Page 65 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

Patient Acceptance of a Self-Management Support System 63
Results show that patients were on average positive towards using the SMSS, both in advance of use and after having used the SMSS for four months. The behavioural intention to start or continue using the SMSS could mostly be explained by patients’ affect towards the SMSS (26% explained variance, supporting H5). The analysis also found performance expectancy on insight and on time, and trust to be correlated with behavioural intention, supporting H1 and H7 respectively. Still, these factors were not able to explain variation in behavioural intention beyond the affect factor. No support was found for the other hypotheses (H2, H3, H4, and H6). This result is different than what is usually found when using TAM or UTAUT [27], with effort expectancy being traditionally one of the most important factors explaining behavioural intention. Although 26% of explained variance is at the lower end of the range of 17% to 70% reported by other studies [27], the regression model included only one factor, which might be a reason for the relatively small R2. Although affect overlapped with performance expectancy to some extent, affect was the only remaining factor in the regression analysis being significantly associated with patients’ behavioural intention to continue using the system after four months of use. In the first few months post-transplantation, only a limited number of outpatient visits was replaced by a telephonic consult. Many patients, therefore, visited their doctors in the usual frequency, putting less need on using the system to be informed on their kidney function. The fact that there was no absolute need to use the system, contrary to what happens when an entire organisation implements a new technology and replaces the old one, might explain why affect was found to be the most important factor related to behavioural intention. When patients are ‘free’ to choose, it seems logic that emotions are crucial. Comments made by patients at the end of study participation confirm the emotional aspect. Some patients mentioned that if possible they would like to continue using the SMSS after one year, as it gave them a feeling of safety. Others indicated that the first year after transplantation is of most risk and as they had safely reached this milestone, they no longer felt the need to use the SMSS.
It was further found that some questionnaire items, especially the social ones such as social influence and facilitation related to the social environment, were rated as not applicable by a substantial part of the group. These participants might not have understood these questions or had not discussed the use of the system with their social environment and felt, therefore, unable to give an answer. Reformulation of these items or informing people that holding social related beliefs does not require actual discussion with the social environment might, therefore, be advisable in the future.
The main scientific contribution of the current study is that it introduced affect as a new factor explaining kidney transplant patients’ behavioural intention to use or continue using a SMSS. In practice, the finding suggests that the emotional experience of using a SMSS should be taken into account when designing and implementing a system to be used in healthcare. Several strategies have been put forward for this, for
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