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      Swedish Primary Care Physicians’ Intentions to Use Telemedicine: A Survey Using a New Questionnaire – Physician Attitudes and Intentions to Use Telemedicine (PAIT)

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          Abstract

          Background

          Research on intentions to use telemedicine in primary care is sparse. This survey study explored primary care physicians’ intentions to use telemedicine by using a newly developed questionnaire: Physician Attitudes and Intentions to use Telemedicine.

          Methods

          An anonymous web-survey with questions focusing on theory-based predictors of behavioral intentions such as Attitudes, Subjective norms and Perceived behavioral control was designed, validated, and sent to all primary care physicians at 160 primary health care centers in southern Sweden from May to August 2019. The questionnaire had 29 subject items (including 49 multiple-choice sub-items). Main outcome measures were intentions to use three domains of telemedicine and correlation between theory-based predictors and behavioral intentions for using telemedicine.

          Results

          The survey was validated by an expert group, amended, and then tested and retested. A majority of the 198 physicians who returned the web-surveys reported that they did not use e-mails (68%), nor video consultations (78%), chat (81%), or text messages (86%) in their everyday patient work. Yet, most physicians described a positive intention to use telemedicine in patient care for all three studied domains with Attitudes and Perceived behavioral control being significant predictors (p<0.01) for Intentions to use digital contacts (R 2 = 0.54), chronic disease monitoring with digital tools (R 2 = 0.47) and artificial intelligence (R 2 = 0.54). A structural validation of a preliminary instrument – Physician Attitudes and Intention to use Telemedicine (PAIT) – containing 28 sub-items was done by exploratory factor analysis with acceptable explanatory, reliability and sampling adequacy measures. Five factors emerged with Eigenvalues between 1.6 and 11.1 explaining 72% of the variance. Total Cronbach’s alpha was 0.91 and Kaiser-Meyer-Olkirk 0.79.

          Conclusion

          Before the covid-19 pandemic, Swedish primary care physicians reported a low use yet high behavioral intention to use telemedicine in a study where we developed the preliminary instrument Physician Attitudes and Intention to use Telemedicine. Perceived behavioral control had the largest predictive value of behavioral intention to use telemedicine. Thus, interventions aiming to increase the use of digital tools in primary care should possibly focus on empowering physicians’ self-efficacy towards using them.

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          Most cited references29

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          The theory of planned behavior

          Icek Ajzen (1991)
          Organizational Behavior and Human Decision Processes, 50(2), 179-211
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            Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES)

            Analogous to checklists of recommendations such as the CONSORT statement (for randomized trials), or the QUORUM statement (for systematic reviews), which are designed to ensure the quality of reports in the medical literature, a checklist of recommendations for authors is being presented by the Journal of Medical Internet Research (JMIR) in an effort to ensure complete descriptions of Web-based surveys. Papers on Web-based surveys reported according to the CHERRIES statement will give readers a better understanding of the sample (self-)selection and its possible differences from a “representative” sample. It is hoped that author adherence to the checklist will increase the usefulness of such reports.
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              Efficacy of the Theory of Planned Behaviour: A meta-analytic review

              The Theory of Planned Behaviour (TPB) has received considerable attention in the literature. The present study is a quantitative integration and review of that research. From a database of 185 independent studies published up to the end of 1997, the TPB accounted for 27% and 39% of the variance in behaviour and intention, respectively. The perceived behavioural control (PBC) construct accounted for significant amounts of variance in intention and behaviour, independent of theory of reasoned action variables. When behaviour measures were self-reports, the TPB accounted for 11% more of the variance in behaviour than when behaviour measures were objective or observed (R2s = .31 and .21, respectively). Attitude, subjective norm and PBC account for significantly more of the variance in individuals' desires than intentions or self-predictions, but intentions and self-predictions were better predictors of behaviour. The subjective norm construct is generally found to be a weak predictor of intentions. This is partly attributable to a combination of poor measurement and the need for expansion of the normative component. The discussion focuses on ways in which current TPB research can be taken forward in the light of the present review.
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                Author and article information

                Journal
                Int J Gen Med
                Int J Gen Med
                ijgm
                ijgm
                International Journal of General Medicine
                Dove
                1178-7074
                15 July 2021
                2021
                : 14
                : 3445-3455
                Affiliations
                [1 ]Department of Clinical Sciences, Lund University , Malmö, Sweden
                [2 ]CPF, Centre for Primary Healthcare Research , Malmö, Sweden
                [3 ]Linnaeus University , Kalmar, Sweden
                Author notes
                Correspondence: Veronica Milos Nymberg Clinical Research Centre (CRC), Skåne University Hospital , Building 28, Floor 11, Jan Waldenströms Street 35, Malmö, 205 02, SwedenTel +46-767700240 Email veronica.milos_nymberg@med.lu.se
                Author information
                http://orcid.org/0000-0002-9808-207X
                http://orcid.org/0000-0002-3785-5630
                http://orcid.org/0000-0002-3836-3048
                Article
                319497
                10.2147/IJGM.S319497
                8290350
                34295177
                1d82817a-cc3f-45e1-ac85-c8d643845e9b
                © 2021 Pikkemaat et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 10 May 2021
                : 14 June 2021
                Page count
                Figures: 1, Tables: 7, References: 30, Pages: 11
                Funding
                Funded by: no financial support;
                The authors received no financial support for the research or authorship of this article.
                Categories
                Original Research

                Medicine
                telemedicine,survey,primary care,theory of planned behavior
                Medicine
                telemedicine, survey, primary care, theory of planned behavior

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