Moblie health from end users' perspective : an acceptance model and a willingness to pay study

Abstract

Background: With the rapid development of mobile health (mHealth) technologies and the accumulating clinical evidence of their effectiveness in improving health outcomes, there has been a growing interest in understanding end users’ perceptions and valuation of mHealth to ensure that the benefits of the technology can be delivered to end users in practical implementation. Objectives: This research focused on one of the most common modalities of mHealth, mobile health applications (apps), and aimed to examine end users’ perspectives about the acceptance of health apps and the willingness to pay (WTP) for health apps. Methods: This research consists of three parts: 1) the development and empirical test of an acceptance model for health apps, 2) a systematic review and meta-analysis of WTP studies for electronic health (eHealth), and 3) the assessment of WTP and marginal WTP for health apps. The acceptance model was developed by integrating relevant factors identified through a thorough literature search, and then tested through a questionnaire survey among 600 adults living in Hong Kong (stratified by age, gender, and district of residence). The survey also collected data for the WTP study, with two contingent valuation (CV) methods (open-ended question, and payment scale method) used to elicit WTP for health apps, and a discrete choice experiment (DCE) conducted to examine the marginal WTP for each attribute of health apps. Results: The acceptance model explained 55% of the variance of intention to use and 58% of the variance of perceived usefulness. Intention to use was positively affected by perceived usefulness, mHealth literacy, smartphone screen size, and healthcare provider’s attitudes, and negatively affected by storage consumption. Perceived usefulness was positively affected by perceived ease of use, favorable features, and quality of information. As for the WTP for health apps, the median WTP value as a one-time payment elicited using open-ended question and payment scale method was 10 (interquartile range=100) HK$ and 25 (interquartile range=100) HK$ respectively (1 US$ ≈ 7.8 HK$). The most highly valued attribute was the assurance of security and privacy, followed by improved usefulness and ease of use, less mobile Internet consumption, less smartphone storage consumption, and recommendations of healthcare professionals. Conclusions: This research provides implications for research and practice. The posited acceptance model showed a good fit with the empirical data and should be considered in future research. To improve the acceptance of health apps, consonance with users’ needs, improvements in usability and quality, and the incorporation of favorable features are needed. From the WTP perspective, almost half of the respondents were not willing to pay anything for health apps, mostly due to a lack of trust. The attribute valued most by users is security and privacy, suggesting that a complete security system to protect personal health information is critical to the perceived benefits of health apps. From the methodological perspective, DCE was more cognitively demanding than CV approaches. Between the two CV approaches examined, open-ended question was related to less certainty of responses, more zero responses and more conservative responses.