文化差異對於不同心理健康狀態使用健康管理資訊系統之影響因素-以台灣及中國大陸為例

Effects of Different Culture and Psychological Health Status on Users’Intention of Health Management Information System : An Empirical Study in Taiwan and China

蕭世榮(Hsiao Shih-Jung)

指導教授 ： 張睿詒 ； 吳帆

國立中正大學/管理學院/資訊管理學系/博士(2013年)

摘要

資管界於探討「使用意願」之眾多理論中，多以科技接受模式（TAM）或其修正模式為其理論基礎，TAM在優點在於模型簡單易懂、具資訊科技特性、堅強的理論基礎和充分的實證支持。雖是如此，TAM及其修正模式之應用，也有所限制及不足（1）僅有將近10％用於HIT相關資訊系統之探討；（2）TAM的發展過程並非依據醫療環境及其特性所建立，若涉及醫療產業之相關研究時，所選取的變數應再進行調整及擴增；（3）TAM 於醫療資訊之討論，範疇較多偏重於醫院臨床人員所使用之醫療資訊系統，較少以民眾為對象，針對健康資訊使用行為進行探討；（4）TAM雖然能夠成功的用於預測接受IT的行為，但在不同的國家文化中；「文化」是一個重要的外生變數，應會影響「主關規範」、「認知有用性」、「認知易用性」及「醫院形象」。
近年來國際健康照護產業之發展趨勢，皆提倡以「健康促進」與「疾病管理」來取代「預防」的概念，已成為現今全面醫療照護服務系統的一部分。主要預防的目標包含「醫療預防服務」、「生活方式干預」及「健康檢查服務」，將自身維持於無病的狀況。再者，通信設備研發的精進，加上民眾的資訊素養持續的提昇，使得網際網路與3G手機的使用者日益成長，由於手機會被使用者隨身攜帶，再配合智慧型手機之應用程式開發的廣度及深度，提昇運用的範疇，提供給健康介入一個良好的途徑，目前許多健康紀錄都以手機當作平台，使用與健康相關的應用程式(application, App)，記錄與傳輸自己的健康記錄。本研究所針對的健康管理資訊系統（HMIS）即是以手機健康紀錄App，為其資料記錄及傳輸平台，藉以記錄生理徵兆（如血壓）、飲食、運動等基本與個人健康相關之資訊。雖然健康管理資訊系統具有廣泛、潛在之正向效益，亦為輔助個人進行自我健康管理的重要利器。
然而，透過許多的研究及相關報告顯示；許多未曾真正使用健康管理系統的民眾，雖對其效益具有濃厚的興趣，但是即使處於健康資訊電子化程度高於台灣的美國而言，包含慢性病人在內之健康管理系統，其使用者仍舊不多。健康管理系統由1978年之概念形成，到實際產品的推出使用，直至現在之相關研究並不多見，影響使用意願的因素亦還未完整地被確立，但系統是否能真正發揮功效，仍決定於民眾對此系統之使用意願。
歸納上述所言，本研究以TAM為其研究基礎，另加入Agarwal ＆ Angst（2006）針對民眾對於個人健康記錄的儲存方式及意願之研究，擴增研究變數，並導入Hofstede五個文化影響構面，探討在台灣及中國大陸的文化差異下，不同心理健康狀況的民眾，使用HMIS之使用意圖及其影響因素。
研究結果發現：無論是台灣或是大陸之樣本，皆顯示「科技熟練度」、「閱讀健康資料的興趣」與「便利性」直接與間接的影響HMIS之使用意圖，整體的模式解釋力（ ）台灣為49%，大陸的樣本高達70%，超過原始TAM 30-40%之解釋力。不幸的是，無論是台灣或是大陸的樣本，皆顯示不同的「心理健康狀態」無法間接影響HMIS之使用意圖。此外，本研究另加入「醫院形象」及「主觀規範」變數，用以觀察是否為使用HMIS之前置變數，不過台灣的樣本與大陸的樣本統計後的結果有所不同，台灣不具顯著差異，中國大陸則反之。
最後，無論是台灣或是中國大陸，文化皆為「主關規範」、「認知有用性」、「認知易用性」及「醫院形象」之前置變數，尤其在全球化地球村的概念下，進行健康資訊科技（HIT）之使用意圖或接受度之研究時，需將文化當成TAM的外生變數，以增加模式的合適性及解釋能力。

