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Article

Quality Characteristics and Acceptance Intention for Healthcare Kiosks: Perception of Elders from South Korea Based on the Extended Technology Acceptance Model

by
Uk Kim
1,
Taerin Chung
1,* and
Eunsik Park
2
1
Department of Life Sports, Dankook University, 119, Dandae-ro, Cheonan-si 31116, Chungcheongnam-do, Republic of Korea
2
Deparment of Life Sports Education, Kongju National University, Gongjudaehak-ro 56, Gongju-si 32558, Chungcheongnam-do, Republic of Korea
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2022, 19(24), 16485; https://doi.org/10.3390/ijerph192416485
Submission received: 31 October 2022 / Revised: 3 December 2022 / Accepted: 5 December 2022 / Published: 8 December 2022
(This article belongs to the Section Health Care Sciences & Services)
Browse Figures
Versions Notes

Abstract

:
This study aimed to perform a path analysis to understand the effects of quality characteristics on perceived usefulness, perceived ease to use, involvement, and acceptance intention of healthcare kiosks in elderly using the extended technology acceptance model. We performed structural equation modeling (SEM) with data from 300 elderly. The following results were obtained. Firstly, elderly’s perceived quality characteristics of healthcare kiosks had a partial positive effect on perceived usefulness. Secondly, elderly’s perceived quality characteristics of healthcare kiosks had a partial positive effect on perceived ease to use. Thirdly, elderly’s perceived ease to use healthcare kiosks had a partial positive effect on perceived usefulness. In addition, elderly’s perceived usefulness of healthcare kiosks had a positive effect on acceptance intention. Lastly, elderly’s perceived ease to use healthcare kiosks had a positive effect on acceptance intention.

1. Introduction

1.1. Introduction

“Healthcare Device” is a collective term for digitalized equipment used for healthcare, such as watches, scales, and kiosks [1,2]. Of the healthcare devices, healthcare kiosks have been highlighted as a promising in modern society with high potential as a useful technology for elderly who have difficulty with self-care [3,4,5]. Healthcare kiosks specifically refer to rectangular shaped touch screens that are equipped with motion recognition, voice recognition sensors and automatic intelligence, etc. [6] (Figure 1). Healthcare kiosks are also equipped with software. The software enables measurement and analysis of people’s health-related data in real time, so users can manage their own health at home or primary residence without having to visit a hospital or health management center in person. The software installed in healthcare kiosks is equipped with functions that can measure body composition, blood pressure, take electrocardiograms, and cholesterol levels, and physical abilities of the elderly, such as muscle strength, muscular endurance, and cardiorespiratory endurance etc. The first commercialized form of a healthcare kiosk was a wearable device resembling a watch, but its high cost significantly limited its availability [7,8].
In recent years, user-friendly devices that can be used in public places have been developed. The innovative advances in healthcare kiosks are attributable to the fact that the technology promotes active interdisciplinary integration, allowing the creation of a new pioneering market with high profit and diverse opportunities [10,11]. Therefore, this technology is expected to play a pivotal role in driving national growth and enterprise in Korea, a country with one of the highest levels of aging. However, the problem is that it is very challenging to achieve the goal of promoting self-management using kiosks, which are often perceived as being a difficult skill for the elderly, where health care is essential in their daily life [12,13]. In Korea, various forms of kiosks have been developed and implemented in places such as banks, fast food restaurants, airports, and terminals. However, there are concerns about elderly choosing to avoid such novel technology developed to enhance convenience due to usage difficulty.
Therefore, it is essential to examine the elderly’s acceptance of healthcare kiosks. The Extended Technology Acceptance Model (ETAM) is understood as the most useful study model for identifying the usability of innovative technology [14]. The ETAM is a modified version (deletion of Attitude toward using) of the Technology Acceptance Model (TAM) introduced by [15], and the primary components are perceived ease to use, perceived usefulness, and acceptance intention.

1.2. Purpose of Study

This study aimed to analyze the causality between quality characteristics of healthcare kiosks and perceived usefulness, perceived ease of use, and acceptance intention among elderly through a path analysis.

