The number of healthcare institutions adopting smartphones continues to increase, implying that their utilization is undoubtedly gaining attention. Understanding the needs of smartphone users will provide a greater opportunity for successful information technology acceptance by expanding the scope of its utilization. This study focuses on how smartphones are accepted and utilized in hospitals and analyzes the factors influencing users' attitude, social influence, and intention of use.
For the study model, the researcher has mainly adopted the Theory of Reasoned Action and further modified and used the models of Technology Acceptance and Information Systems Success. To test the model empirically, a survey was conducted with 122 professionals on information development teams in Korean tertiary hospitals.
The common smartphone usage modes were Internet searching, e-mail, scheduling, and social networking in consecutive order. Phone calls consisted of 51.4% of work-related purposes, while other functions, such as text message, Web browser, and scheduling, were mostly used for personal purposes. Costs, contents quality, innovation, ease of use, and support were shown to have statistically significant effects on user attitude, and social influence, portability, security, content quality, and innovation were significant. User attitude and social influence were both statistically significant with respect to intention of use, with user attitude greater than social influence.
The participating staff were analyzed as having strong personal faith and principles, independent from their external environment. Timely information exchanges among medical staff will facilitate appropriate communication and improved health services to patients in need.
Today we live in an information society that creates and transfers various types of information. Everyday tasks are completed efficiently and effectively using computers and communication devices. Information systems are being used to further achieve organizational goals, such as decreasing costs, developing new products, expanding businesses, furthering research and development, and providing better services.
The information technology paradigm is shifting to a 'ubiquitous environment' that enables real-time data exchange [
Personal device tastes are also shifting from personal digital assistants (PDAs) and laptops to a wide variety of smartphones and tablets. In particular, smartphones have been one of the success stories of the last decade. In a relatively short period of time, smartphone technology has significantly penetrated society, reaching subscribers in Western industrialized nations from school children to senior citizens. Smartphones are the latest evolution in a long history of communication devices, leading to a rapid adoption of mobile communication devices starting in the latter part of the last century [
Therefore, smartphones are changing many industries, including the medical industry. Mobile devices are increasingly used in healthcare industries with more sophisticated treatment and diagnosis, improved financial regulation, and larger volumes of information. Information technology in healthcare provides clinicians with information and tools, such as clinical decision support that can improve the quality of care and reduce potential medical errors [
Recently, many academic medical centers and hospitals have begun to distribute smartphones to physicians and other healthcare professionals. For instance, the University of Pittsburgh Medical Center distributed smartphones to doctors and nurses in some of its emergency rooms and surgical floors [
Medical staff can assist homebound or preoccupied patients using smartphones, providing check-ups, schedule management, and test results. Information technology also permits remote access to hospital databases, allowing for the exchange of data during business hours and the improvement of doctors' work.
The purpose of this study is to analyze and determine factors that influence the application of smartphones to hospitals. Smartphone application status, application problems, and the influence factor on hospital applications will be investigated. Specifically, this study aims to examine smartphone application status at hospitals, show acceptability factors by analyzing smartphone acceptance at hospitals, and suggest successful guidance for smartphone application and user acceptance at hospitals.
The theoretical background of this study focuses on the Theory of Reasoned Action (TRA) by Fishbein and Ajzen [
The research subjects of this study were medical staff from two tertiary hospitals, which use smartphones at work. A self-administered questionnaire was distributed to 400 employees in November 2010, and 36.3% (145) were returned during a 3-week period. After discarding 16 surveys of participants who did not use a smartphone and 7 surveys with incomplete answers, a total of 122 surveys were analyzed.
The survey was developed from literature review and face-to-face interviews with directors of the hospital departments of information technology and management. The survey consisted of 61 total questions: 4 questions on smartphone use status; a question set on smartphone awareness that included 7 questions on devices, 3 questions on costs, 4 questions on portability, 6 questions on contents quality, 4 questions on social influence, and 5 questions on user innovation; and a question set about smartphones usage awareness with 5 questions on usefulness, 6 questions on support, 4 questions on attitude, 3 questions on purpose of use, and 5 questions on demographic characteristics. Survey responses were recorded on a 7-point Likert scale, with 1 being 'strongly disagree' and 7 being 'strongly agree', except for the questions with respect to the awareness of smartphones and their use.
