International Journal of Information Management 49 (2019) 58–68

Contents lists available at ScienceDirect

International Journal of Information Management

journal homepage: www.elsevier.com/locate/ijinfomgt

Mobile technology identity and self-efficacy: Implications for the adoption T

of clinically supported mobile health apps
⁎
Ali Balapoura, Iris Reychavb, , Rajiv Sabherwala, Joseph Azuric
a
Department of Information Systems, Sam M. Walton College of Business, University of Arkansas, Fayetteville, AR, 72701, USA
b
Department of Industrial Engineering & Management, Ariel University, P.O.B 40700, Ariel, Israel
c
Sackler Faculty of Medicine, Tel Aviv University and Maccabi Healthcare Services, Israel

A R T I C LE I N FO A B S T R A C T

Keywords: Despite smartphone applications (apps) being key enablers of telemedicine, telehealth, and self-monitoring,
mHealth apps adoption issues persist for mobile healthcare (mHealth) apps. This study diverged from the traditional adoption
IT identity approach and drew on more innovative theories to predict the intentions of patients for adopting apps supported
Self-efficacy by clinics. More specifically, technology identity literature was explored to make this prediction and the study
Mobile technology identity (MTI)
surveyed 292 patients who were seated in the waiting room of a local clinic. The results suggested that perceived
Mobile apps
mobile technology identity (MTI), perceived related IT experience, and perceived self-efficacy positively influ-
ences patients’ perceived intentions to adopt mHealth apps provided by clinics or hospitals. Furthermore, the
results suggested that perceived related IT experience positively influences users perceived self-efficacy and
perceived MTI. However, education was found to negatively influence patients’ perceived intentions to use
mHealth apps. This study contributes to the growing literature on the use of these apps in trying to elevate the
quality of patients’ lives. Moreover, there are implications for mHealth-app designers who are trying to make
healthcare services accessible via smartphones.

1. Introduction
Mobile devices are contributing greatly to the improvement of
people’s lifestyles and healthcare delivery (Faiola, Papautsky, & Isola,
2018). This significant change has taken place for two reasons: first,
smartphone use has become much more widespread as a result of being
affordable and accessible to many classes of society; second, their
computational power has improved so significantly that many apps can
now be developed and offered to enhance healthcare delivery to pa-
tients (Kaphle, Chaturvedi, Chaudhuri, Krishnan, & Lesh, 2015;
Petrovčič, Rogelj, & Dolničar, 2018). Therefore, it can easily be ob-
served that over 325,000 mHealth apps are available at all major app
stores (Research2Guidance, 2017) in several health-related categories
such as fitness, cardiology, diabetes, obesity, smoking cessation, and
chronic diseases (Silva et al., 2015). The benefits of using such apps are
many for both patients and healthcare providers: for delivering care
and monitoring patients remotely, saving time, and reducing costs
(Reychav, Kumi, Sabherwal, & Azuri, 2016; Shin, Lee, & Hwang, 2017;
Silva et al., 2015).
Smartphone apps are unrivaled enablers of telemedicine, telehealth,
and self-monitoring (Reychav et al., 2019; Weinstein et al., 2014). The
majority of healthcare providers lack the time to provide patients with
the continuous care necessary to manage chronic diseases (Quinn et al.,
2008), so mHealth apps can potentially compensate for this issue
(Deng, Hong, Ren, Zhang, & Xiang, 2018). By extension, clinics can use
mHealth apps for direct monitoring of patients, drug-referencing, de-
cision support, electronic health records, medical education, and so
forth (Boulos, Brewer, Karimkhani, Buller, & Dellavalle, 2014). For
example, apps such as InpharmD, which is adopted by some physicians,
will help practitioners to make quicker pharmacological decisions,
particularly in complex cases where they must spend a lot of time
searching for answers to technical questions about drugs in order to
avoid prescribing the incorrect medication or dosage (Wicklung, 2018).
Similarly, mHealth apps that are designed for self-monitoring can save
patients from visiting clinics and also save physicians’ time with un-
necessary checkups which can instead be done through mobile-enabled
computing (Mendiola, Kalnicki, & Lindenauer, 2015). As previously
stated, there are thousands of healthcare apps available online which
are attempting to push for improvements in the current state of
healthcare (Veríssimo, 2018). Nevertheless, the issue regarding

⁎
Corresponding author.
E-mail addresses: ABalapour@walton.uark.edu (A. Balapour), irisre@ariel.ac.il (I. Reychav), RSabherwal@walton.uark.edu (R. Sabherwal),
azuri_yo@mac.org.il (J. Azuri).

