Skip to main content
Top
Published in: Journal of Medical Systems 1/2023

Open Access 01-12-2023 | Original Paper

Patient Acceptance of Prescribed and Fully Reimbursed mHealth Apps in Germany: An UTAUT2-based Online Survey Study

Authors: Marie Uncovska, Bettina Freitag, Sven Meister, Leonard Fehring

Published in: Journal of Medical Systems | Issue 1/2023

Login to get access

Abstract

The study aims to (1) investigate current levels of patient acceptance of mHealth in Germany; (2) determine the influencing factors of patients' intention to use, and (3) test the influence of prescription and reimbursement status on patient acceptance. Online survey with 1349 participants, of which 1051 were complete and included for statistical analysis, from a broad cross-section of the German population, addressing both users of mobile health (mHealth) applications and people without prior experience. SEM modeling based on a combination of two theoretical frameworks: the extended Unified Theory of Acceptance and Use of Technology and Health Protective Behavior Theories were used to assess acceptance. Users of mHealth in Germany are mostly patients between the ages of 30 – 50 with mental health or endocrine conditions. General willingness to use mHealth apps / DiGAs (mHealth apps fully reimbursed by social health insurance) is high at 76%, especially if they are governmentally certified, however only 27% of respondents were willing to pay out of pocket. With the exception of a spike in performance expectancy and data security, DiGAs lack a clear differentiation from mHealth apps. Perceived self-efficacy and performance expectancy are significant predictors of willingness to use digital health interventions; with age, attitude, and e-literacy being key demographic predictors. A key takeaway for regulators, providers of mHealth apps/ DiGAs, and other stakeholders involved in mHealth adoption is the importance of addressing negative beliefs early on, targeted communication around effortless usage of mHealth services across age groups and demographics, and focus on highlighting expected benefits of mHealth app/ DiGA usage.
Appendix
Available only for authorised users
Literature
2.
go back to reference M. Lingg and V. Lütschg, “Health system stakeholders’ perspective on the role of mobile health and its adoption in the swiss health system: Qualitative study,” JMIR Mhealth Uhealth, vol. 8, no. 5, May 2020, https://doi.org/10.2196/17315. M. Lingg and V. Lütschg, “Health system stakeholders’ perspective on the role of mobile health and its adoption in the swiss health system: Qualitative study,” JMIR Mhealth Uhealth, vol. 8, no. 5, May 2020, https://​doi.​org/​10.​2196/​17315.
3.
go back to reference K. Morton et al., “Using digital interventions for self-management of chronic physical health conditions: A meta-ethnography review of published studies,” Patient Education and Counseling, vol. 100, no. 4. Elsevier Ireland Ltd, pp. 616–635, Apr. 01, 2017. https://doi.org/10.1016/j.pec.2016.10.019. K. Morton et al., “Using digital interventions for self-management of chronic physical health conditions: A meta-ethnography review of published studies,” Patient Education and Counseling, vol. 100, no. 4. Elsevier Ireland Ltd, pp. 616–635, Apr. 01, 2017. https://​doi.​org/​10.​1016/​j.​pec.​2016.​10.​019.
6.
go back to reference WHO Global Observatory for eHealth., mHealth: new horizons for health through mobile technologies: second global survey on eHealth. , vol. 3. World Health Organization, 2011. WHO Global Observatory for eHealth., mHealth: new horizons for health through mobile technologies: second global survey on eHealth. , vol. 3. World Health Organization, 2011.
11.
