Chandra Chanda Razib, Vafaei-Zadeh Ali, Hanifah Haniruzila, Nikbin Davoud, Chang Ruiqi
Graduate School of Business, Universiti Sains Malaysia, Minden, Malaysia.
College of Economics and Political Science, Sultan Qaboos University, Muscat, Oman.
J Health Organ Manag. 2025 Feb 14. doi: 10.1108/JHOM-09-2024-0376.
With the pandemic reshaping healthcare delivery, telemedicine has emerged as a vital solution for overcoming access barriers, particularly in resource-constrained settings. Hence, this study explores the key drivers behind the sustained use of telemedicine services in low-income countries during the post-pandemic period.
DESIGN/METHODOLOGY/APPROACH: Using a quantitative research approach and purposive sampling technique, 273 valid responses were gathered from participants in Bangladesh. A comparative analysis utilizing partial least squares structural equation modeling (PLS-SEM) and fuzzy-set qualitative comparative analysis (fsQCA) were conducted to ensure greater accuracy.
The PLS-SEM analysis revealed that expectation confirmation and perceived ease of use positively influence satisfaction. Similarly, perceived usefulness and perceived ease of use directly impact Attitude toward telemedicine services. However, perceived usefulness and perceived security were not significantly associated with satisfaction and attitude toward telemedicine services, respectively. The findings highlight that user satisfaction drives continuance use intention for telemedicine services, but only when it also cultivates a positive attitude toward telemedicine services. While the PLS-SEM findings indicate that perceived usefulness has no significant relationship with satisfaction and perceived security is not significantly associated with attitude toward telemedicine services, the fsQCA results offer a different perspective. fsQCA reveals that perceived usefulness retains a significant association with satisfaction and that perceived security, regardless of whether its effect is high or low, is equally effective in contributing to the intention for continuous telemedicine use. These findings underscore fsQCA's ability to provide deeper insights into the complex causal relationships among the antecedents.
The findings provide valuable insights for hospitals, doctors and telemedicine providers on retaining existing users. Additionally, governments can leverage this information to address healthcare disparities between urban and rural areas. The study also identifies strategies to reduce costs and improve the efficiency of healthcare services.
ORIGINALITY/VALUE: This study advances telemedicine research by employing the extended technology continuance theory (ETCT) alongside a hybrid analytical approach that integrates PLS-SEM and fsQCA. It highlights that telemedicine organizations can boost patient confidence and encourage continued use by enhancing satisfaction and cultivating a positive user attitude. The innovative use of ETCT and the combined methodologies provide a comprehensive analysis, offering actionable strategies to retain telemedicine users in low-income countries during the post-pandemic period.
随着疫情重塑医疗服务模式，远程医疗已成为克服就医障碍的重要解决方案，尤其是在资源有限的环境中。因此，本研究探讨了疫情后低收入国家持续使用远程医疗服务的关键驱动因素。
设计/方法/途径：采用定量研究方法和目的抽样技术，从孟加拉国的参与者中收集了273份有效回复。利用偏最小二乘结构方程模型（PLS-SEM）和模糊集定性比较分析（fsQCA）进行比较分析，以确保更高的准确性。
PLS-SEM分析表明，期望确认和感知易用性对满意度有积极影响。同样，感知有用性和感知易用性直接影响对远程医疗服务的态度。然而，感知有用性和感知安全性分别与对远程医疗服务的满意度和态度没有显著关联。研究结果表明，用户满意度驱动远程医疗服务的持续使用意愿，但前提是它也要培养对远程医疗服务的积极态度。虽然PLS-SEM的研究结果表明感知有用性与满意度没有显著关系，感知安全性与对远程医疗服务的态度没有显著关联，但fsQCA的结果提供了不同的视角。fsQCA表明，感知有用性与满意度仍有显著关联，并且感知安全性，无论其影响程度高低，在促进持续使用远程医疗的意愿方面同样有效。这些发现强调了fsQCA在深入洞察前因之间复杂因果关系方面的能力。
研究结果为医院、医生和远程医疗服务提供商留住现有用户提供了有价值的见解。此外，政府可以利用这些信息来解决城乡之间的医疗差距。该研究还确定了降低成本和提高医疗服务效率的策略。
原创性/价值：本研究通过运用扩展技术持续使用理论（ETCT）以及整合PLS-SEM和fsQCA的混合分析方法推进了远程医疗研究。它强调远程医疗组织可以通过提高满意度和培养积极的用户态度来增强患者信心并鼓励持续使用。ETCT的创新性应用和综合方法提供了全面的分析，为疫情后低收入国家留住远程医疗用户提供了可操作的策略。