https://doi.org/10.1016/j.ijinfomgt.2019.03.005
Received 20 October 2018; Received in revised form 14 March 2019; Accepted 14 March 2019
0268-4012/ © 2019 Elsevier Ltd. All rights reserved.
A. Balapour, et al.
adoption in mHealth apps persists (Kwon, Mun, Lee, McLeod, &
D’Angelo, 2017).
The adoption literature, even though widely discussed, falls behind
in representing and predicting the adoption of these apps, as a phe-
nomenon, for two reasons. First, it could be argued that adoption
models in the mHealth context have relied heavily on traditional
adoption theories such as Theory of Reasoned Action (TRA; Fishbein &
Ajzen, 1975; Zhang, Guo, Lai, Guo, & Li, 2014), Technology Acceptance
Model (TAM; Davis, 1989; Deng et al., 2018; Dou et al., 2017) and
Unified Theory of Acceptance and Use of Technology (UTAUT; Hoque &
Sorwar, 2017; Venkatesh, Morris, Davis, & Davis, 2003) with minimal
modification to the original framework in the form of introducing new
contextual variables (for example: Kwon et al., 2017; Lee & Cho, 2017;
Lee, Han, & Jo, 2017; Quaosar, Hoque, & Bao, 2018; Yuan, Ma,
Kanthawala, & Peng, 2015). Meanwhile, users’ internet behavior, in-
formation consumption, and digital media use have shifted significantly
(Beaunoyer, Arsenault, Lomanowska, & Guitton, 2017). Second, some
studies on mHealth apps have collected samples that are not re-
presentative of the target population, including students or occasional
app users who may or may not be patients (Kwon et al., 2017; Lee &
Cho, 2017; Lee et al., 2017; Quaosar et al., 2018; Yuan et al., 2015).
While traditional literature can explain patients’ intentions to adopt
mHealth apps, there are other overarching concepts that may play a
role, especially in the mobile context, such as technology identity
theory (Carter & Grover, 2015). The purpose of this study, therefore,
was to address these gaps.
Against this backdrop, the above issues will be discussed and an
adoption model for mHealth apps will be proposed that is clinically
supported and which connects patients with clinics and physicians
using IT identity theory (Carter & Grover, 2015) and self-efficacy
(Compeau & Higgins, 1995). Mobile technology is becoming an integral
part of the individual’s self-identity and such a phenomenon is affecting
people’s daily lives, decisions, and behavior (Alahmad, Carter, Pierce, &
Robert, 2018; Carter & Grover, 2015; Carter, Grover, & Thatcher,
2016). Recent works show that MTI theory which builds on IT identity
theory is a relevant lens through which to explain the interaction of
patients with mHealth apps (Reychav et al., 2019). In thus study, MTI
refers to the extent to which an individual views use of mobile tech-
nology as integral to his or her sense of self (Carter & Grover, 2015).
Thus, creating opportunities for further application of this theory in
mHealth studies. In short, an attempt will be made to find an answer to
the following research questions:
(1) What are the effects of mobile technology identity and self-efficacy on
the adoption intentions of patients with regard to telehealth apps?
(2) What is the effect of prior experience on adoption intention, perceived
self-efficacy, and perceived mobile technology identity?
By addressing these questions, this study contributes to mHealth
literature and practice. By utilizing a new theory – that is, MTI – the
literature will be extended beyond the traditional adoption models. In
particular, MTI affects individuals’ behavior (Carter et al., 2016) and
has become an integral aspect of self-identity. In using such a novel
approach, it is hoped that: (a) future researchers will be motivated to
adopt MTI theory in their study of mobile apps within and beyond
healthcare settings; (b) this emerging theory, which is in its early
stages, will be contextualized. Without such contextualization and ap-
plication, the generalizability of theories is not achievable; thus, an-
other contribution of this study will be the application of IT identity
theory in the mHealth context (Johns, 2006; Hong, Chan, Thong,
Chasalow, & Dhillon, 2013). Furthermore, developers who have been
working to produce apps for patients’ continuous use can attempt to
manipulate and benefit from or its sub-dimensions (Dependency, Re-
levance, and Emotional Energy; Carter & Grover, 2015) so as to de-
termine the success of their apps. This paper will do the following: (1)
review and discuss the existing literature on mobile healthcare,
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International Journal of Information Management 49 (2019) 58–68
information technology identity, and self-efficacy; (2) articulate the
hypotheses and present the research model; (3) outline the research
method, analysis, and results; (4) discuss the results and highlight their
implications for theory and practice and; (5) finally, explore the study’s
limitations and possible future directions as well as provide a conclu-
sion.
2. Literature review
This section will summarize the existing literature on mHealth apps
and self-tracking, technology identity, and self-efficacy. Next, the im-
portance of these concepts in the mobile healthcare context will be
discussed and, lastly, the way in which the aforementioned concepts
informed the research design and helped to address the proposed re-
search questions will be discussed.
2.1. Mobile healthcare adoption
The contemporary studies on adoption of mobile apps and services
relied on variety of theories such as TAM, UTUAT, TRA, and IS Success
model to predict adoption of mobile apps by users (Alalwan, Dwivedi,
Rana, & Williams, 2016; Alalwan, Dwivedi, & Rana, 2017; Baabdullah,
Alalwan, Rana, Kizgin, & Patil, 2019; Malaquias & Hwang, 2019;
Shareef, Dwivedi, Kumar, & Kumar, 2017; Shaw & Sergueeva, 2019;
Wang, Ou, & Chen, 2019). For example, in the mobile banking context,
Alalwan et al. (2017) found that hedonic motivation, performance ex-
pectancy, effort expectancy, price value, and trust are main predictors
of users’ intention to adopt mobile apps. Baabdullah et al. (2019) ex-
tended Alalwan et al. (2017) by combining the IS success model with
UTAUT2 and found that habit, service quality, and system quality will
play an important role in the adoption of apps. In addition, there are
studies that identified factors such as trust and user satisfaction as the
main driver of adoption (Fox & Connolly, 2018; Shareef et al., 2017;
Wang et al., 2019). On the other hand, there is an established niche that
specifically focused on the adoption of mHealth apps.
Mobile apps in healthcare can be recognized as both emerging and
enabling technologies that are in use in many countries. These apps can
reduce the number of hospital or clinic visits and atomize the mon-
itoring process of patients by physicians. This facilitating technology
not only helps patients but also physicians and hospital staff who can
benefit from wearable and mobile app devices (Wu, Wang, & Lin, 2007;
Wu, Li, & Fu, 2011). Nowadays, smartphones are easily accessible and
offer unique processing powers that allow for complex apps to run, such
as those that provide health services. Reasonably, self-tracking devices
(for example, the Fitbit) are particularly designed for tracking patients’
health, but they are not as widespread and accessible as mobile apps on
smartphones. Thus, mHealth apps remain the most accessible form of
affordable healthcare services for patients and can even be used for
tracking health status (via measures of blood pressure and weight, for
instance) through self-reports. Furthermore, there is a wide range of
apps available related to fitness, cardiology, diabetes, obesity, smoking
cessation, and chronic disease tracking for all age ranges (Lim & Noh,
2017; Silva et al., 2015).
Adoption of general mHealth apps has been studied through mul-
tiple lenses such as extrinsic/ intrinsic motivation, ease of use, useful-
ness, privacy concerns, risk beliefs, self-efficacy, autonomy, and control
(Fox & Connolly, 2018; Liu, Ngai, & Ju, 2019; Zhao, Ni, & Zhou, 2018).
However, there is a paucity of research dedicated to the adoption of
focused mHealth apps which are designed, supported, and sponsored by
clinics and hospitals for the purpose of tracking their own visiting pa-
tients and which this study attempted to address. The purpose of these
apps is to reduce the frequency of visits and track patients with special
needs. There are two elements at play here: one is the acceptance of
these apps by physicians and healthcare professionals (Chen, Lieffers,
Bauman, Hanning, & Allman‐Farinelli, 2017) prior to authorization for
patient use; as well as patients’ own willingness to use these apps. Wu
A. Balapour, et al.