Reliability and validity tests were conducted for the developed survey instrument. Cronbach's α was analyzed to measure internal reliability, and factor analysis and principal component analysis were conducted as validity tests. As shown in
Descriptive statistics and frequencies were computed for subjects' characteristics and their status of smartphone purchase and use. According to the research model, statistical significances were tested using multiple regression analyses by generating equations to describe the statistical relationship between influential factors and response variables, such as user attitude, social influence, and intention of use. Explicitly, the independent variables consisted of device, cost, portability, security, contents quality, innovation, ease of use, and support, while attitude, social influence, and intention to use were dependent variables. In general, the significance was tested at the alpha level of 0.05.
The general characteristics of the sample group were analyzed using descriptive statistics. The resulting demographic characteristics are shown in
As is shown below in
Most respondents were unaware of the exact smartphone purchase price because they obtained the device under a 1- to 3-year service plan with an account transfer. Therefore, the average smartphone cost was calculated based on the purchase price and Internet service costs. The average price was $287.8 for self-purchased devices and $276.7 for hospital-purchased devices. Over 90% of the respondents bought their smartphones on a 2-year contract. The monthly wireless plan fee averaged $51.6 for individuals and $13.8 for hospitals, as is shown below in
As shown in
Many people and organizations today use mobile wireless technology via wireless application protocol (WAP) phones, handheld devices, smartphones, wireless laptops, mobile commerce, and other portable devices. However, despite this market's growth, research examining the key factors affecting user behavior and mobile adoption is scarce [
Even though younger groups adopt IT technology more quickly than older groups in hospitals [
Current users tend to use smartphones for Web services, such as Internet searches and e-mail, but were able to use the full functionality of smartphones by also including scheduling, social networking, staff information inquiries, drug information inquiries, diagnosis information inquiries, PACS, and in-company calls. Since smartphone adoption is still in its early stages at hospitals, education, infrastructure expansion and medical software applications will increase smartphone use. In addition, smartphones could potentially be used in emergency settings to document injuries or lesions [
As was shown in the results section, costs, contents quality, innovation, ease of use, and support affected user attitude while device, portability and security were insignificant, since medical doctors were unaware of smartphones' usefulness in providing accurate information at their current stage. Developers should develop and upgrade their contents for accuracy, promptness, usefulness, and individual suitability for smartphone usage.
Also, the research did not show a significant influence on user attitude, but after hospitals expand the scope of smartphone use, device input, resolution, and size are expected to play a more important role in actual use. The hardware and software functionality of the devices should be improved to expand smartphone use.
After looking over the factors studied, this study found that portability, security, contents quality, and innovation significantly affect the social influence of smartphones. Such factors are equally important in other industries. Exchanging information and enhancing communication will promote a timely and high-quality diagnosis on patients. Security systems should also be developed to protect medical information. In case smartphones are lost or stolen, an independent security system should be used over wireless control to prevent the theft of patients' medical records.
Finally, user attitude influenced the intention to use a smartphone more than social influences within the subject group. Medical doctors who participated in the survey are more likely to rely on their beliefs than peer pressure from their environment. However, the findings of this study need to be further investigated in specific subgroups and/or processes. For example, Ismail et al. [
This research has many implications when compared to earlier research. Lee et al. [
Oliva et al. [
Ajzen [
Despite the suggested implications, additional study is needed to address the limitations of this research. Testing research relationships across multiple hospitals would generalize the smartphone study among healthcare professionals [
After smartphones become more available in hospitals, further studies, such as the effect of smartphones on hospital performance and the suitability of smartphones for hospital work, would be important to research. In addition, the further study would focus on the influence of smartphones on the quality of work outcome and performance.
No potential conflict of interest relevant to this article was reported.
Research model.
Proportion of smartphone usage mode. SNS: social network service, PACS: picture archiving and communication system.
Proportion of official smartphone use. SMS: short message service.
Test results of the research model.
Results of reliability and validity tests
Subject characteristics
Status of smartphone purchase
Costs of smartphone and its use (unit: US dollar)
Multiple regression results of factors influencing attitude and social influence
B is the unstandardized regression coefficient, β is the standardized regression coefficient.
Multiple regression results of attitude and social influence on intention to use
B is the unstandardized regression coefficient, β is the standardized regression coefficient.