Health Belief and Social Support with Related Anxiety of Electronic Health Record Systems (Preprint)
Authors: Chang Hsin Hsin , Hung Chian Ru 
Published: March 2021

BACKGROUND

This study adopts the health belief model (HBM) and the social support theory (SST) to explore the effects of system anxiety and health consciousness on anxiety and willingness to use electronic health record (EHR) systems.
The use of EHR systems has been associated with some problems. One of them is that medical staff have to face and deal with lots of technique-related problems, which may lead to high levels of stress-related to learning new systems and interacting with patients at the same time. Federman et al. (2017) and Shachak and Reis (2009) have studied the use of electronic record systems impacts physician-patient relationships. There have only been a few studies discussing the influence of EHR systems on the public. EHR systems can help medical staff to make accurate decisions and is the first medical system allowing individuals to personally participate and gain self-management of their physical conditions. Therefore, this study mainly focuses on the influence of the individuals who use EHR systems rather than medical staff to explore individual willingness toward use by using HBM and SST. However, HBM is often used to explore threat-related anxiety and is rarely used to discuss other types of anxiety. On the other hand, SST is also commonly used in a community context and is seldom discussed in the health field. Thus, in this research, HBM is used to explore the influence of use on anxiety, as the SST is used to explore the impact of encouragement and appreciation by members of medical staves on individual attitudes.
Savoy et al. (2019) Mentioned that with the application of human factors engineering, information requirements can be developed to guide the development of user interfaces that better support the referral process and its related communication, information exchange, and care coordination. Moreover, cognitive computing in healthcare links the functioning of humans and machines where computers and the human brain truly overlap to improve human decision-making (Behera et al., 2019). Kummer et al. (2017) indicated that anxiety is a substantial driver of human behavior, and they researched anxiety when medical staff used sensor-based healthcare systems, which is a type of medical information system. Literature reviews also stated that there are has been no research exploring the impact of anxiety on willingness to take action to support health from the perspective of the public, such as when using EHR systems. Therefore, this study adopted HBM and SST to discuss the influence of willingness toward the use of EHR systems on anxiety from a public perspective. In this study, HBM and SST are used to discuss the effects of the two different facets of perceptions of anxiety. The HBM explores perceptions that come from within the individual and SST explores the perceptions resulting from encouragement from medical staff. It is worth exploring the impact of different aspects of perception on anxiety and the impact of the anxiety on willingness to use EHR systems.

OBJECTIVE

To cover the gaps and research questions addressed previously, this study is proposed to examine willingness toward the use of EHR systems from the public. Variables from HBM and SST as an antecedent, anxiety as a public emotion as a mechanism, and willingness to use EHR systems as a result. Moreover, system anxiety and health consciousness are adopted as control variables to determine their effects on threat-related anxiety, surveillance anxiety, relational anxiety, and willingness to use EHR systems. The objectives of this study are as follows:
(1)	Adopting the HBM and SST to develop a research model to understand individual willingness to use EHR systems for self-recording health information.
(2)	To understand the effects of health belief (perceived susceptibility and perceived seriousness) and Social support on perceived anxiety (threat-related anxiety, surveillance anxiety, and relational anxiety) as well as the effects of perceived anxiety on willingness to use EHR systems.
(3)	To examine the relation between perceived anxiety and individual willingness to use EHR systems.
(4)	To examine the effects on anxiety and willingness to use EHR systems.

METHODS

There were also six background information items, including: 1) When was your last visit hospital or clinic, and what was the reason for your last visit? 2) Do you have a family history of disease? 3) Have you been hospitalized or undergone any surgeries? 4) How many times do you exercise more than twenty minutes per week? 5) In general, what do you believe your health status is? These were intended to help respondents understand the topic context and to determine whether other factors would affect their perceptions under different conditions. There were also demographic items, which included the answerer’s gender, age, educational background, and company’s industry division.
A pretest was conducted to ensure whether the answers could clearly understand the wording of the questionnaire and items, and it was also used to collect opinions from the respondents to address any difficulties that might have occurred when they were answering the questions. 145 respondents (people) were used for the pretest analysis.
The formal data collection was a web-based questionnaire called “Surveycake” was used to collect the respondents and were distributed in the National Taiwan University and National Cheng Kung University second-hand place on Facebook, and PTT, which is a type of BBS in Taiwan. The respondents’ qualifications are not restricted because everyone can use this system, and people should be responsible for their health. A total of 833 valid questionnaires were used to conduct the SEM analysis.

RESULTS

The results show that the perceptions of seriousness and susceptibility have reduced the threat-related anxiety of individuals and cause them to use EHR systems to record their health information. The perception of seriousness and susceptibility would increase the degree of surveillance anxiety.
Individuals take the initiative to record their health information due to support and recognition from the medical staff, and they will in turn reduce their surveillance anxiety and the relational anxiety existing in the medical-patient relationship. The implementation and development of the EHR systems, while simultaneously educating the public about prevention of disease, increasing awareness, encouraging and recognizing the people who provide health information, and assisting the public with solving the problems associated with the use of the EHRs.
Finally, this study suggests that government and hospitals should develop information security that ensures the trust of individuals in the EHR and should promote and encourage the willingness of the public to use EHR systems to enhance overall medical quality and services for the public.

CONCLUSIONS

Due to the development of medical electronics, there have been lots of studies exploring the impact of technology on the medical staff, their contribution can be classified to disease control, or the impact of using the EMRs’ on physician-patient relationships. There are some difficulties in the development of EHR systems in Taiwan, such as the related costs, among other issues. Taiwanese government adopted a nationwide health insurance system in 1995, Health Insurance Agency 2018 reported that the number of medical visits by Taiwanese people exceeded one hundred times a year, on average in 2017. Due to the benefits of health insurance, many people who did not previously pay attention to their health are now going to see a doctor resolve even a slight condition.
EHR systems can help individuals and medical staff to control and track their situation, thereby reducing the waste of resources. Thus, this study explores the factors motivating them to use EHR systems. If this can be universalized in the future, the results of this study can provide a reference for the emotions of the public toward such systems. This study verifies that when people experience anxiety, it will affect their willingness to use these systems, and different types of anxious emotions will have different effects on their degrees of willingness toward use.
From the management perspective, individuals can use EHR systems to prevent disease. In recent years, Taiwan has gradually entered an aging society; more and more people are concerned about issues related to health and long-term care. However, most young people are less concerned with such issues, and most people do not know that some diseases will put them at risk and that some diseases can be avoided through preventive actions. Prevention is better than a cure. Preventive medicine, getting vaccines, health screening, and tracking, and so on, are preventive ways to avoid deterioration of a disease or its occurrence. Therefore, the government can help the public increase their awareness and build up a consensus on different diseases through advertising or policy advocacy. Hospitals can continuously track patient conditions via EHR systems, and individuals can be immediately notified when the danger is imminent. This may help raise the public’s degree of perceived seriousness and perceived susceptibility, which can motivate them to use the system to improve the quality of care and disease control. Because EHR systems are medical systems that allow individuals to participate and upgrade self-management of their physical condition personally, they will help medical staff track specific conditions and help them prevent or control the disease.

CLINICALTRIAL

NULL.