et al. (2007) and Wu et al. (2011) studied the former whilst this study
addressed the acceptance of such apps by their target patients.
2.2. Information technology identity
Individuals identify themselves through self-categorization and so-
cial comparison. People see themselves as members of organizations,
religions, families, and so forth (Ashforth & Mael, 1989). Self-categor-
ization in nature serves two functions: for individuals to put the social
environment into order and also so that they may understand and
perceive the identity of their peers within the environment (Stets &
Burke, 2000). How individuals perceive and understand categories,
classifications and roles are predominantly affected by the cultural
characteristics, values, and norms that make his or her identity unique.
Similarly, individuals perceive others in comparison to themselves
based on the same elements of personality, cultural norms, and values.
As a result, an individual’s identity is subjective. It should also be re-
minded that the aggregation of parallel categorizations builds an in-
dividual’s identity so that they do not experience conflict (Carter &
Grover, 2015). For example, being a wife and mother together form a
female’s identity without contradiction. This combination of categories
contributes to the consistency and integrity of a person’s identity, dis-
ruption of which could lead to an identity crisis and the beginning of
the self-re-identification route. Individuals develop self-identity which,
over time, continuously develops and stabilizes through loops of feed-
back and change.
An embodiment of self-categorization is seeing IT (the object of
attention) as integral to the sense of self. Therefore, IT identity is de-
fined as “the extent to which a person views use of IT as integral to his
or her sense of self” (Carter & Grover, 2015, p. 938). Traditionally, the
role of IT has been to enhance and overcome humans’ neuro- and
physio-logical limitations (Bakos & Treacy, 1986). IT has empowered
individuals to the extent that without it the individual would feel
something of the self is missing. The wide application of IT becomes
part of the individual and the daily roles they maintain. For example,
young people’s engagement with their mobile phones is related to their
self-concept (Walsh, White, & Young, 2010) and the sense of empow-
erment an individual feels as a result of using IT devices (e.g. smart-
phones and tablets) pushes the demand for access to them in everyday
life. Consequently, IT becomes so embedded in individuals’ lives that it
becomes ensnared with their identity and personality in different si-
tuations (Carter, 2012). The existing literature on identity theory does
not explore the relationship with objects as part of one’s identity per-
ception (Clayton & Opotow, 2003; Stets & Biga, 2003). However, the
“embeddedness” of IT with oneself takes the concept of identity to
another level – that is, the individual now has IT-enabled identities (e.g.
being a better employee, mother, or wife) and IT identity (seeing IT as
an inseparable part of the self).
Carter (2012) proposed three dimensions for IT identity that re-
present an individual’s self-perception in relation to IT: Dependency,
emotional energy, and relatedness. Dependency refers to “the degree of
reliance a person feels on a particular IT or class of ITs as a source of
personal well-being” (Carter, 2012, p. 115). IT is so prevalent and in-
tuitive that businesses, the social environment, and personal lives de-
pend upon it, so it constitutes individuals’ identity. As such, individuals
express the feeling of a great need for IT devices and rely on them. For
example: “The one day of not having my phone available for use made
me realize how dependent I have become on it…. My phone is like a
lifeline to me.” (Carter et al., 2016, p. 1438). The frequency of IT usage
directly affects an individual’s dependency on a device for conducting
social relationships, resolving work-related issues, and pursuing leisure
and fun (Carter, Grover, & Thatcher, 2013, 2016). In a high-de-
pendency situation, if a device malfunctions, the user experiences in-
convenience. However, in the absence of said device, the user becomes
vulnerable and instead experiences emotional tension, panic, anxiety,
and fear.
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International Journal of Information Management 49 (2019) 58–68
Emotional energy refers to “an individual’s enduring feelings of
emotional attachment and enthusiasm in relation to an IT or class of
ITs” (Carter, 2012, p. 115). The result of continuous and long-term
interaction with an IT device is a feeling of confidence, energy, and
enthusiasm in relation to the self. In fact, a lack of these emotions
among individuals creates negative feelings such as boredom
(Hackbarth, Grover, & Mun, 2003). For example: “The phone is a means
to inform and empower us. It can be something as simple as avoiding
traffic or checking the price of an item at different stores. Either way,
you have the power and the control… you live by your schedule and
don’t have to wait for others. Your self-esteem is then fuelled by that
power, so you feel more secure.” (Carter, 2012, p. 22). The impact of
the device in terms of emotional dependency varies based on individual
beliefs and personality (Clayton & Opotow, 2003). For some, the ab-
sence of a mobile phone that holds their personal information, mem-
ories, and documentation of their emotions (such as photos and videos)
in relation to previous interactions of the individual with the device
(Vincent, 2006) can cause emotional trauma.
The last dimension, relatedness, refers to “a blurring of boundaries
between notions of the self and an IT experienced as feelings of con-
nectedness with an IT or class of ITs” (Carter, 2012, p. 114). This di-
mension reflects the fact that individuals incorporate resources and the
characteristics of their devices within their individual self-concept; as a
consequence, they feel intimately connected to these IT devices.
Clayton and Opotow (2003) claimed that relatedness is the most
sought-after component of the perceived personal identity. Carter et al.
(2013) showed that the level of significance which individuals assign to
the use of mobile phones affects their feeling of relatedness to the de-
vice. People who use their phones more for communication and as a
means of connecting with their surroundings tend to identify them-
selves more with relatedness than other dimensions. Loss of a device for
these individuals tends to cause severe feelings of detachment from
their surroundings.
In the healthcare setting, recent literature proposed that the use of
wearable fitness devices at the workplace could affect users’ IT identity.
In particular, businesses are promoting the use of such devices, which
are becoming integral to individuals’ identity owing to the frequency of
interaction and on which they are developing am emotional de-
pendency (Giddens, Gonzalez, & Leidner, 2016). Savoli and Bhatt
(2017) proposed that IT identity directly influences emotion relating to
IT which, in turn, affects patients’ decisions on whether or not to adopt
healthcare outlets (e.g. devices, apps, and so on). Carter et al. (2013)
also found that mobile devices are becoming part of an individual’s
identity. Accordingly, this study adopted IT identity and its dimension
to predict users’ adoption of healthcare mobile apps used for self-
tracking.
2.3. Self-efficacy
Self-efficacy refers to an individual’s judgments of their ability to
organize and execute courses of action required to attain designated
types of performance (Bandura, 1986). This concept has been adopted
and applied to Information System (IS) research by Compeau and
Higgins (1995). When using a device such as a computer, higher self-
efficacy leads to easier use and lower resistance. In this context, the
computer may simply be replaced with an mHealth app, which was
done in the study outlined in this paper as an adopted measure to obtain
subjectivity regarding how users believe in their capabilities to use
mHealth apps.
Contemporary studies showed that self-efficacy affects behavioral
intention to adopt e-government, e-commerce, and mobile apps and
services both directly and indirectly (Irani, Dwivedi, & Williams, 2009;
Alalwan, Dwivedi, Rana, Lal, & Williams, 2015, 2016; Fox & Connolly,
2018; Rana & Dwivedi, 2015; Rana, Dwivedi, & Williams, 2015;
Shareef, Kumar, Kumar, & Dwivedi, 2011; Shaw & Sergueeva, 2019).
Lim and Noh (2017) studied the adoption of fitness apps and found that
A. Balapour, et al. International Journal of Information Management 49 (2019) 58–68

