Introduction
Over the past decades, a variety of eHealth technologies have been accessible as nations have implemented eHealth efforts to support the objectives for health education and person-centred care.1 Adoption of personal health records (PHRs) has been linked to numerous advantages, including improved patient–provider relationships, patient engagement improvements, better medication adherence, good health outcomes (such as blood pressure and glycaemic management) and higher organisational efficiencies.2 Even though PHRs are intended to be consumer-oriented tools, simply understanding the consumer’s perspective is not enough. Although these issues have gotten less attention, consumer PHR use has significant consequences for healthcare providers and delivery systems as well.3 The value that consumers obtain from using a PHR will probably be directly influenced by the acceptance and behaviours of healthcare professionals and team members within the context of the clinical setting, despite the fact that PHRs have received a lot of attention as tools to help consumers.4Although electronic PHRs (ePHRs) have a great deal of potential to enhance healthcare, there are obstacles to their widespread implementation.5 Despite general agreement on the advantages of ePHRs, healthcare professionals have not been made aware of or receptive to this technology.6 According to preliminary research findings in the literature, patient adoption of a PHR may be influenced by provider endorsement, and continuing physician involvement in patient PHR use may be necessary to achieve and maintain predicted good health outcomes.7 Providing proper control for patient information disclosure and finding out how to process potentially enormous amounts of self-reported data within the constrained time allotted for the clinical visit are healthcare providers’ tasks.8
In Ethiopia, eHealth has been developing slowly. Technology problems, a lack of government support and budget over-runs are few of the reasons for this slow progress.9 Given this, ePHRs are not widely used and accessible electronic records are likewise reluctant to catch on. The most significant factors influencing health providers’ support for a national patient portal were expected positive influences on their work, the usability of the portal and benefits for the patients, according to a study conducted in Finland with a wide range of health providers (including nurses, pharmacists, health officers, doctors, physical therapists and psychologists).10
In Ethiopia, there is little evidence about acceptance of healthcare professionals of using PHR system to change the current healthcare system through eHealth technologies. The study may have effects on practice, policy and upcoming researches. Accordingly, this study investigates, introduces and empirically tests a modified theoretical model based on technology acceptance model (TAM) to identify the main factors influencing healthcare professionals’ acceptance of using ePHRs.
Theoretical background and hypothesis
Several models have been used to predict factors associated with the acceptance of health information system technologies.11 12 The TAM is primarily applied at the individual level (but can also be applied in organisational settings), whereas Unified Theory of Acceptance and Use Technology 2 is primarily applied at the organisational level one of the most used models, and focuses on factors influencing end users’ behavioural intentions to use new technologies.13 14
Perceived usefulness (PU) and perceived ease of use (PEU) are considered to be the main factors that either directly or indirectly determine behavioural intentions to use or embrace new technology in TAM.13 15 In this study, we included information technology and digital literacy components to measure the behavioural intention of health professionals to use ePHRs in low-resource settings. Since the actual use of ePHRs in the setting was unclear, the construct ‘actual use’ was not used (figure 1).
The following parts provide an explanation of the research question hypotheses that were produced for this study’s examination based on our model, which we adopted.
Perceived usefulness
PU describes how much users believe the new technology will help them in their jobs, and studies showed that PU influences acceptance of using ePHRs.15 16 Based on those findings, the following hypotheses were tested.
H1: PU has a positive influence on the user’s attitudes towards ePHRs.
H2: PU has a positive influence on intention to use ePHRs.
H3: PU mediates the relationship between PEU and attitude towards ePHRs.
H4: PU mediates the relationship between information technology experience (ITE) and attitude towards ePHRs.
Perceived ease of use
PEU is the degree to which a person believes that using technology will be simple and easy, and studies showed that PEU influences acceptance of using ePHRs.13 15 16 The following hypotheses were tested.
H5: PEU has a positive influence on the perceived usefulness of ePHRs.
H6: PEU has a positive influence on the user’s attitudes towards ePHRs.
H7: PEU has a positive influence on intention to use ePHRs.
Attitude
Attitude exhibits how individuals’ thoughts toward a new technology affect their feelings and behaviour, and studies showed that attitude influences acceptance of using ePHRs.13 16 This study tests the following hypotheses:
H8: attitude towards eHealth positively influences intention to use ePHRs.
H9: attitude mediates the relationship between PU and intention to use ePHRs.
H10: attitude mediates the relationship between PEU and intention to use ePHRs.
H11: attitude mediates the relationship between ITE and intention to use ePHRs.
H12: attitude mediates the relationship between digital literacy and intention to use ePHRs.
Information technology experience
ITE focuses on the information technology expertise of healthcare professionals, their exposure to technology and their comprehension of its fundamental advantages, and studies showed that ITE influences acceptance of using ePHRs.13 17 This study tests the following hypotheses:
H13: healthcare providers’ ITE has a positive influence on users’ PU of ePHRs.
H14: healthcare providers’ ITE has a positive influence on attitude towards ePHRs.
H15: healthcare providers ITE has a positive influence on intention to use ePHRs.
Digital literacy
Digital literacy describes a person’s capacity to seek, evaluate, and communicate information using writing and other media across a range of digital platforms, and influences acceptance of using ePHRs.18 The following hypotheses were examined in this study:
H16: healthcare providers’ digital literacy has a positive influence on attitudes toward ePHRs.
H17: healthcare providers’ digital literacy has a positive influence on intention to use ePHRs.