個人健康記錄系統使用意向之影響因素探討

Abstract

背景：個人健康記錄系統(PHR System)係一個可幫助民眾管理其個人健康記錄之工具，此系統除了可協助民眾記錄與儲存個人健康相關資訊，尚包括其他工具可輔助個人做健康決策，並增進與醫療專業人員之互動，因此，PHR系統不僅對病人之疾病有幫助，亦可協助個人管理並維持健康。PHR之概念近年來廣受歐美各主要國家及我國政府的重視，因此PHR系統之實現已是指日可待。然而，系統是否能真正發揮功效，乃決定於民眾對此系統之接受與使用程度。因此，瞭解使用者對於PHR系統之看法與態度，以做為政府以及醫療機構未來發展與推動之參考，係目前PHR系統發展與規劃初期相當重要之課題。 目的：本研究之主要目的在於瞭解民眾對PHR系統記錄內容與系統功能之看法以及偏好之儲存媒介，並以TAM為基礎，發展適當之模式以探討影響民眾PHR系統之知覺有用性、知覺易使用性、系統安全性信任、資料安全考量等各項知覺與使用意向之相關因素。 方法：本研究係採立意取樣之方式，以至台北市某醫學中心地下商場購物或用餐之18歲以上民眾為對象，利用結構式問卷調查民眾對於PHR系統記錄內容與應具備功能之看法，以及其對系統之相關知覺、使用意向、與可能之影響因素等相關資訊；其次，則利用結構方程模式進行分析，探討民眾對PHR系統之知覺有用性、知覺易使用性、系統安全性信任與資料安全考量等知覺構面對其系統使用意向的影響；以及人口變項、健康狀況、電腦自我效能以及主觀規範等因素對各知覺構面與系統使用意向之影響。 結果：本研究共回收607份有效問卷。研究結果顯示大部分之民眾均願意記錄或保存自己的疾病及用藥相關資訊，且樂於與醫師分享。而民眾所偏好之PHR系統儲存媒介前四項依序為隨身儲存裝置、個人電腦並備份於隨身儲存裝置、網站、網站並備份於隨身儲存裝置；大專以上學歷者有較多之比率偏好將PHR儲存在網路上、個人電腦並備份於隨身儲存裝置、以及網站並備份於隨身儲存裝置。此外，45歲以上之民眾有較高之比率選擇不想儲存或以紙本型式儲存其健康資訊，而44歲以下之民眾則有較高之比率偏好將其健康記錄儲存在網路上。 在民眾對PHR系統之各項知覺、使用意向與相關影響因素方面，民眾對PHR系統之知覺有用性持正向之態度，其主要受民眾對PHR系統之系統安全性信任、資料安全考量、電腦自我效能、知覺易使用性、以及主觀規範等因素所影響；在知覺易使用性方面，電腦自我效能與系統安全性信任對民眾PHR系統之知覺易使用性有顯著之正面影響，而年齡則有顯著之負面影響；在系統安全性信任方面，民眾對於PHR系統之安全性仍存有些許疑慮，而主觀規範、電腦自我效能對系統安全性信任有顯著之正面影響，教育程度則有顯著之負面影響；在資料安全考量方面，民眾對PHR系統內之資料安全仍存有相當之疑慮，且年紀愈輕之民眾對PHR系統之資料安全考量愈高；最後，在使用意向方面，本研究相關變項共可解釋使用意向50%之變異，其中知覺有用性、主觀規範、知覺易使用性以及系統安全性信任等四個變項對使用意向有顯著且正面之直接影響，而電腦自我效能雖對PHR系統之使用意向沒有直接影響，但卻透過知覺有用性、知覺易使用性與系統安全性信任對使用意向產生相當大之間接效用。 結論：民眾對PHR系統之使用意願會受知覺有用性、知覺易使用性、主觀規範、系統安全性信任以及電腦自我效能之影響，因此將來在PHR系統之設計上應力求系統介面簡單、容易操作；在推廣策略之研擬上則可加強宣導PHR系統所記錄之資訊內容與所具備之功能，強調其在民眾健康照護與管理上所能提供之助益，並顧及電腦自我效能較低之民眾，透過短片或簡報等媒介以簡單、易懂之方式向民眾示範PHR系統之操作，以提升民眾之系統操作能力與信心，若能再配合醫護相關工作人員之鼓勵，相信可獲得更大之成效。此外，在PHR系統發展與推廣之同時，亦應透過法令之規範、賦予民眾對相關資訊使用之同意權以及PHR系統明確之資料安全保護聲明等方式，降低民眾對於PHR系統之安全性疑慮，提高其使用意願。