Fig. 1. Research model.

self-efficacy promotes healthy behavior and adoption of such apps. Si-
milarly, Fox and Connolly (2018) found that mHealth self-efficacy po-
sitively influences the mHealth adoption intentions. However, there are
some contradictory findings with respect to its effect in the mHealth
context (Rana et al., 2015). On the contrary, Asimakopoulos,
Asimakopoulos, and Spillers, (2017) found that neither general self-
efficacy nor computer self-efficacy have any effect on participants’ at-
titudes toward mobile fitness-tracking health technology. Surprisingly,
empirical results also show that computer self-efficacy can negatively
influence the intention of patients to adopt mHealth (Bhatnagar,
Madden, & Levy, 2017). Theoretically, this concept should be a relevant
and well-established predictor of mHealth adoption, but empirical re-
sults are conflicting. As such, this study will further investigate the
effect of this construct.
3. Hypothesis development
2014). Consistently, this paper argues that users who have experience
using mHealth apps are more inclined to adopt a particular mHealth
app designed to facilitate their care delivery. Evidently, this prior ex-
perience removes cognitive barriers or users’ resistance toward adop-
tion of these apps. Thus:
H1. Perceived related IT experience positively influences perceived
intention to use mHealth apps.
It is argued that prior experience also affects self-efficacy.
Knowledge of using similar apps and smartphones, in general, is likely
to affect users’ judgment of their own abilities to use a specific mHealth
app for reporting their health status or for other medical services
(Zhang et al., 2016). In particular, the way in which knowledge re-
moves barriers to learning and adoption has been discussed and how
this alters users’ perceptions in assessing his/her abilities to use
mHealth apps. As such, advanced prior IT experience positively influ-
ences self-efficacy. Thus:

In this section, we develop hypotheses and a theoretical model H2. Perceived related IT experience positively influences perceived self-
based on adoption, technology identity, and self-efficacy literature. efficacy.
Fig. 1 summarizes the proposed research model. In short, it is suggested
Experience of mobile devices increases as a result of day-to-day use
that related IT experience affects self-efficacy, MTI, and adoption in-
of mobile apps. The more experience gained as a result of regularly
tentions; further, it is argued that self-efficacy and mobile identity are
checking the mHealth app the more dependency on the mobile device
the predictors of adoption intentions.
grows (Carter et al., 2016). Carter and Grover (2015) suggested that
The first three hypotheses deal with the effects of prior IT experi-
dependency is a dimension of IT identity and they emphasized the
ence on self-efficacy, MTI and adoption intentions. Prior IT experience
functional features that come with the device (e.g. email, alarm clock,
specifically refers to users’ previous experience of mHealth apps. In the
group messaging system, social media, and mHealth apps). They also
mid-nineties, Taylor and Todd (1995) published a paper in MIS Quar-
gave examples of how these practical features increase user interaction
terly highlighting the sole role of prior IT experience in IT usage. The
with the device. This could include mHealth apps which require the
underlying logic of prior experience is that “knowledge gained from
user to (a) report their health status frequently during the week; (b)
past behavior shape human intentions because experience makes
pose questions to physicians through the app; (c) make appointments;
knowledge more accessible in memory” (Taylor & Todd, 1995). A sig-
(d) receive dietary plans or reminders to take medication, and so forth.
nificant body of research suggests that without direct experience of
Consequently, as knowledge of how to use mobile apps and smart-
interaction with objects (mobile apps in this case), users’ acceptance of
phones increases, dependency on these devices grows. Similarly, prior
it is the mere result of group norms or peer pressure, which can lead to
studies have discussed this effect by showing that proficiency with
failure (Venkatesh & Morris, 2000). Users’ experience of software pro-
devices through continued use increases dependency on the device it-
ducts is valuable to developers because knowledge barriers and high
self (Lin, Chiang, & Jiang, 2015; Park, Kim, Shon, & Shim, 2013).
learning needs in relation to newly developed software can impose
Moreover, mHealth apps that are specifically designed to foster the
considerable unfavorable costs on providers (Mellarkod, Appan, Jones,
relationship between clinics and patients make users feel empowered to
& Sherif, 2007). However, when users have prior experience with such
achieve things they could not achieve otherwise, as discussed. For in-
apps they are more prone to adopt them. This effect on adoption in-
stance, an enormous advantage for users is that their frequency of visits
tentions has been studied and the results suggest that it is an important
to clinics can be reduced through the use of these apps thus saving time.
factor which has both direct and indirect effects on shaping users’ at-
Emotional energy (another dimension of IT identity devised by Carter &
titudes toward IT usage (Al-Qeisi, Dennis, Alamanos, & Jayawardhena,