1.3. Hypotheses

The following hypotheses were established to this end (Figure 2):
H1-1. 
Elderly’s perceived service quality of healthcare kiosks will have a positive effect on perceived usefulness of healthcare kiosks.
H1-2. 
Elderly’s perceived system quality of healthcare kiosks will have a positive effect on perceived usefulness of healthcare kiosks.
H1-3. 
Elderly’s perceived information quality of healthcare kiosks will have a positive effect on perceived usefulness of healthcare kiosks.
H2-1. 
Elderly’s perceived service quality of healthcare kiosks will have a positive effect on perceived ease to use healthcare kiosks.
H2-2. 
Elderly’s perceived system quality of healthcare kiosks will have a positive effect on perceived ease to use healthcare kiosks.
H2-3. 
Elderly’s perceived information quality of healthcare kiosks will have a positive effect on perceived ease to use healthcare kiosks.
H3. 
Elderly’s perceived ease to use of healthcare kiosks will have a positive effect on perceived usefulness of healthcare kiosks.
H4. 
Elderly’s perceived usefulness of healthcare kiosks will have a positive effect on acceptance intention.
H5. 
Elderly’s perceived ease to use healthcare kiosks will have a positive effect on acceptance intention.

2. Research Methods

2.1. Research Subjects

To achieve the objective of this study, online and offline questionnaire surveys were administered to panels of 300 elderly participating in the development of a healthcare kiosk. A sample was derived via convenience sampling from the population, and the surveys were administered in person or via the internet. Considering the ongoing COVID-19 pandemic, the first 300 questionnaires were administered via Google Survey at five senior welfare facilities and long-term care hospitals in three cities of the Republic of Korea, and all questionnaires were retrieved. Specifically, 100 paper-based questionnaires and 200 online-based survey links were administered at two senior welfare centers in Seoul and Seongnam, Gyeonggi Province, respectively, and all questionnaires were retrieved. From the collected questionnaires, 31 inappropriate surveys such as incomplete surveys, answering wrong numbers, missing questions, careless responses like returning the paper very quickly for rewards, were excluded. A total of 269 questionnaires were included in the analysis. Table 1 shows the demographic characteristics of the participants.

2.2. Research Tools

A questionnaire was used as the survey method. Table 2 contains the summarized questionnaire scale.

2.3. Analysis Procedure

The collected data were analyzed using SPSS 230.0 and AMOS 210.0. Specifically, SPSS 230.0 was used for the frequency analysis to analyze demographic characteristics, and reliability and correlation analysis were performed to test the questionnaire’s reliability and multicollinearity, respectively. AMOS 21.0 was used for confirmatory factor analysis (CFA) to establish the validity of the latent variables to test the validity between factors, the causal relationships between variables, and the hypothesis. After checking the parameter estimates and GOF (Goodness of Fit) of the measurement model based on the values of the CFI (comparative fit index), TLI (Tucker–Lewis Index), and RMSEA (Root Mean Square Error of Approximation), the validity between the observation and latent variables was tested. Lastly, hypothesis were accepted or refused by testing the causal relationships between the variables for the structural modeling analysis.

2.4. The Validity and Reliability of the Measured Variables

The internal validity of each study variable was assessed by the CFA. During this process, four items (two items in service quality, one in easy to use, and one in usefulness) were determined to diminish internal validity and thus were excluded. The results are shown in Table 3.
The internal validity results for each variable were applied to the overall model, and the discriminant validity and reliability of each variable were evaluated. Discriminant validity can be evaluated based on construct reliability (CR) and average variance explained (AVE), where discriminant validity is considered established with ≥0.500 and 0.700, respectively. Reliability is evaluated using Cronbach’s α. In general, a Cronbach’s α of 0.700 or higher is considered to indicate good reliability. The CR, AVE, and Cronbach’s α values are shown in Table 4.

3. Results

3.1. The Results of Correlation Analysis

The relationships among elderly’s perceived quality characteristics of healthcare kiosks, ease of use, usefulness, and acceptance intention were analyzed with the Pearson correlation analysis. The results are shown in Table 5. The correlations among each variable were below 0.700, confirming the absence of multicollinearity.

3.2. Results of the Structural Modeling Analysis

To achieve the procedure and goals designed in this study, the fit of the overall model was analyzed. The fit indices were: χ2 of 479.153, df of 365, TLI of 0.964, CFI of 0.968, and RMSEA of 0.034. The results are shown in Table 6.

