter, Theory of user acceptance of information technologies: An examination of health care...

H.C. Triandis, Values, attitudes and interpersonal behaviour, in: M.M. Page. (Ed.), Nebraska Symposium on Motivation,...

N.C. Facione

The Triandis model for the study of health and illness behavior: a social behavior theory with sensitivity to diversity

Advances in Nursing Science

(1993)

G. Paré et al.

Discretionary use of personal computers by knowledge workers: testing of a social psychology theoretical model

Behavior and Information Technology

(1995)

R.L. Thompson et al.

Personal computing: towards a conceptual model of utilization

MIS Quarterly

(1991)

G. Godin et al.

The theory of planned behavior: a review of its application to health-related behaviors

American Journal of Health Promotion

(1996)

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An adaptation of the theory of interpersonal behaviour to the study of telemedicine adoption by physicians

Abstract

Introduction

Section snippets

Theoretical background

Conceptual model and research hypotheses

Instrument development and validation

Results

Discussion

Conclusion

Acknowledgements

Organizational Behavior and Human Decision Process

Decision Support Systems

Soc. Sci. Med.

A Telemedicine Primer: Understanding the Issues

Examining the technology acceptance model using physician acceptance of telemedicine technology

Journal of Management Information Systems

Perceived usefulness, perceived ease of use, and user acceptance of information technology

MIS Quarterly

Physician acceptance of telemedicine technology: an empirical investigation

Topics in Health Information Management

The Triandis model for the study of health and illness behavior: a social behavior theory with sensitivity to diversity

Advances in Nursing Science

Discretionary use of personal computers by knowledge workers: testing of a social psychology theoretical model

Behavior and Information Technology

Personal computing: towards a conceptual model of utilization

MIS Quarterly

The theory of planned behavior: a review of its application to health-related behaviors

American Journal of Health Promotion