App-based primary care in South Africa: A conceptual pathway from telemedicine service acceptance to patients’ continuance intentions

Background: This study reports on the quantitative research phase of a mixed-methods study that investigated patients’ acceptance of an application (app)-based telemedicine service for primary care aimed at South African public healthcare sector patients. Aim: This study aimed to investigate the relationships between telemedicine service acceptance and eight antecedents of such acceptance, as well as the relationships between telemedicine service acceptance, perceived value, patient participation, patient satisfaction with a telemedicine service, patient trust in telemedicine services and two dependent variables, namely both patients’ continuance intentions towards a telemedicine service and towards a telemedicine service provider. Setting: The research was conducted in South Africa and focused on an app-based telemedicine service, Kena Health, a provider of app-based primary care at the time this research was conducted. Methods: Quantitative data were collected using a self-administered online questionnaire through the Qualtrics data collection platform. Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to conduct the statistical analysis of a sample (n = 505) of respondents. Results: Statistically significant effects on patients’ telemedicine service acceptance were confirmed for perceived compatibility, innovativeness, privacy perception and care perception. All the hypothesised relationships between telemedicine service acceptance, perceived value, patient participation, patient satisfaction with a telemedicine service, trust in telemedicine services and patients’ continuance intentions towards the service and the telemedicine service provider were statistically significant. Conclusion: In South Africa, telemedicine services present a practical and scalable solution to more effectively address healthcare, particularly for underserved communities. This novel study offers much needed insights to improve healthcare delivery through digital innovation. Contribution: Two antecedents of telemedicine service acceptance that had not previously been considered in the technology acceptance theory, namely (positive) privacy perception and care perception, were confirmed. Insights are provided regarding the effect of patients’ trust in telemedicine services on their continuance intentions towards the service and the service provider under investigation.