University of South Carolina, 550 Assembly Street, Columbia, SC 29298, USA.
Virginia Tech, 880 West Campus Drive, Blacksburg, VA 24061, USA.
Int J Med Inform. 2021 Jan;145:104295. doi: 10.1016/j.ijmedinf.2020.104295. Epub 2020 Oct 23.
With the advancement of mobile technologies, patients can access medical and patient educational information anytime and anywhere. Computer-aided patient education has been advocated as a key means of interventions for improving patient knowledge and compliance (i.e., adherence). However, evidence of the efficacy of computer-aided patient education remains relatively limited. For example, little is known about how the latest mobile technologies influence patients' compliance intention and their actual compliance behavior. The objective of this study is to investigate patients' compliance intention and behavior using a personalized mobile patient education system (PMPES) as a novel technological intervention for patients based on rational choice theory (RCT) and the theory of planned behavior (TPB).
We conducted a field survey with 125 actual patients in U.S. who obtained their patient education through PMPES while seeking medical treatment advice from their doctors. We used partial least squares (PLS) regression path modeling to test our model.
We found that, based on RCT, the benefits of compliance and cost/threat of noncompliance positively influenced intention toward treatment compliance; in contrast, costs of compliance negatively influenced intention toward treatment compliance. However, the benefits of noncompliance had no effect on intention toward treatment compliance. The results also indicated that intention toward treatment compliance, response efficacy, and self-efficacy related to TPB jointly influenced the degree of actual compliance behaviors. Social influence factors including subjective norms and descriptive norms had no influence on patients' actual treatment compliance behavior.
Overall, the research model explains 69.2 % of the variance in patients' actual compliance behavior. We find our model robust in using RCT as a key theoretical lens for the assessment of patients' compliance intention to follow medical recommendations enabled by the PMPES and delivered to mobile devices. The factors associated with RCT and TPB jointly influence patients' actual compliance behavior. Future mobile patient education programs should consider patients' age groups, mixed-gender groups, different medical settings, and cross-cultural contexts.
随着移动技术的进步，患者可以随时随地获取医疗和患者教育信息。计算机辅助患者教育已被提倡为改善患者知识和依从性（即遵从性）的关键干预措施之一。然而，计算机辅助患者教育的疗效证据仍然相对有限。例如，对于最新的移动技术如何影响患者的遵从意愿及其实际遵从行为，我们知之甚少。本研究旨在基于理性选择理论（RCT）和计划行为理论（TPB），使用个性化移动患者教育系统（PMPES）作为一种新颖的技术干预措施，调查患者的遵从意愿和行为。
我们对在美国接受 PMPES 患者教育的 125 名实际患者进行了实地调查，他们在向医生寻求医疗建议的同时获得了患者教育。我们使用偏最小二乘（PLS）回归路径模型来检验我们的模型。
我们发现，基于 RCT，遵从的益处和不遵从的成本/威胁正向影响治疗遵从意愿；相反，遵从的成本负向影响治疗遵从意愿。然而，不遵从的益处对治疗遵从意愿没有影响。结果还表明，治疗遵从意愿、反应效能和与 TPB 相关的自我效能共同影响实际遵从行为的程度。社会影响因素包括主观规范和描述性规范对患者的实际治疗遵从行为没有影响。
总体而言，研究模型解释了患者实际遵从行为的 69.2%的方差。我们发现，我们的模型在使用 RCT 作为评估 PMPES 提供并发送到移动设备的医疗建议的患者遵从意愿的关键理论视角方面是稳健的。与 RCT 和 TPB 相关的因素共同影响患者的实际遵从行为。未来的移动患者教育计划应考虑患者的年龄组、混合性别组、不同的医疗环境和跨文化背景。
