The Impact of Confidentiality and Privacy Concerns on Behavioral Intention to Adopt Electronic Personal Health Records (e-PHRs) Among Chronic Patients in Southwest Ethiopia, 2023: An Application of the UTAUT2 Model

Sisay Kassie^1*Adamu Ambachew Shibabaw¹Alex Ayenew Chereka¹Abiy Tasew Dubale¹Addisalem Workie Demsash¹Yitayish Damtie²Habtamu Setegn Ngusie³Agmasie Damtew Walle¹

• ¹Department of Health Informatics, College of Health Sciences, Mattu University, Mattu, Ethiopia
• ²Department of Reproductive and Family Health, College of Medicine and Health Science, Injibara University, Injibara, Amhara Region, Ethiopia
• ³Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia

Background: Using e-PHRs is essential for chronic patients. It helps to improve self-care management and communication between caregivers. However, when implementing e-PHRs, patients often express their concerns regarding privacy and confidentiality. Therefore, this study aimed to assess the impact of confidentiality and privacy concerns on predicting their level of intention to use e-PHRs among chronic patients in southwest Ethiopia, 2023. Method: A cross-sectional study design was conducted among 680 chronic patients from July 24 to September 17, 2023, in Southwest, Ethiopia. A translated interviewer-administered questionnaire was used to collect the data. A systematic random sampling approach was employed to recruit study participants. Patients' intention regarding the impact of confidentiality and privacy concerns on e-PHRs adoption was examined by an extended Unified Theory of Acceptance and Use of Technology 2 model. We have used measurement and structural model statistics to assess the validity of the proposed model. All hypotheses were tested using structural equation modeling (SEM) analysis and presented by AMOS version 23. Standardized regression coefficients (β), 95%CI, and a significant level of p-values < 0.05 were used to examine the association of exogenous and endogenous variables. Result: A total of 680 chronic patients, with a response rate of 87.3 %, were included in the study. The proportion of behavioral intention to adopt e-PHRs was 288 (42.4%) (95%CI: 39.0, 46.2). The results show that the extended model of the UTAUT2 can explain about 75% of the variance of the e-PHRs adoption. Confidentiality (β=0.156, p<0.01), privacy (β=0.216, p<0.05), and social influence (β=0.157, p<0.01) showed a significant association with adopting e-PHRs. Social influence and facilitating condition mediate confidentiality and behavioral intention at a p-value <0.001while only social influence mediates the privacy concern and behavioral intention to adopt e-PHRs at a p-value <0.001. Conclusion: Less than half of the surveyed patients intend to use e-PHRs. The result confirmed the significant impact of confidentiality and privacy concerns on e-PHRs adoption. As a result, this study acknowledged that confidentiality and privacy concerns were two main challenges that should be considered when considerable implementation of e-PHRs is in progress in low-income countries by stakeholders and program developers.