DISCUSSION
The results suggest that COVID-19 anxiety has a positive effect on
willingness to try telediagnostics, intention to use it and satisfaction
with currently available e-health services, confirming hypotheses H1, H2
and H3. However, it should be noted that the negative effect of mistrust
in e-health and technology is also demonstrated (hypotheses H4 and H6),
and the coefficient is higher in both cases, i.e. fear of coronavirus
alone is not sufficient to overcome techno-phobia.
Hypothesis H5 must be rejected, as distrust of technology and e-health
does not affect intention to use. This is presumably because the
intention to use implies a complete switch to telediagnostics, whereas
the intention to try is essentially a one-off, requiring a completely
different level of commitment. In the former case, face-to-face contact
with doctors would be virtually absent, which could make the process
impersonal, and the patient-doctor bond and trust would be lost. Several
studies [8, 20, 31] have highlighted the importance of the latter:
appropriate doctor-patient communication, friendliness, emotional
support or even explaining test results in a simple, understandable way
have greatly improved patient satisfaction.
This is probably why mistrust of e-health and technology was not
significant and why technological readiness had a negative impact on
intention to use. This question does not focus on the technological
shortcomings of the services, but on whether the individual would forego
the traditional but intimate doctor-patient relationship, which has a
major impact on satisfaction. In fact, for those who were more
technology-savvy and had more experience with Hungarian e-health
services - the logistic regression model clearly showed that they were
more likely to have tried services such as EESZT - technological
proficiency was associated with a negative sign, i.e. they were even
less willing to give up the personal doctor-patient relationship.
Hypotheses H7 and H8 must therefore be rejected, as technological
literacy has no positive effect on either intention to use or
willingness to try.
As expected and in line with the literature, positive attitudes had a
significant positive effect on intention to use and willingness to try
telediagnostics, as well as satisfaction with the services tried, so
that hypotheses H11, H12 and H13 can be accepted. The positive effect of
individual benefits on intention to try and willingness to use (H9) also
confirmed expectations, while the expected social benefits were not
significant in any of the models (H10 is therefore rejected). This is
not surprising, as perceived social benefits have not been reported as a
relevant factor in the literature, in contrast to e.g. social pressure
[11, 26, 54] - it will be useful to include the phenomenon of
perceived social pressure in future research on e-health.
It is clear that the uncertainty and fear caused by the pandemic has had
a positive impact on perceptions of e-health and may increase the
willingness to try new technologies. However, it is unlikely to be
enough on its own to achieve widespread acceptance of e-health. Mistrust
of the technology seems to be a more relevant factor in the results, and
positive attitudes and perceived individual benefits seem to have a
greater positive impact. Therefore, it would be useful to launch
awareness campaigns that point out the personal benefits of e-health in
an easily understandable and clear way, and dispel the general mistrust
of the technology.
It should also be noted that the sample is not representative of the
society of the Central European country analysed, so there are obvious
limitations. The survey used random sampling, which meant that our
sample consisted mainly of young people with an average/above-average
standard of living. This is probably the reason why several demographic
variables (education, income, place of residence) did not reach
significance, and it would be desirable to repeat the data collection in
the future with a representative sample by gender, age and region.
Alternatively, it would be more useful to look at the effects of
perceived social pressure rather than social benefits, and it may be
interesting to see how e-health and perceptions of available services
have changed in almost a year since our sample was taken and the
pandemic restrictions were lifted.