Background: Personal Health Record System (PHR system) is a person-centered tool through which individuals can access, manage and share their health information with whom they are authorized. It is designed to manage one’s health information and support health decisions, and is a tool that can be helpful in managing health and wellness as well as illness. Many governments including U.S., European Union and our country have paid much attention on the concept of PHR and PHR systems. But the efficacy of the system depends on individuals’ acceptance and usage. Objectives: The objectives of the study are two folds: 1) to understand individuals’ opinions on contents and functions of PHR systems as well as preferred mediums of PHR systems, and 2) applying revised technology acceptance model (TAM) to examine the determinants of individuals’ perceived usefulness, perceived ease of use, confidence in security of PHR systems, data security concerns, and use intention toward PHR systems. Methods: Subjects for the study were the customers aged 18 and more in the bazaar of a medical center in Taipei, and data was collected by interviews with a structured questionnaire. The structure equation modeling technique was used to evaluate the effects of perceived usefulness, perceived ease of use, confidence in system security, and data security concerns on use intention of PHR systems, and the effects of demographics, health condition, computer self-efficacy, and subjective norms on the perceptions and use intention of PHR systems. Results: There were 607 valid samples returned. The results indicate that most people want to reserve their health care information, and love to share with their doctors. The preferred medium of PHR system is portable flash memory devices, followed by personal computers with a copy in portable electronic devices, internet, and internet with a copy in portable electronic devices. Compared with their counterparts, individuals with college or higher education levels are more willing to store and access their health information through internet and computer-related devices than through paper tracking. While individuals age 45 and older prefer to store and access their health information through paper tracking or not to keep it, those age 44 and younger prefer internet more. Participants perceived PHR systems are useful, and individuals’ perceived usefulness of PHR systems is affected by confidence in system security, data security concerns, computer self-efficacy, perceived ease of use, and subjective norms. The perceived ease of use of PHR systems is positively affected by computer self-efficacy and confidence in system security, and negatively affected by age. Nevertheless, participants do not have full confidence in the security of PHR systems. The confidence in system security of PHR systems is positively affected by subjective norms and computer self-efficacy, and negatively affected by education. Furthermore, participants worry about the data security of PHR systems to a considerable extent, and younger persons concerns their data security more. The model as a whole explains 50% of the variances in PHR system use intention. The perceived usefulness, subjective norms, perceived ease of use and confidence in system security significantly and directly affect use intention of PHR systems, and computer self-efficacy indirectly affect use intention of PHR systems through perceived usefulness, perceived ease of use, and confidence in system security. Conclusions: The use intention of PHR systems is affected by perceived usefulness, perceived ease of use, subjective norms, confidence in system security, and computer self-efficacy. Hence, when designing PHR systems, it should be assured that the interface is simple and easy to use. When promoting PHR systems, the contents and functions of PHR systems and its benefits to one’s health and healthcare should be addressed. Moreover, the use of PHR systems should be demonstrated in simple and understandable ways to increase individuals’ ability and confidence in using PHR systems, especially for those with lower computer self-efficacy. Besides, government should eliminate individuals’ security concerns about PHR systems by means of enhancing relevant regulations to protect the consumer’s right of consents to information use and to pronounce the accountability of PHR system vendors with respect to privacy and data security. Consequently, individuals’ use intention of PHR systems will be accelerated.