*Results from Telehealth DOI: http://dx.doi.org/10.5772/intechopen.101183*


#### **Table 1.**

*Facilitators to staff acceptance [9].*


#### **Table 2.**

*Barriers to staff acceptance [9].*

introduction of new technology and approaches. Such insight is essential to understand effective techniques for change management.

The standard approach in information systems research is to understand the dynamics of interaction between the key stakeholders, the wider context of the organisation, external factors, and the technology innovation, through models and frameworks. The usual technique is based on grounded theory, where information is gathered through interviews, communications and documentation, and analysed to determine the themes (often by frequency analysis) that are then connected together.

A general view of this approach may be seen in the Triality Framework [12], which relates all possible interactions between the key stakeholders (the technology, the organisation, and the user), highlighting how the interactions may include a two-way effect, which extends significantly the concepts which should be considered compared to TAM (**Figure 5**).

Therefore a broader consideration of interaction will bring in the concepts of the Triality Framework [12], and that are highlighted within the factors of **Table 1** and **Table 2**, such as acceptability (does it provide for the role of users), demand (are changes required), efficacy (does it fulfill the role), expertise (are users able to use the technology), trust (is it reliable and safe), legitimacy (does it meet legal requirements), optimality (does it perform the task), and equity (does it provide equal service to all patients).

#### **2.2 Acceptance by the patient**

Patient acceptance is less well studied and understood as it is influenced by very many more factors than acceptance by the clinician. However the majority of the studies using TAM have been conducted in the work place on cohorts largely familiar with technology. Patients present very different characteristics and circumstances and therefore have different motivations and responses.

For example, one study [13] used assessment of the perceived usefulness of telehealth services to act as a predictor of acceptance, but had to extend the concepts to include effort expectancy, social influence, and facilitating conditions as its root constructs when applied to patients.

Moreover it is essential not to consider patients as a homogeneous group; patients differ greatly by age, education, social status, economic status, belief, coping strategy, stage of disease, prior experience, familiarity with technology,

**Figure 5.** *Triality framework [12].*

## *Results from Telehealth DOI: http://dx.doi.org/10.5772/intechopen.101183*

surrounding support, relationship with their physician, and location. A much richer model to describe factors affecting patient technology acceptance is required.

In one model [14], age and stage of illness are considered as primary influences, and further recognises that age impacts illness and that the severity of illness can impact on the age perceived by the patient. The patient then brings a further multiplicity of factors that affects their willingness to accept telehealth and continue its use.

In addition, the approach and support of the physician can influence the understanding of the need and purpose for telehealth, and thus the acceptance and use (**Figure 6**).

The effect of the stage of illness is considered in the transtheoretical model (TTM) [15] which identifies individuals moving through six stages as their condition changes:


It is observed that people in the later stages of the TTM are more likely to pursue intervention and are more likely to have successful outcomes than people in earlier stages, and therefore adhere to a programme of telehealth.

Age has a major influence on acceptance of a technological approach. For example, a survey of usage of smartphones [14] reveals the majority of people over 60 are

**Figure 6.** *Patient Technology Acceptance Model (PTAM) [14].*

non-users (with many others having only trivial use), with a significant proportion of people in the 46-59 age group also being non-uses. A similar proportion will not have access to broadband, and many will have little or no experience of use of technology. It is therefore important to understand how to deploy telehealth in a non-threatening and unobtrusive way. It is therefore appropriate to develop specific models to describe the behaviour of the elderly, such as the Senior Patient Technology Model [16], that must address the specific concerns of this group, such as stigmatisation, simplicity, unobtrusive, independent (no reliance on broadband or telephone), non-threatening, and privacy in use (hidden from general view). It should complement their relationship with the clinician, and not threaten to remove (**Figure 7**).