go back to reference R. S. Palacholla et al., “Provider- And patient-related barriers to and facilitators of digital health technology adoption for hypertension management: Scoping review,” JMIR Cardio, vol. 3, no. 1. JMIR Publications Inc., Jan. 01, 2019. https://doi.org/10.2196/11951. R. S. Palacholla et al., “Provider- And patient-related barriers to and facilitators of digital health technology adoption for hypertension management: Scoping review,” JMIR Cardio, vol. 3, no. 1. JMIR Publications Inc., Jan. 01, 2019. https://​doi.​org/​10.​2196/​11951.
13.
go back to reference YouGov, “Befragung: Apps auf Rezept | SBK,” SBK, 2021. YouGov, “Befragung: Apps auf Rezept | SBK,” SBK, 2021.
17.
go back to reference D. Harborth and S. Pape, “GERMAN TRANSLATION OF THE UNIFIED THEORY OF ACCEPTANCE AND USE OF TECHNOLOGY 2 (UTAUT2) QUESTIONNAIRE,” 2018. D. Harborth and S. Pape, “GERMAN TRANSLATION OF THE UNIFIED THEORY OF ACCEPTANCE AND USE OF TECHNOLOGY 2 (UTAUT2) QUESTIONNAIRE,” 2018.
18.
go back to reference T. Koivumäki, S. Pekkarinen, M. Lappi, J. Vaïsänen, J. Juntunen, and M. Pikkarainen, “Consumer adoption of future mydata-based preventive ehealth services: An acceptance model and survey study,” J Med Internet Res, vol. 19, no. 12, Dec. 2017, https://doi.org/10.2196/jmir.7821. T. Koivumäki, S. Pekkarinen, M. Lappi, J. Vaïsänen, J. Juntunen, and M. Pikkarainen, “Consumer adoption of future mydata-based preventive ehealth services: An acceptance model and survey study,” J Med Internet Res, vol. 19, no. 12, Dec. 2017, https://​doi.​org/​10.​2196/​jmir.​7821.
20.
go back to reference I. M. Rosenstock, “Health Belief Model,” in Encyclopedia of psychology, vol. 4, A. E. Kazdin, Ed. New York: Oxford University Press, 2000, pp. 78–80. I. M. Rosenstock, “Health Belief Model,” in Encyclopedia of psychology, vol. 4, A. E. Kazdin, Ed. New York: Oxford University Press, 2000, pp. 78–80.
23.
go back to reference N. S. Klaver, J. van de Klundert, R. J. G. M. van den Broek, and M. Askari, “Relationship Between Perceived Risks of Using mHealth Applications and the Intention to Use Them Among Older Adults in the Netherlands: Cross-sectional Study,” JMIR Mhealth Uhealth, vol. 9, no. 8, p. e26845, Aug. 2021, https://doi.org/10.2196/26845. N. S. Klaver, J. van de Klundert, R. J. G. M. van den Broek, and M. Askari, “Relationship Between Perceived Risks of Using mHealth Applications and the Intention to Use Them Among Older Adults in the Netherlands: Cross-sectional Study,” JMIR Mhealth Uhealth, vol. 9, no. 8, p. e26845, Aug. 2021, https://​doi.​org/​10.​2196/​26845.
28.
go back to reference W. Boontarig, “Effect of personality factors on attitude towards the adoption of health information via online social networking,” 20th International Computer Science and Engineering Conference: Smart Ubiquitos Computing and Knowledge, ICSEC 2016, 2017, https://doi.org/10.1109/ICSEC.2016.7859897. W. Boontarig, “Effect of personality factors on attitude towards the adoption of health information via online social networking,” 20th International Computer Science and Engineering Conference: Smart Ubiquitos Computing and Knowledge, ICSEC 2016, 2017, https://​doi.​org/​10.​1109/​ICSEC.​2016.​7859897.
30.
go back to reference A. Dzimiera, “Consumer’s Acceptance of Mobile Health Technologies in Germany Consume’s Acceptance of Mobile Health Technologies in Germany,” no. May, p. 69, 2017. A. Dzimiera, “Consumer’s Acceptance of Mobile Health Technologies in Germany Consume’s Acceptance of Mobile Health Technologies in Germany,” no. May, p. 69, 2017.
45.
go back to reference H. O. Woldeyohannes and O. K. Ngwenyama, “Factors Influencing Acceptance and Continued Use of mHealth Apps,” Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), vol. 10293 LNCS, pp. 239–256, 2017, https://doi.org/10.1007/978-3-319-58481-2_19. H. O. Woldeyohannes and O. K. Ngwenyama, “Factors Influencing Acceptance and Continued Use of mHealth Apps,” Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), vol. 10293 LNCS, pp. 239–256, 2017, https://​doi.​org/​10.​1007/​978-3-319-58481-2_​19.
48.
