Design and Validation of a Questionnaire to Measure the Acceptance of Telemedicine by Healthcare Professionals in Germany

Abstract

Background: Telemedicine allows healthcare professionals to manage patient treatments remotely and to benefit from the interaction of telemedicine centers. Even though telemedicine responds to the current burdens in healthcare systems, these complex infrastructures depend on technology, financing, organization, policy, legislation, and, not least, on their corresponding acceptance by the user. Little is known in this context about the drivers for this acceptance by healthcare professionals giving treatment. Germany, with the highest healthcare spending in the world, is particularly lagging here. As there is less focus on guidance for building acceptance constructs, and, in particular, little research on the acceptance of interactive telemedicine by healthcare professionals in Germany, the objective was the collection of the relevant factors influencing German healthcare professionals in the implementation of telemedicine service programs (TSSs). Acceptance constructs were built and operationalized in a questionnaire, taking into consideration the gold standard technology acceptance model of Davis.Methods: A literature review was conducted to identify the acceptance factors that had already been detected and frequently confirmed. These factors were evaluated according to the coverage of the interactive infrastructures with telemedicine centers and how accurately they fitted Germany. The identified factors were adapted, and missing factors were designed, via an idea collection for items. The reliability of the developed constructs was tested using a field test to check the constructs using item revision analysis.Results: Frequently supported external variables, taken from 17 filtered studies covering the technical, organizational, social, legal, and individual context, were identified. However, the review showed that there was less focus on the German setting and the interactive aspect, so the market-related variables were adapted and new constructs of “trust in the telemedicine center” and “relationship to patient” were added. Ten variables were proven to have a reliability, measured with Cronbach’s Alpha, of more than 0.7.Conclusion: This paper enhances the already existing technology acceptance studies in healthcare by covering German specifications and the interactive character of TSSs. A corresponding questionnaire has been developed ready for future research.

Stressors, Resources, and Strain Associated with Digitization Processes of Medical Staff Working in Neurosurgical and Vascular Surgical Hospital Wards: A Multimethod Study

“…One way to measure the usage perception and acceptance of digital technologies, and thus, to also make assumptions about the levels of digital stress, is with the TAM. This model, which is commonly considered the gold standard of instruments to predict technology acceptance, was developed in 1989 by Davis, and is based on two well-established psychological models of behavior, more specifically the theory of planned behavior (TPB) and the theory of reasoned action (TRA) [46][47][48]. The model consists of the two main determinants of "perceived usefulness" (PU) and "perceived ease of use" (PEOU), which, briefly explained, have mediating roles between the external variables, such as the characteristics of the respective technology and the attitude of the user towards the technology and their behavioral intention to use it, which then eventually has an influence on the actual utilization of the technology [47].…”

“…For the assessment of utilization frequency and duration, two self-developed items were utilized, with the one measuring the utilization frequency based on the studies by Hübner [20,74,75]. Additionally, for the query of the attitudes towards the utilized technologies, the two validated construct scales of perceived usefulness (PU) and perceived ease of use (PEOU) from the German version of the technology acceptance model (TAM) were used [46]. Cronbach's alpha values were at 0.875 for the PU scale and at 0.806 for the PEOU scale, thus indicating good to almost very good reliability [46].…”

“…Additionally, for the query of the attitudes towards the utilized technologies, the two validated construct scales of perceived usefulness (PU) and perceived ease of use (PEOU) from the German version of the technology acceptance model (TAM) were used [46]. Cronbach's alpha values were at 0.875 for the PU scale and at 0.806 for the PEOU scale, thus indicating good to almost very good reliability [46]. For more details regarding the utilized scales and items, please find the questionnaire in the annex.…”