61
A. Balapour, et al.
Grover, 2015) refers to the feelings of empowerment, excitement, se-
curity, and energy as the result of using IT. One extremely useful feature
of mHealth apps is that they empower users and elevate their emotional
energy which makes them identify themselves with using a mobile
device. Users’ knowledge and prior experience with these apps can
elevate this emotional energy by awakening its potentials within the
user, making them more efficient in using their smartphones as a result
of gaining experience through daily use. Hence, it was hypothesized
that:
H3. Perceived related IT experience positively influences perceived
mobile technology identity.
Self-efficacy becomes important in this context because patients
must use it for reporting their status. If they believe they cannot use
their mobile device for this purpose, the whole idea of developing an
app for monitoring patients at clinics becomes fruitless. Computer self-
efficacy was found to be a precursor to computer use by Compeau and
Higgins (1995). In particular, believing in one’s ability to use IT devices
is expected to motivate use when necessary. While it has been studied
widely in internet and mobile contexts (Alalwan et al., 2015, 2016;
Irani et al., 2009;), the self-efficacy has been found to affect adoption in
the healthcare information system by indirectly (Rana & Dwivedi,
2015) or directly (Fox & Connolly, 2018) affecting behavioral intention
to adopt. Following the above rationale as discussed by Compeau and
Higgins (1995) it was hypothesized that:
H4. Perceived self-efficacy positively influences perceived intention to
use mobile for reporting health status.
Carter and Grover (2015) listed three behavioral consequences of IT
identity: device feature use behavior, enhanced use, and resistance
behavior and claim that MTI can lead to both resistance and adoption.
In a group setting, members’ identity is defined in terms of complying
with the affective, cognitive, relational, and evaluative components of
the group which reinforces identity. This includes IS-usage behavior for
participating and engaging with the community as one form of com-
pliance (Pan, Lu, Wang, & Chau, 2017). Self-identification with IT is
recognized as the extent to which the use of a particular technology is
an integral part of the self (Alahmad et al., 2018). Prior studies have
examined the effect of social identity on IS-usage behavior, yet tech-
nology identity, which is a recently developed concept, has not been
very well explored in the context of usage behavior, even though it is
inherently linked to adoption (Pan et al., 2017). This paper argues that
higher levels of MTI lead to higher motivation to adopt a specific
mHealth app because high MTI means the individual is highly depen-
dent on the device and very enthusiastic about using it and, subse-
quently, feels a sense of connection with it. As such, this sense of en-
thusiasm regarding the device may increase the individual’s motivation
to adopt mHealth apps. Similarly, when feelings of dependence or re-
latedness to the device are high, individuals are more motivated to
adopt mHealth apps because they can elevate these feelings as dimen-
sions of identity, according to Carter and Grover (2015). Therefore:
H5. perceived mobile technology identity positively influences
perceived intention to use mobile apps for reporting health status.
This study outlined in this paper also included age, gender, and
education as the control variables since existing literature on adoption
suggests that these elements affect behavioral intentions either directly
or indirectly (Venkatesh et al., 2003; Venkatesh, Thong, & Xu, 2012).
Consequently, these factors were included in the proposed model in the
hope that it would enrich understanding of the adoption of mHealth
apps by patients for self-monitoring.
4. Method
To test the proposed research model, a study was conducted in a
medical setting in order to capture actual patients’ thoughts about those
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International Journal of Information Management 49 (2019) 58–68
mHealth apps supported by clinicians and targeted to facilitate the re-
lationship between health clinics and patients. Given that prior studies
have emphasized how clinicians’ own self-efficacy and approval of
mHealth apps can impact patient uptake of such apps (Chen & Allman-
Farinelli, 2018), an attempt was made to factor this into the study de-
sign, as explained in the following sub-section.
4.1. Study setting and participants
The participants in this study were adults who made use of
healthcare services at a clinic in the center of Israel, one of the main
branches of the National Health Fund. While patients were in the
clinic’s waiting room during their visit, they were asked to use an app
on their smartphones or tablets to report their health status (height,
weight, blood pressure etc.) and to complete a short online ques-
tionnaire via the same device. At the very beginning of the process, the
patients were informed that participation in the study was voluntary
and that their personal information would remain confidential. They
were additionally assured that participation would have no influence
on their treatment. The entire process – from distribution of the ques-
tionnaire to the taking of measurements – was conducted at the health
clinic by a research team of nurses who had received appropriate
training and were authorized by the management of the health care
provider and the branch administration. Furthermore, the branch em-
ployees and medical staff were provided with an explanation of the
study's purposes and objectives in order to facilitate the process of data
collection and collaboration if patients had questions. To operationalize
the constructs in this study, scales from the existing literature were
used. The constructs were measured along a five-point Likert scale (1 =
Strongly agree; 2 = Agree; 3 = Neutral; 4 = Disagree; 5 = Strongly
disagree); the items and sources are shown in Appendix A.
Overall, 292 subjects participated in the study. A number of in-
dividuals did not answer all the demographic questions (e.g. 19 did not
report their age and one person did not report on education), but it was
decided that their responses would be retained as they had completed
all the measurement questions. This process provided 266 useful re-
sponses. Table 1 summarizes the descriptive statistics of the clinical
patients who volunteered to participate in this study.
4.2. Survey analysis
The constructs were tested for reliability and validity. The
Cronbach’s alpha for Dependence, Emotional Energy, Related IT ex-
perience, Intention to Use and Self-efficacy were above the suggested
value of 0.70 (Hair, Anderson, Tatham, & Black, 2006). The relatedness
dimension of identity was excluded due to reliability and validity is-
sues. In addition, one or two items from the dimensions of identity were
removed in the analysis process due to not meeting the same reliability
or validity requirements in the confirmatory factor analysis process
(Hair et al., 2006). The results of the principal component analysis
suggested that the items met the threshold of 0.40 in terms of their
reciprocal factors (Table 2). Next, common method variance tests were
performed (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003).
Harmon’s one-factor test was carried out by allowing all items to
load on a single factor. The emerging factor explained 40 percent of the
total variance; given that this number was under 50 the common
method bias was not a concern. After this, an unmeasured latent-factor
method was employed in conjunction with a measurement model by
adding a common factor, fixing its variance to ‘one’ and adding paths
from this factor to all observed variables in the model, fixing the
loadings so as to render these paths equal. The estimated coefficient for
this path was 0.42 and the square of this value produced the common
variance, which was about 17 percent, thus the common method bias
was not a concern in this sample (Podsakoff et al., 2003).
A. Balapour, et al. International Journal of Information Management 49 (2019) 58–68

Table 1 & Larcker, 1981). All composite reliabilities exceed 0.70. In summary,
Descriptive statistics. these results show convergent and discriminant validities of the mea-
Variables Frequency Percent sures.