3.3. Results of Hypothesis Verification

The results of hypothesis testing are shown below (Figure 3). H1-1, pertaining to the path from service quality of healthcare kiosks to perceived ease to use, was rejected (t = 1.351). H1-2, pertaining to the path from system quality of healthcare kiosks to perceived ease to use, was accepted (t = 2.814, p < 0.01). H1-3, pertaining to the path from information quality of healthcare kiosks to perceived ease to use, was rejected (t = 1.033). H2-1, pertaining to the path from service quality of healthcare kiosks to perceived usefulness, was accepted (t = 2.304, p < 0.05). H2-2, pertaining to the path from system quality of healthcare kiosks to perceived usefulness, was accepted (t = 3.362, p < 0.001). H2-3, pertaining to the path from information quality of healthcare kiosks to perceived usefulness, was rejected (t = −0.432). H3, pertaining to the path from perceived ease to use healthcare kiosks to perceived usefulness, was accepted (t = 2.675, p < 0.01). H4, pertaining to the path from perceived usefulness of healthcare kiosks to acceptance intention, was accepted (t = 3.830, p < 0.001). H5, pertaining to the path from perceived ease to use healthcare kiosks to acceptance intention, was accepted (t = 2.014, p < 0.05). These results are delineated in Table 7.

4. Discussion

Some points of discussion, drawn up according to the results of the study are summarized.
First, elderly demonstrated intention to accept healthcare kiosks if they perceived the kiosk services as easy to use. These kiosks, including the software and its services, can be defined as adding structure and technology to elderly’s perceived services to use kiosks and enhances their understanding and expectations [18,19]. In Korean culture, the ease to use and understand kiosk services for the elderly is understood as being able to obtain the desired services with the help of an assistant [20,21]. This is the reason why the Korean government issues a certificate for guiding physical activities and sports in the elderly in Korea with the title of “National Sports Instructor for the Elderly of Korea” (Figure 4). In recent years, the expansion of service industries, such as the functioning of the device for an auxiliary role or a manpower training business, for internationally, could be understood in the same context [22,23]. Thus, it can be said to have been proven that easily understood and were motivated to accept using healthcare kiosks in the presence of a service providing a helper to guide them through the technology. Therefore, elderly’s intentions in adopting the technology with the technological development of a health care device like health kiosk, should be improved to make health care more effective [24,25,26]. To accomplish this, fostering and training an assistive personnel industry and improving the accessibility of the industry that is supposed to be invested in boosting healthcare kiosks, is required.
Second, were motivated to accept healthcare kiosks if they perceived these to be easy to use and useful in their daily lives. Healthcare kiosks are state-of-the art machines that are aimed at promoting health management among elderly, as well as the entire human population, more effectively [2,3,27]. Therefore, the system is quickly being advanced and becoming more sophisticated [28]. Many scholars have already substantiated that user utilization declines if system quality deteriorates [29,30]. However, this applies only to the majority younger generations or very tiny number of elderly who can adapt to system advances easily. Specifically, it might be impossible for elderly to keep abreast of, and fully utilize, scientific advances of operating systems, and study findings support such hypothesis [31,32]. Hence, healthcare kiosks using systems that consider the level of cognitive and adaptive capacities of elderly must be developed. In this context, it would be more appropriate to develop basic and convenient devices, as opposed to highly advanced technologies using artificial intelligence or the meta-verse. A launch of an ATM service for at a bank in Korea is a good example (Figure 5).
Third, it is difficult to motivate to accept healthcare kiosks through their perceived information quality of kiosks. These results vividly demonstrate the challenges face in using these kiosks, which is an emerging societal issue [33,34]. Specifically, at the point of this research the results were interpreted as the elders remembering that the information provided by healthcare kiosks that they experienced were mostly difficult to understand and impractical to them. Thus, to inspire elderly to accept healthcare kiosks, they should be filled with information that is easy to understand and applicable in their daily lives, to instill a positive memory of kiosks [35,36].

