What roles do quality and cognitive absorption play in evaluating cloud-based e-learning system success? Evidence from medical professionals
Authors: Cheng Yung-Ming 
Published: April 2022

Purpose
The purpose of this study is to propose a hybrid model integrating the expectation-confirmation model with the views of cognitive absorption (CA) theory and updated DeLone and McLean information system success model to examine whether quality factors as antecedents to medical professionals’ beliefs can affect their continuance intention of the cloud-based e-learning system.

Design/methodology/approach
This study’s sampling frame was taken from among medical professionals working in hospitals with over 300 beds in Taiwan which had implemented the cloud-based learning management system (LMS) with a blend of asynchronous and synchronous technologies. Sample data for this study were collected from medical professionals at six hospitals in Taiwan. The data for this study were gathered by means of a paper-and-pencil survey, and each sample hospital that participated in this study was asked to identify a contact person who could distribute the survey questionnaires to medical professionals who had experience in using the cloud-based LMS in their learning. A total of 600 questionnaires were distributed, and 378 (63.0%) usable questionnaires were analyzed using structural equation modeling in this study.

Findings
This study proved that medical professionals’ perceived learner–content interaction quality, learner–system interaction quality, service quality, cloud storage service quality and learner–human interaction quality all positively caused their perceived usefulness, confirmation and CA elicited by the cloud-based e-learning system, which jointly explained their satisfaction with the system, and resulted in their continuance intention of the system.

Research limitations/implications
Several limitations and suggestions may open avenues for future research. First, the limitation of self-reported measures should be considered; future research may combine with qualitative data (e.g. semi-structured, narrative, in-depth interviews, focus group interviews and open-ended questions) to get more complete interpretations of medical professionals’ cloud-based e-learning continuance intention. Next, this study’s data were collected from hospitals in Taiwan only; given this study’s limited scope, future research may generalize this study’s sample to the respondents of other national cultural backgrounds and make cross-country comparisons to enhance the completeness of this study. Finally, this study’ results were based on cross-sectional data; future research may use a longitudinal analysis by taking into account the evolution of medical professionals’ cloud-based e-learning continuance intention over time.

Originality/value
This study fully evaluates interaction-related and cloud-related quality determinants through an understanding of medical professionals’ state of CA in explaining their cloud-based e-learning system continuance intention that is difficult to expound with only their utilitarian perception of the system. Hence, the results contribute to deep insights into an all-round quality evaluation in the field of medical professionals’ cloud-based e-learning continuance intention, and extrinsic and intrinsic motivators are both taken into consideration in this study’s theoretical development of medical professionals’ cloud-based e-learning continuance intention to acquire a more comprehensive and robust analysis.