Age: 5. Results
18–30 59 22.18
31–60 123 46.24
61+ 65 24.44
Given that the structural model includes demographics as the con-
NA 19 7.14 trols and, as discussed, a few respondents did not fully complete this
Gender: information (see Table 1), a “missing value" estimation was included in
Male 91 31.12 the analysis of the structural model using maximum likelihood for the
Female 175 59.31
missing values in STATA. The results of the structural model are pre-
NA 26 8.9
Education: sented in Fig. 2. The fit indices for the structural model met the re-
Academic 150 51.36 commended values according to prior studies (Gefen et al., 2000):
Non-academic 115 39.38 RMSEA = 0.05; CFI = 0.96; TLI = 0.95; χ2/degree of freedom =
NA 27 9.24
204.64 (d.f. = 117; p < 0.001); N = 266. Fig. 2 suggests that related
BMI groups*:
Underweight (0-18.49) 4 1.36
past experience with IT positively influenced intention to use mHealth
Normal (18.5 – 24.99) 103 35.27 apps for self-report of health status by patients (β = 0.23, p < 0.01),
Overweight (25 – 29.99) 88 30.13 thus H1 was supported. Relevant past experience also positively af-
Obese (30 or more) 39 13.35 fected perceived self-efficacy among patients (β = 0.46, p < 0.01) and
NA 58 19.86
perceived MTI (β = 0.49, p < 0.01); therefore, H2 and H3 were sup-
Systolic blood pressure*:
Low (Under 90) 5 1.71 ported. Furthermore, the results suggested that perceived self-efficacy
Normal (91-120) 141 48.29 positively influenced intention to use (β = 0.54, p < 0.01), so H4 was
Pre-high (121-140) 90 30.82 supported. Similarly, it was found that perceived MTI positively influ-
High (141 and above) 56 19.18 enced intention to use (β = 0.16, p < 0.05), supporting H5 as well. A
Diastolic blood pressure*:
Low (under 60) 21 7.19
mixed result, however, was found regarding the effects of the control
Normal (61-80) 174 59.58 variables. In particular, it was noted that the effects of age (β = 0.07,
Pre-high (81-90) 45 15.41 p = 0.17) and gender (β = -0.06, p = 0.16) were not statistically sig-
High (91 and above) 42 14.38 nificant on intention to use mHealth apps, but education level nega-
NA 10 3.42
tively influenced this intention (β = -0.09, p < 0.10).
NA = No access (not reported by the patient).
* Based on CDC.gov standards. 6. Discussion

Table 2 MHealth apps are rapidly changing the landscape of healthcare

Principle component analysis. delivery. Thousands of healthcare apps are available online which at-
tempt to push for improvements in the current state of healthcare
Variable Comp1 Comp2 Comp3 Comp4 Comp5 Unexplained
(Veríssimo, 2018). However, the adoption and diffusion of these apps is
IntUse1 0.5735 −0.0192 −0.03 0.0201 0.066 0.139 an issue that the literature is trying to address (Kwon et al., 2017). The
IntUse2 0.5955 −0.0016 −0.0676 0.0096 0.0611 0.1357 study in this paper diverged from the traditional adoption approach
IntUse3 0.4473 0.051 0.1138 −0.0286 −0.1045 0.3172 used in mHealth literature (Kwon et al., 2017; Lee & Cho, 2017; Lee
IDep1 −0.1328 0.5522 0.0856 0.0383 0.0493 0.2358
et al., 2017; Quaosar et al., 2018; Yuan et al., 2015) and used the more
IDep2 0.0948 0.6156 −0.0859 −0.0737 −0.0675 0.2589
IDep3 0.0011 0.5126 −0.0477 0.0437 0.052 0.3461 innovative MTI theory. Moreover, the study focused on those apps that
SelfEff1 0.0303 0.0004 0.5397 0.0177 0.0062 0.2657 would facilitate the relationship between patients and physicians or
SelfEff3 −0.0831 −0.0474 0.67 −0.031 0.005 0.2214 clinics which has been raised as a challenge for health research
SelfEff3 0.2228 0.0261 0.4023 0.0066 −0.0875 0.235
(Chandwani, De, & Dwivedi, 2018). Many mHealth apps are very
Pex1 −0.011 0.0613 0.007 0.607 −0.0498 0.1502
Pex2 0.0001 −0.1373 −0.0728 0.6081 0.1344 0.2424
general and are used without the supervision of the individual’s family
Pex3 0.0462 0.096 0.0762 0.4929 −0.1513 0.2733 doctors. However, when these apps are offered by clinics, the use of
IEng1 −0.1456 0.0873 0.1989 0.0646 0.4307 0.4108 such apps becomes very important because patient interaction with the
IEng2 0.0836 0.0653 0.0621 −0.0538 0.5477 0.2554 app is monitored by the clinic and family doctors. As such, this study
IEng3 0.0431 −0.0613 −0.0895 0.0172 0.6593 0.2667
attempted to shed light on the factors that affect patients’ attitudes
IntUse = Intention to use; IDep = Dependence (MTI dimension); toward the adoption of mHealth apps offered by healthcare providers
IEng = Emotional energy (MTI dimension); SelfEff = Self-efficacy; for close monitoring of their health status. The theories of technology
Pex = Related IT experience. identity (Carter & Grover, 2015) and self-efficacy (Compeau & Higgins,
1995) were relied upon to predict individuals’ intention to use such
4.3. Measurement model mobile apps. To test the hypotheses, patients were surveyed in the
clinic waiting room. In particular, it was found that self-efficacy posi-
The examined measurement model met the recommended fit indices tively influenced patients’ intentions to use mobile apps for reporting
(Fornell & Larcker, 1981; Gefen, Straub, & Boudreau, 2000; Hair et al., their health status along measures such as weight, and systolic and
2006; Hu & Bentler, 1999): The indices were as follows: RMSEA = 0.05; diastolic blood pressure. Compeau and Higgins (1995) contextualized
CFI = 0.96; TLI = 0.95; χ2/degree of freedom = 199.29 (d.f. = 113; self-efficacy in information systems and introduced computer self-effi-
p < 0.001), all of which are within the threshold of good-fit models. cacy. This concept is applicable to other IS-related contexts such as
Table 3 shows the internal consistency and discriminant validity of mHealth apps. Likewise, Zhang et al. (2016) reported a positive effect
constructs. The diagonal represents the average variance extracted of self-efficacy on adoption intentions. The study herein similarly
(AVE) for each construct and the other cells in the discriminant validity concluded that patients’ confidence in their own ability to complete and
section show the correlations. All AVEs are above 0.5 and the square submit their own medical reports directly affected their intentions to
root of each AVE exceeds all correlations among the constructs (Fornell use such mobile apps (Hypothesis 4).
Furthermore, the results showed that MTI positively influenced the

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A. Balapour, et al. International Journal of Information Management 49 (2019) 58–68

Table 3
Reliability and Validity.
Construct Mean Std. dev. Cronbach’s alpha CR 1 2 3 4 5 6 7

1.Education 0.56 0.49 – – – –

2.Gender 1.65 0.47 – – – –
3.Age 46.71 18.06 – – – −0.05 –
4.Identity 3.14 0.94 0.82 0.84 – 0.13* −0.33*** 0.85
5.Self-efficacy 3.85 1.07 0.83 0.82 – 0.05 −0.21*** 0.39*** 0.78
6.Related IT experience 2.67 1.30 0.82 0.84 – 0.01 −0.30*** 0.38*** 0.46*** 0.72
7.Intention to use 3.74 1.17 0.88 0.83 – 0.07 −0.16** 0.39*** 0.67*** 0.50*** 0.77

Diagonal = Square root of AVE; St.d. = Standard deviation; CR = Composite Reliability.

