Accepted for/Published in: JMIR Formative Research
Date Submitted: Aug 11, 2025
Date Accepted: Jan 23, 2026
Patient Acceptance of Disruptive Technology: An Exploratory Study on the Perceptions of Smart Contracts in Primary Care
ABSTRACT
Background:
Healthcare has seen several new disruptive technologies. One such innovation is the introduction of blockchain smart contracts. These smart contracts are activated automatically once pre-programmed conditions are met. Smart contracts have improved patient outcomes, the efficiency of care delivery as well as reduced costs. Despite their benefits, patients have had limited interactions with smart contacts in primary care; therefore, they may not trust blockchain-based smart contracts and may perceive them as risky or have concerns about their security.
Objective:
This study aimed to evaluate how patient perceptions of smart contracts will impact their adoption in primary care. Specifically, we investigated the impact of patients’ perceptions of smart contract security, risk and patients’ trust in their healthcare providers.
Methods:
This study used an experimental survey design to evaluate patient acceptance of smart contracts. Patients were randomly assigned to one of two research scenarios proposing either the positives using of blockchain smart contracts or the loss of benefits if a patient opted out. We collected data from a total of 387 participants. The Likert survey used three items to explicate five constructs in the conceptual model. The five hypotheses include: Gain/loss framed messaging, perceived security, and trust are hypothesized to have a positive impact on the adoption of smart contracts, whereas perceived risk and the clinical setting are hypothesized to have a negative impact on patient intention to adopt smart contracts. The conceptual model was tested using structural equation modeling (SEM). The model fit indices suggested a good fit.
Results:
Most of our hypotheses were supported, except for the gain/loss framing effect. As hypothesized, perceived security had the strongest positive influence on the intention to use smart contracts at 0.504 (P<.001). Trust in healthcare providers also showed a significant positive relationship (0.433, P<.001), while perceived risk had a smaller but still significant negative impact (-0.071, P=.048). Clinic-based patients had a lower intention to use smart contracts than telehealth patients, and male patients had a lower intention to use smart contracts than females.
Conclusions:
The results of our study have implications for the healthcare providers who intend to adopt early, i.e., the early majority or late adopters of smart contracts. To facilitate their implementation, providers should highlight the security benefits of smart contracts and leverage patient trust. Providers should customize smart contract implementation strategies based on patient demographics such as age, health status, and gender. By understanding these factors, healthcare organizations can more effectively promote the adoption of smart contracts and realize the potential benefits of this disruptive technology in primary care.
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Copyright
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