4.1. Conclusions

Amid the super-aging of human societies across regions and cultures, health management among elderly holds significance in enhancing human quality of life. Thus, a variety of innovative devices have been developed to facilitate a scientific approach to human health management, and healthcare kiosks have been highlighted as an innovative technology to maximize the effectiveness of health management. However, there are doubts about the effectiveness of these healthcare kiosks. This is because physical and cognitive aging of humans hinder individuals to keep abreast with scientific advances, and this gap is widening. Moreover, healthcare kiosks equipped with more specialized systems, services, and information would be more challenging to use by who have difficulty utilizing more basic and convenient kiosks in airports, restaurants, and movie theaters.
Therefore, we determined that it is essential to investigate what features of healthcare kiosks would motivate to accept the technology, and we have achieved our goal to some degree. We hope that our findings serve as important data for developing health management devices not only for elderly but for the entire human race.

4.2. Limits of Study

This study has a few limitations.
First, the study participants only comprised aged 65 years and over. Thus, generalizing the findings to the entire age group may cause significant errors. Subsequent studies should expand the age group of the study population.
Second, the healthcare device of interest in this study was kiosks. Thus, the findings cannot be generalized to other smart devices, such as watches and tablets. Future studies could consider expanding the scope of healthcare devices.
Third, the questionnaire responses were dependent on elderly’s experiences with kiosks. Thus, the findings cannot be applied to other forms of kiosks or healthcare devices to be developed.

Author Contributions

Conceptualization, U.K., T.C. and E.P.; methodology, T.C.; software, T.C.; validation, formal analysis, U.K. and T.C.; investigation, U.K.; resources, U.K.; data curation, U.K.; writing—original draft preparation, U.K. and T.C.; writing—review and editing, U.K., T.C. and E.P.; project administration, T.C. and U.K.; and funding acquisition, U.K. and E.P. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

This research received an informed consent statement from all research subjects.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

