JMIR Publications

ABSTRACT

Background:

Mobile health portals (MHPs) are becoming increasingly important and prevalent among healthcare organizations for engaging and retaining patients. However, their success hinges on patient adoption and usage. Organizations face ongoing challenges with high adoption but low usage of MHP. While affordance theory offers a valuable theoretical perspective for exploring patient perceptions and uses of MHP, there is a gap in research that empirically investigates the distinct types of affordances and their determinants.

Objective:

This study develops and empirically evaluates an integrated socio-technical research model and hypotheses to bridge the literature gap by connecting theoretical constructs with empirical evidence and practical guidelines to understand patient MHP use. We extend the existing literature by differentiating three MHP affordance types: general, contextual, and behavioral. We examine the effects of patient absorptive capacity and hospital mobile health portal innovativeness on the three types of affordances and their relationships. Based on the integrated socio-technical research model and empirical results, we provide theoretical insights and practical guidelines on how organizations may enhance patient MHP use by enhancing patient absorptive capacity and improving patient-centered designs.

Methods:

We evaluated our research model and hypotheses using survey data from 401 patients regarding a WeChat-based MHP platform in four large urban hospitals in China. We pre-tested the measures via three rounds of Q-sorting, supplemented by field observations, expert reviews, and patient pilot tests. We tested the research model and hypotheses with PLS-SEM using the SmartPLS software.

Results:

General affordance was significantly affected by patient absorptive capacity (b=.191, P<.01) and MHP innovativeness (b=.567, P<.01). Contextual affordance was influenced significantly by patient absorptive capacity (b=.148, P<.01) and general affordance (b=.484, P<.01), but not by MHP innovativeness (b=.036, P>.05). Behavioral affordance was significantly influenced by contextual affordance (b=.430, P<.01) and general affordance (b=.140, P<.01). General affordance and contextual affordance mediate the effects of patient absorptive capacity and the innovativeness of hospital MHP on behavioral affordance.

Conclusions:

Patient absorptive capacity and the innovativeness of MHP in hospitals play distinct roles in predicting the three types of affordances. While the technology innovativeness of MHP affects only general affordance but not contextual affordance, patient absorptive capacity affects both. Yet, contextual affordance is three times more effective in explaining behavioral affordance than general affordance. An unexpected finding related to the only unsupported hypothesis suggests that while the technology innovativeness of MHP is necessary for general affordance, it does not directly influence MHP use, but rather, is indirectly and fully mediated by contextual affordance. Understanding and appropriately managing the contextual affordance of MHP is critical in enhancing patient MHP use. To achieve the benefits of investing in MHPs, organizations must holistically understand and manage the three types of affordances, their determinants, and their relationships.