go back to reference A. Adjekum, A. Blasimme, and E. Vayena, “Elements of trust in digital health systems: Scoping review,” Journal of Medical Internet Research, vol. 20, no. 12. JMIR Publications Inc., 2018. https://doi.org/10.2196/11254. A. Adjekum, A. Blasimme, and E. Vayena, “Elements of trust in digital health systems: Scoping review,” Journal of Medical Internet Research, vol. 20, no. 12. JMIR Publications Inc., 2018. https://​doi.​org/​10.​2196/​11254.
51.
go back to reference R. Cudeck and M. Browne, “of Assessing Model Fit: Testing Structural Equation Models,” SAGE, vol. 154, p. 136, 1993. R. Cudeck and M. Browne, “of Assessing Model Fit: Testing Structural Equation Models,” SAGE, vol. 154, p. 136, 1993.
53.
go back to reference B. G. Tabachnick and L. S. Fidell, “Using Multivariate Statistics Title: Using multivariate statistics,” 2019. B. G. Tabachnick and L. S. Fidell, “Using Multivariate Statistics Title: Using multivariate statistics,” 2019.
54.
go back to reference M. Hair, J., Hult, G., Ringle, C. & Sarstedt, A primer on Partial Least Squares Structural Equation Modeling (PLS-SEM). SAGE Publications, 2014. M. Hair, J., Hult, G., Ringle, C. & Sarstedt, A primer on Partial Least Squares Structural Equation Modeling (PLS-SEM). SAGE Publications, 2014.
56.
go back to reference G. Kenny and R. Connolly, “Towards an inclusive world: Exploring m-health adoption across generations,” Proceedings of the 25th European Conference on Information Systems, ECIS 2017, no. September, pp. 1129–1144, 2017. G. Kenny and R. Connolly, “Towards an inclusive world: Exploring m-health adoption across generations,” Proceedings of the 25th European Conference on Information Systems, ECIS 2017, no. September, pp. 1129–1144, 2017.
57.
go back to reference F. Dahlhausen, M. Zinner, L. Bieske, J. P. Ehlers, G. Q. P. Boehme, and L. Fehring, “There’s an app for that , but nobody’s using it : Insights on improving patient access and adherence to digital therapeutics in Germany,” Digital Health, SAGE, vol. 8:1-12, 2022, https://doi.org/10.1177/20552076221104672.CrossRef F. Dahlhausen, M. Zinner, L. Bieske, J. P. Ehlers, G. Q. P. Boehme, and L. Fehring, “There’s an app for that , but nobody’s using it : Insights on improving patient access and adherence to digital therapeutics in Germany,” Digital Health, SAGE, vol. 8:1-12, 2022, https://​doi.​org/​10.​1177/​2055207622110467​2.CrossRef
61.
go back to reference H. Stewart and J. Jürjens, “Data security and consumer trust in FinTech Innovation in Germany Information & Computer Security Data security and consumer trust in FinTech Innovation in Germany Article information :,” Information & Computer Security, vol. 26, no. 1, pp. 109–128, 2018.CrossRef H. Stewart and J. Jürjens, “Data security and consumer trust in FinTech Innovation in Germany Information & Computer Security Data security and consumer trust in FinTech Innovation in Germany Article information :,” Information & Computer Security, vol. 26, no. 1, pp. 109–128, 2018.CrossRef
63.
go back to reference L. Buhr, S. Schicktanz, and E. Nordmeyer, “Attitudes Toward Mobile Apps for Pandemic Research among Smartphone Users in Germany: National Survey,” JMIR Mhealth Uhealth, vol. 10, no. 1, 2022, https://doi.org/10.2196/31857. L. Buhr, S. Schicktanz, and E. Nordmeyer, “Attitudes Toward Mobile Apps for Pandemic Research among Smartphone Users in Germany: National Survey,” JMIR Mhealth Uhealth, vol. 10, no. 1, 2022, https://​doi.​org/​10.​2196/​31857.
Metadata
Title
Patient Acceptance of Prescribed and Fully Reimbursed mHealth Apps in Germany: An UTAUT2-based Online Survey Study
Authors
Marie Uncovska
Bettina Freitag
Sven Meister
Leonard Fehring
Publication date
01-12-2023
Publisher
Springer US
Published in
Journal of Medical Systems / Issue 1/2023
Print ISSN: 0148-5598
Electronic ISSN: 1573-689X
DOI
https://doi.org/10.1007/s10916-023-01910-x

Other articles of this Issue 1/2023

Journal of Medical Systems 1/2023 Go to the issue