Effect of older adults willingness on telemedicine usage: an integrated approach based on technology acceptance and decomposed theory of planned behavior model

Background: Telemedicine, as a novel method of health management system, has demonstrated to have a significant impact on health levels. However, a challenge persists in the form of low usage rates and acceptance among older adults in China. There are accumulating evidence that willingness will affect the telemedicine usage among older adults. This study investigates factors influencing older users' trust in adopting telemedicine technology, thereby promoting actual use. Methods: A questionnaire survey was conducted with 400 urban seniors aged 60 and above. Drawing from the Technology Acceptance Model (TAM) and the Decomposed Theory of Planned Behavior (DTPB), the author combines elements such as Perceived Usefulness, Perceived Ease of Use, Subjective Norms, Service Environment, Self-Efficacy, Behavioral Intention to Use, and Usage Behavior. The aim is to explore the interrelationships between these factors. Results: Perceived Usefulness (PU) and Service Environment (SE) significantly and positively impact Behavioral Intention (BI) to use telemedicine, with Trust (TR) identified as a crucial mediating variable. Enhancing trust can substantially increase older adults' intention to use telemedicine services. Furthermore, the study reveals a significant relationship between older adults' trust in telemedicine and factors such as Perceived Usefulness (PU), Service Environment (SE), Subjective Norms (SR), as well as Emotional Risk (ER) and Cost Risk (CR), the latter two tending to decrease Trust(TR). Conclusions: This paper constructs and validates a combined model based on TAM and DTPB, comprehensively exploring the potential factors influencing the older adults' intention to use telemedicine. The findings suggest that telemedicine services for older adults should prioritize improving user perception and enhancing trust throughout the service process to effectively increase their willingness to use these services.