* p < 0.05.
** p < 0.01.
*** p < 0.001.

Fig. 2. Results of the SEM model.

intentions to adopt mHealth apps (Hypothesis 5). Social identity theory
is used to explain aspects of individuals’ behavioral responses in a
particular environment, which means that behavior is affected by in-
dividuals’ sense of social identity (Stets & Biga, 2003). Technology
identity theory (Carter & Grover, 2015), which is based on social
identity, posits that behavior manifests in forms of feature use, en-
hanced use, and resistance in relation to IT. Carter et al. (2016) theo-
rized that mobile phone identity affects behavior (i.e. adoption). The
MTI dimensions of emotional energy and dependence that were applied
in this study correlated well with intentions to adopt mHealth apps
provided by clinics. In particular, being confident, enthusiastic, and
inspired by mobile phones creates a positive attitude toward its features
(one of which is mHealth apps); hence, patients are more prone to
adopt such apps when offered by clinics. In a similar vein, patients’
dependency on their phones occurs as a result of their reliance on the
benefits they provide, such as communication, support, health man-
agement, entertainment, and so on. Therefore, dependency contributes
to patients’ intention to adopt mHealth apps.
Conversely, the results showed that related IT experience positively
influenced the intention to adopt mHealth apps (Hypothesis 1), self-
efficacy (Hypothesis 2), and MTI (hypothesis 3). By extension, the role
of prior IT experience has been highlighted in adoption literature and is
well-established (Al-Qeisi et al., 2014; Mellarkod et al., 2007; Taylor &
Todd, 1995; Venkatesh & Morris, 2000). As such, the findings in this
paper regarding the effects of related IT experience on the intention to
use mobile apps is consistent with previous studies. IT-related
experience refers to an individual’s knowledge of how to leverage
technology and its features to achieve a goal; thus, the greater the
knowledge an individual possesses the greater his or her confidence in
using mHealth apps because of an expectation that the experience will
be familiar. Lastly, patients’ background knowledge in using similar
mHealth apps will contribute to their dependency on such apps and also
create a feeling of empowerment (emotional energy; Carter & Grover,
2015). For instance, if a patient has used mHealth apps in the past for
help with taking medicine on time, she or he will feel empowered and
dependent on his or her mobile device. Without the device and app, the
individual might not remember to take the pills on time. In accordance
with prior studies, the results demonstrated that background knowl-
edge of an app’s capability and what it can accomplish on behalf of a
patient affects the individual’s self-identification with mobile tech-
nology (Carter et al., 2016).
Surprisingly, the results showed that age and gender had no effect
on the intention to adopt mHealth apps. The existing literature on
adoption emphasizes the roles of age and gender which directly or in-
directly influence attitude and behavioral intentions (Venkatesh et al.,
2003, 2012); however, the results of this study did not support this
notion. Perhaps this is because the prevalence of smartphones among
all classes of society make it easy for individuals to use them for dif-
ferent tasks; thus, the same behavioral intentions exist across different
genders and ages. In a study of mobile banking adoption, Malaquias and
Hwang (2019) also found no support for the effect of age and gender on
adoption intentions. This indeed could be different for other