關鍵字

健康管理資訊系統 ； 醫院形象 ； 國家文化 ； 科技接受模式

並列摘要

Many theories of "intention to use" in traditional Information Management field, Technology Acceptance Model (TAM) or its modified model is strong than other models. The advantage of TAM is simple and easy to understand, with information technology features, a strong theoretical foundation and sufficient empirical support.
Although this is the case, the study of TAM and its modified model, only nearly 10% for the system of HIT-related information. Furthermore, the development process of TAM is not established according to the medical environment and its characteristics, if it relating to healthcare and a mobile phone setting, the selected variables should be adjusted, in order to increase the TAM appropriateness. TAM for HIT discuss, its scope more emphasis on the use of medical information systems in the hospital clinical staff. Fewer study employed public as the research subjects to explore use of Health Information Technology (HIT) related behavior. Even TAM can be used to predict the success of IT adoption behaviors, but in different national cultures; "culture" is an important external variable, it will affect the correlation of perceived usefulness, perceived ease of use, subjective norms and hospital image.
In recent years, development trends of the international health care industry are "promote health promotion" and "disease management" instead of "prevention", and it becomes part of the modern comprehensive system of health care services. The primary goals of prevention to self-sustaining in the disease-free status, it includes: preventive medical services, lifestyle intervention, and health check-up services.
Furthermore, the research and development of sophisticated communications equipment, coupled with the continued improvement of the people's information literacy, making internet and 3G mobile phone users growing. Due to the phone is carried by the user, if it enhances use areas together with the breadth and depth of the smart phone application, it can provide a good way for health intervention. Nowadays, many health records use phone as the platform, use health-related applications (App) to record and transmits their own health records. In this research, we employed Health Management Information System; HMIS (a mobile health records App) as data record and transmission platform, in order to record the physiological signs such as blood pressure, diet, exercise and other personal basic health-related information.
Although HMIS has a wide range of potential positive benefit, and also assisted individuals of self-health management. However, through many studies and related reports: many people never actually use the health management system, although its benefits have a keen interest, but even in the United States, includes the health management system, the user is still not much. The concept of health management system formed by the 1978, until now, the research is rare, and the factors affecting the willingness to use have not been fully established. But the system is truly effective or not, it still depends on the people willing to use.
This study based on TAM, and the research study variables according to Agarwal and Angst (2006) to amplified for the wishes of the people for the storage way. In addition support Hofstede's cultural framework as external variables to explore the intention to use HMIS and influence factors under cultural differences in Taiwan and Mainland China’s different health status.
Through statistical analysis and discussion of this study. In this study found that not only use TAM, but also added three variables: "technology sophistication", "interest in reviewing health data", and "conveniences" into our research to seen whether they can be antecedents of HMIS usage intention. The result showed: No matter samples in China or Taiwan, their Technology Sophistication, Interest in Reviewing Health Data, and Conveniences all affect HMIS usage intention. Overall R2 in Taiwan is 49% and in China is 70%. Their explanatory power is more than TAM (30-40%). Unfortunately, both samples in Taiwan or China display different mental health status cannot indirect affects HMIS usage intention. Furthermore, this research study is now added "hospital image" and "subject norm", which are discussed in HIT via literature research, to see if can employ as antecedents. But statistical test of research result showed: There is different between Taiwan and China’s sample. In Taiwan, it is not significant, China contrary.
Finally, no matter samples in China or Taiwan, Culture are the antecedent of subject norm, perceived usefulness, perceived ease of use and hospital image. Especially in the study of globalization of the global village concept for HIT usage intention or adoption. It needs to take culture as exogenous variable of TAM for consideration, in order to increase the model fit, increase the explanatory power.

並列關鍵字

Health management information system (HMIS) ； Hospital image ； National culture ； Technology acceptance model (TAM)

參考文獻

Chen, C.S., Tsang, H., Chong, M.Y., & Tang, T.C. (2000). Validation of the Chinese Health Questionnaire (CHQ-12) in Community Elders. Kaohsiung J Med Sci, 16, 559-565.

Hung, C.H. (2007). The Psychosocial Consequences for Primiparas and Multiparas. The Kaohsiung Journal of Medical Sciences, 23(7), 352-360.

Tseng, H.M., Chan, P.T & Chiang, C.Y. (2009). Applying technology acceptance model to examine factors related to nurses’ acceptance for the use of mobile nursing station in hospitals. THE Journal of Taiwan Association for Medical Informatics, 18(1), 23-38.

Tu, J.T., Liu, S.W., & Ting, M.J. (2009). A Comparative Analysis of Culture among Taiwan, Hong Kong, and Mainland China: Employing Hofstede’s Cultural Dimensions. Journal of Science and Technology and Humanities of Transworld Institute of Technology, 9, 43-59.

Wu, I.L., & Wu, K.W. (2005). A hybrid technology acceptance approach for exploring e-CRM adoption in organizations. Behavior & Information Technology, 24(4), 303-316.