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Ijerph 19 16485 g001 550
Figure 1. Image of a Healthcare Kiosk [9].
Figure 1. Image of a Healthcare Kiosk [9].
Ijerph 19 16485 g001
Ijerph 19 16485 g002 550
Figure 2. Research Model.
Figure 2. Research Model.
Ijerph 19 16485 g002
Ijerph 19 16485 g003 550
Figure 3. Research Results.
Figure 3. Research Results.
Ijerph 19 16485 g003
Ijerph 19 16485 g004 550
Figure 4. Recruiting Advertisement for Sports Instructor Certificate for the Elderly in Korea.
Figure 4. Recruiting Advertisement for Sports Instructor Certificate for the Elderly in Korea.
Ijerph 19 16485 g004
Ijerph 19 16485 g005 550
Figure 5. Image of ATM Kiosk Screen of a Bank in Korea.
Figure 5. Image of ATM Kiosk Screen of a Bank in Korea.
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Table
Table 1. Demographic Analysis of Research Subjects.
Table 1. Demographic Analysis of Research Subjects.
ContentsFrequencyPercentages
GenderMale12847.6
Female14152.4
Ages60~65 6523.8
66~704416.7
70~756821.6
76~804215.6
81~853011.2
86~90124.5
Higher than 90186.7
Self
Health
Evaluation		Very Good5721.2
Good4115.2
I don’t know well7026.0
A Bit Bad4316.0
Very Bad5821.6
EducationMiddle School8632.0
High School16059.9
College124.5
Grad School114.1
DisabilityRegistered Disabled3412.6
Not Disabled21981.4
Nonregistered Disabled166.0
Total269100.0
Table
Table 2. Research Tools.
Table 2. Research Tools.
VariablesSub-variables# of QuestionsReferences
Quality CharacteristicsService Quality6[16]
System Quality4
Information Quality5
Ease to Use6[14]
Usefulness6[14]
Acceptance Intention6[16,17]
Table
Table 3. Results of Confirmative Factor Analysis II.
Table 3. Results of Confirmative Factor Analysis II.
VariablesEarly QsFinal Qsχ2dfTLICFIRMSEA
Quality
Characteristics		Service Q64117.778620.9470.9580.058
System Q44
Information Q 55
Ease to Use6512.10350.9790.9900.070
Usefulness6512.65550.9730.9850.076
Acceptance Intention6617.59190.9800.9880.060
Total3329478.4113620.9630.9670.035
Table
Table 4. Results of Confirmative Factor Analysis II and Reliability Analysis.
Table 4. Results of Confirmative Factor Analysis II and Reliability Analysis.
VariablesContentsEstSECRAVEα
Service
Quality		1. The device runs fast.0.7680.3020.5400.8240.819
2. The connection speed is high. 0.7080.296
3. The device has effective features. 0.7190.333
6. It is easy to access information.0.7420.380
System
Quality		7. It responds quickly. 0.7540.2770.5360.8220.822
8. It provides information relevant to me. 0.7690.354
9. I can expect my desired service. 0.6880.354
10. I think it will continue to provide the same services as now.0.7150.394
Information
Quality		11. Information is accurate. 0.7130.3050.5230.8450.812
12. Information is clear. 0.7610.389
13. Adequate information is provided. 0.7350.311
14. Most up-to-date information is provided. 0.7470.428
15. It is useful for obtaining information.0.6540.410
Ease
to
Use		16. I can learn things more easily. 0.7390.2480.5600.8640.865
17. It allows me to control things I wish to do. 0.7250.230
18. I can do what I wish to do with more flexibility. 0.7290.255
19. It allows to me to achieve what I want to do with skills. 0.7640.292
21. I can learn things I want to learn more easily. 0.7840.342
Usefulness22. I can do things I want to do more quickly. 0.7750.3040.5650.8660.864
24. It makes good outcomes. 0.7730.359
25. It is efficient. 0.7730.358
26. It is effective. 0.7350.322
27. It is useful for doing things I want to do.0.7000.292
Acceptance
Intention		28. I will use it again in the future. 0.7370.3200.5510.8600.881
29. I will recommend it to others. 0.7300.300
30. I will use this as my go-to device for learning. 0.7360.275
31. I will accept the information provided0.7560.266
32. I will search the provided information. 0.7510.303
33. I will recommend the provided information to others. 0.7560.314
χ2= 478.411, df = 362, TLI = 0.963, CFI = 0.967, RMSEA = 0.035
Table
Table 5. Results of Confirmative Factor analysis and Reliability Analysis.
Table 5. Results of Confirmative Factor analysis and Reliability Analysis.
SystemServiceInformationUsefulnessEaseAcceptance
System Quality1
Service Quality0.688 **1
Information Quality0.133 *0.1041
Usefulness0.564 **0.522 **0.1131
Ease to Use0.585 **0.524 **0.0820.539 **1
Acceptance Intentions0.326 **0.248 **0.0880.371 **0.323 **1
* p < 0.05, ** p < 0.01.
Table
Table 6. Fit of Entire Model.
Table 6. Fit of Entire Model.
Model #χ2dfTLICFIRMSEA
1479.1533650.9640.9680.034
Table
Table 7. Results of Analysis on direct Effects.
Table 7. Results of Analysis on direct Effects.
HPathEstSETResults
1-1Service Quality→Usefulness0.1460.1081.351Rejected
1-2System Quality→Usefulness0.3570.1272.814 **Accepted
1-3Information Quality→Usefulness0.0660.0641.033Rejected
2-1Service Quality→Ease to Use0.2830.1232.304 *Accepted
2-2System Quality→Ease to Use0.4650.1383.362 ***Accepted
2-3Information Quality→Ease to Use−0.0310.03−0.432Rejected
3Ease to Use→Usefulness0.2020.0762.675 **Accepted
4Usefulness→Acceptance Intention0.3350.0883.830 ***Accepted
5Easy to Use→Acceptance Intention0.1530.0762.014 *Accepted
* p < 0.05, ** p < 0.01, *** p < 0.001.
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Kim, U.; Chung, T.; Park, E. Quality Characteristics and Acceptance Intention for Healthcare Kiosks: Perception of Elders from South Korea Based on the Extended Technology Acceptance Model. Int. J. Environ. Res. Public Health 2022, 19, 16485. https://doi.org/10.3390/ijerph192416485

AMA Style

Kim U, Chung T, Park E. Quality Characteristics and Acceptance Intention for Healthcare Kiosks: Perception of Elders from South Korea Based on the Extended Technology Acceptance Model. International Journal of Environmental Research and Public Health. 2022; 19(24):16485. https://doi.org/10.3390/ijerph192416485

Chicago/Turabian Style

Kim, Uk, Taerin Chung, and Eunsik Park. 2022. "Quality Characteristics and Acceptance Intention for Healthcare Kiosks: Perception of Elders from South Korea Based on the Extended Technology Acceptance Model" International Journal of Environmental Research and Public Health 19, no. 24: 16485. https://doi.org/10.3390/ijerph192416485

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