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A. Balapour, et al.
technologies (for instance, tablets or desktop computers) because
smartphones are much more widely used in developed countries
(Anderson, 2015). This study also found that education negatively in-
fluences intention to use mHealth apps, which means that intention is
greater amongst patients who are less well-educated. Logically, it might
be expected that individuals with academic degrees would show a
stronger intention to use mHealth apps for self-monitoring but the re-
sults were contradictory. In fact, it could be that patients who are for-
mally educated are more skeptical about the safety and quality of these
apps compared to patients who are not.
6.1. Theoretical contribution
This study makes several contributions to the mobile healthcare
literature. First, it adds to the adoption and diffusion literature, which
promotes mHealth-app use for enabling healthy lifestyle management
by delivering health education, self-monitoring, and patient-provider
collaboration (Faiola et al., 2018). By extension, mHealth services have
not been successful even though there are many apps available for
smartphones (Lee et al., 2017) for reasons such as poor accountability
(Chen, Cade, & Allman-Farinelli, 2015) and there have been several
attempts to endorse and promote the adoption and diffusion of all types
of mHealth apps. This literature has been extended by proposing a
conceptual model which leverages self-efficacy and MTI as the pre-
dictors of mHealth-app adoption. The focus here was on mHealth apps
that are either developed or supported by clinicians because without
clinicians’ own mHealth-app self-efficacy, the adoption of mHealth apps
by patients is less likely (Chen & Allman-Farinelli, 2018). Second, by
surveying real clinical patients instead of randomly surveying students
(Kwon et al., 2017; Lee & Cho, 2017) or app users (Lee et al., 2017), the
applicability and generalizability of the proposed model was enhanced.
mHealth apps should also seek to serve the appropriate target popula-
tion and, for this reason, patients were surveyed in this study in order to
capture the essential elements that affect their adoption. Third, the
existing technology identity literature was extended by testing this re-
cently developed construct within a nomological network of causes and
consequences (Carter & Grover, 2015). Carter et al. (2016) proposed
that MTI affects behavior but their model was based on a qualitative
study. The study outlined in this paper complemented their work by
empirically testing the causes and consequences of MTI.
6.2. Implications for practice
Moreover, this study has implications for practice. First of all, based
on the results, developers and clinics can focus on promoting self-effi-
cacy and educating patients on how physician-approved mHealth apps
(Chen, Lieffers, Bauman, Hanning, Allman‐Farinelli et al., 2017) could
be used to improve their health. For example, professionals can direct
patients to educational programs in community centers and universities
(Fox & Connolly, 2018). On-site training is another approach that can
improve patients’ capabilities in using mHealth apps, especially when
the clinicians are in favor of such apps (Alalwan et al., 2015). Altering
patients’ attitudes will mitigate subsequent resistance behaviors.
Second, developers should actively participate in finding ways to as-
sociate designed mHealth apps with patients’ MTI. That means focusing
on the emotional energy (if not dependency) dimension of MTI so as to
make the experience of using apps more energizing and exciting. One
way of achieving this is to rely on the gamification of mHealth apps
(Seaborn & Fels, 2015).
Third, the results of this study suggest that individuals background
experience in IT use can significantly change the equation in favor of
the adoption of mHealth apps, which is good news for providers and
designers if in early stages they identify their target users. For example,
mHealth app targeted for elderly people with limited prior knowledge
of IT use, should consider these individuals will have low confidence in
their mobile use abilities, so the provider should spend more time on
65
International Journal of Information Management 49 (2019) 58–68
establishing the background knowledge in how to use smartphones
before teaching the users how to use the mHealth app. Or if the
mHealth app is used for tracking young adults with depression, then the
provider and designer should consider that these individuals have more
background experience with mobile use, thus more complex designs
would not bother them.
Lastly, it was found that patients holding an academic degree were
already using some mHealth apps or had experience using them, yet
they showed less interest in adopting new ones. Perhaps this is because
there are thousands of mHealth apps and the majority do not effectively
help patients. This is both a positive and negative signal for mHealth
app developers: positive in the sense that if clinics design an mHealth
app that is supervised by physicians and professional app developers,
the quality of the app will make it stand out in a mass of impractical and
useless mHealth apps (Chen, Lieffers, Bauman, Hanning, & Allman-
Farinelli, 2017); and negative in the sense that offering a new mHealth
app and trying to make it diffuse quickly will be challenging.
7. Conclusion
In conclusion, this study attempted to predict the factors affecting
the adoption of mHealth apps provided by clinics and hospitals. To do
so, a deviation was made from traditional adoption predictors, such as
ease of use and usefulness (Davis, 1989); instead, MTI, self-efficacy, and
prior experience were taken as the main predictors of intention to use
mHealth apps offered by healthcare providers. Surprisingly, education
was negatively associated with adoption intention among patients.
Hospitals and clinics can leverage the findings of this study to promote
their mHealth apps.
7.1. Limitations and future research
Despite the discussed implications, this study has limitations like
many others. In the first instance, data were collected via a ques-
tionnaire that presented issues such as high measurement errors
(Podsakoff et al., 2003). Using archival data of actual mHealth-app use
may compensate for such limitations. Second, the data were also col-
lected in a setting where it was not possible to place too much pressure
on patients to complete all the questions. As such, they were permitted
to complete the survey if they felt so inclined. This resulted, therefore,
in some missing data values that slightly affected prior predictions. This
was compensated for by estimating the structural model using the
“missing value” option in STATA. Third, the study was conducted in
one context, precluding any examination of potential cultural or con-
textual effects. Lastly, on data source was relied upon, although it is
recommended that researchers use more than one sample – or even
multiple sources – of data collection in order to better predict and ex-
plain phenomena (Orlikowski & Baroudi, 1991).
This study recommends that future researchers investigate the role
of hedonic factors in the adoption of mHealth apps. Gamification is
becoming a trend among all non-entertainment apps (Hamari &
Koivisto, 2015; Seaborn & Fels, 2015); for example, Lee et al. (2017)
studied the effect of enjoyment on intentions to use mHealth apps but
did not find any correlation. As such, there is a need for further in-
vestigation in this field. Furthermore, this paper recommends future
studies to consider factors that stimulate or affect resistance behavior
among mHealth-app users. It was found that education negatively in-
fluenced the intention to adopt such apps. This finding has implications
for resistance behavior and it is suggested that future researchers in-
vestigate these factors in greater detail. Carter and Grover (2015) in-
troduced MTI as a reflective construct with three dimensions but the
study herein did not find a case for the reliability of relatedness (one of
the dimensions), so it was abandoned. It is further recommended that
future researchers adopt MTI with all its three dimensions in different
contexts and contribute to the refinement of this theory. In addition,
longitudinal study designs may shed light on adoption of mHealth apps.
A. Balapour, et al. International Journal of Information Management 49 (2019) 58–68

MTI is one such longitudinal concept in nature and denotes the idea
that, over time, technology identity increases with continued use.

Appendix A

Measurement items

Items λ Mean St.d. Cronbach's alpha

Mobile Technology Identity : 1

– 3.14 0.94 0.82
Dependence 0.93 3.56 1.16 0.79
1 Thinking about myself in relation to a mobile device, I feel dependent on mobile device. 0.83 3.42 1.50
2 Thinking about myself in relation to a mobile device, I feel needing the device. 0.69 4.00 1.24
3 Thinking about myself in relation to a mobile device, I feel reliant on the device. 0.72 3.26 1.40
4 Thinking about myself in relation to a mobile device, I feel counting on the device.* – 3.74 1.25
Emotional Energy 0.77 2.73 0.97 0.74
1 Thinking about myself in relation to a mobile device, I feel energized. 0.63 3.15 1.12
2 Thinking about myself in relation to a mobile device, I feel enthusiastic about the device. 0.84 2.89 1.28
3 Thinking about myself in relation to a mobile device, I feel pumped up. 0.64 2.13 1.18
4 Thinking about myself in relation to a mobile device, I feel confident.* – 3.73 1.03
Self-efficacy2: – 3.85 1.07 0.82
1 I believe I can complete this medical report using mobile technology if there was no one around to tell me what to do. 0.78 3.93 1.20
2 I believe I can complete this medical report using mobile technology even if I have never used a similar technology before. 0.68 3.70 1.27
3 I am confident that I can effectively report medical information using mobile technology. 0.88 3.92 1.24
Related IT experience3: – 2.67 1.3 0.82
1 To what extent do you use applications related to health on a mobile device? 0.85 2.75 1.52
2 To what extent do you use monitoring options on a mobile device? 0.56 2.23 1.41
3 To what extent do you use the Maccabi application on a mobile device? 0.84 3.03 1.58
Intention to use4: – 3.74 1.17 0.87
1 I intend to use a mobile device app in order to maintain my health. 0.81 3.64 1.33
2 I believe I will continue using clinical mobile apps in order to maintain my health. 0.78 3.59 1.32
3 .If any health care provider will ask me to report personal health data using a mobile device app, I will do so. 0.77 4.01 1.26

1. Adopted from: Carter (2012), Carter and Grover (2015), Carter et al. (2013).
2. Adopted from: Davis (1985), Liao, Palvia, and Chen, (2009).
3. Adopted from: Compeau, Higgins, and Huff, (1999), Liao et al. (2009).
4. Adopted from: Goodhue and Thompson (1995)
* Dropped.

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