| Objective Under the background of the "Internet + medical service" policy and the post-epidemic era,Internet diagnosis and treatment services have ushered in opportunities for development.However,at present,the public’s awareness and usage rates of Internet diagnosis and treatment services were low,and there are obstacles to the development of Internet diagnosis and treatment services.User behavior is largely determined by the willingness to use.This study focuses on the application of Internet diagnosis and treatment in stoma care services,and conducts an investigation from the perspective of people in need of health.It aims to explore the influencing factors of their willingness to use Internet diagnosis and treatment services,in order to propose optimization strategies for promoting the development of Internet diagnosis and treatment services.Methods Questionnaire development and reliability and validity testing stage: based on the Unified Theory of Acceptance and Use of Technology（UTAUT）and Dual-factor model,combined with the characteristics of Internet diagnosis and treatment services and the results of interviews with medical staff and colostomy patients,three external variables including trust,e-health literacy and resistance to change were introduced to the model of influencing factors of the willingness to use Internet diagnosis and treatment services for patients with colostomy.The researcher revised and adjusted the questionnaire according to the research object and research situation of this study by reading relevant literatures at home and abroad and drawing from some mature questionnaires or scales.Six experts who were familiar with the field were invited to expert consultation on the initial questionnaire.The content validity index（CVI）of experts was calculated and the opinions and suggestions of experts were integrated to form the revised questionnaire.The internal consistency reliability and face validity of the revised questionnaire were explored through a small sample pre-survey.Finally,the official version of the 《 Questionnaire of Intention to Use of Internet Diagnosis and Treatment Services for Enterostomy》was formed,which contained seven dimensions including performance expectations,effort expectations,social influence,facilitating Conditions,usage intention,trust,and resistance to change.Empirical research stage: 310 patients with enterostomy in gastrointestinal surgery,emergency surgery and wound stoma clinics in three tertiary A-level hospitals in Hefei were selected by convenience sampling to participated in the survey.SPSS 23.0 was used for statistical analysis,and descriptive statistical analysis and normality test were performed on the collected data.AMOS 24.0 was used to develop a structural equation model for path coefficient analysis and hypothesis testing judgment,and the potential error variable control method was used to test common method biases.Bootstrap was used to test he mediating effect of the model.Results Questionnaire development and reliability and validity testing stage: The expert consultation results show that the degree of enthusiasm of experts was 100%,The expert authority was 0.83,and the scale-level content validity index（Scale-level Content Validity Index/average,S-CVI/Ave）was 0.933,the Item-level Content Validity Index（I-CVI）of each item was 0.78 ～ 1,The pre-survey results showed that the overall Cronbach’s alpha coefficient of the revised questionnaire was 0.906,and the Cronbach’s alpha coefficient of each dimension was 0.622～0.910.The revised questionnaire had sound reliability and content validity.Empirical research stage: A total of 310 patients with enterostomy were investigated,and 295 valid questionnaires were obtained.Middle-aged and elderly patients with enterostomy accounted for 93.9% of all patients.（1）The willingness to use Internet diagnosis and treatment services for patients with enterostomy was（3.37±1.31）points,and the average scores of each dimension from high to low were performance expectations（4.08 ± 0.76）points,trust（4.06 ± 0.58）points,and social influence（3.66 ± 1.02）points,enabling conditions（3.80 ± 1.06）points,effort expectations（3.11 ± 1.33）points,resistance to change（3.07 ± 1.29）points,e-health literacy（2.53 ± 1.07）points;There were statistically significant differences in the willingness to use the colostomy patients in terms of gender,age,education,living status,family per capita monthly income,nature of the stoma,and acknowledgement of Internet diagnosis and treatment services（P<0.05）.（2）The model test results show that the Cronbach’s alpha coefficient of each dimension was 0.828～0.970,and the CR was0.825～0.97,the AVE was 0.541～0.901.The correlation coefficients of other dimensions,the convergent validity and the discriminant validity of the measurement model were all up to the standard.The structural model was tested,and the model fitting index reached the standard of fitness;path analysis found that effort expectation,social influence and e-health literacy all had a positive impact on usage intention（P<0.05）,and resistance to changes negatively affected usage intention（P<0.05）.（3）The mediating effect of performance expectation on effort expectation,trust,resistance to change and usage intention was not significant,but effort expectation plays a partial mediating role between e-health literacy and usage intention.Conclusion Resistance to change,social influence,effort expectations and e-health literacy are the key factors influencing the usage intention of Internet diagnosis and treatment services among the colostomy patients.Therefore,advices and suggestions are proposed from the perspective of government,medical institutions,families,technology providers and patients.It is recommended that the aging adaptation and usability testing of service platforms should be paid attention in the future,and Internet skills training and education should be provided for patients to improve their electronic health literacy.Differentiated publicity programs should be adopted for people of different ages,and the interaction between family members and patients should be concerned.Medical staff and patients’ family members should provide continuous technical guidance to patients to reduce the prejudice effect on Internet diagnosis and treatment services. |
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