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European Journal of Applied Sciences – Vol. 11, No. 1

Publication Date: February 25, 2023

DOI:10.14738/aivp.111.14101.

Türkyılmaz, S. (2023). Investigation of Telemedicine Services, An Innovative and Technology-Based Healthcare Application, by

Using the Extended Technology Acceptance Model (TAM2): An Example from Turkey. European Journal of Applied Sciences, Vol

- 11(1). 594-621.

Services for Science and Education – United Kingdom

Investigation of Telemedicine Services, An Innovative and

Technology-Based Healthcare Application, by Using the Extended

Technology Acceptance Model (TAM2): An Example from Turkey

Dr. Serap Türkyılmaz

Beykent University, İstanbul, Turkey

Abstract

Today, people use the internet to meet their information and communication needs

related to health. This study aims to develop an acceptance model for Telemedicine

Services, which is a technology-based health application in the new world order in

which we experience digital transformation, and to determine the factors affecting

the intention of individuals living in Turkey to use Telemedicine services in line

with the results of the study. The quantitative survey research method was used for

the purpose of this study. Research data were collected from 248 participants by

using the online survey method. The data were analyzed using the Partial Least

Squares (PLS) method. The results revealed that perceived usefulness, self-efficacy,

trust, price value, technology anxiety, and perceived risk are a function of the

intention to use telemedicine services. Moreover, facilitating conditions, perceived

ease of use, resistance to use, and social influence were observed to not significantly

affect the behavioral intention to use such applications. In the current literature, no

study has been conducted to determine the factors affecting the intention of

individuals living in urban centers and rural areas in Turkey, a developing country,

to adopt telemedicine applications. This study may contribute to the literature on

telemedicine and the development of future telemedicine applications in the health

industry in Turkey. This research confirms that the Technology Acceptance Model

(TAM) can be used to model the adoption of telemedicine services in developing

countries by including additional variables. The results of this study will facilitate

understanding the acceptance of telemedicine services. It will not only facilitate

predicting the future adoption but also developing proper solutions to address

barriers to the use of telemedicine applications.

Keywords: Telemedicine, Technology Acceptance Model, Technology, Innovation,

Digitalization, Partial Least Squares (PLS)

INTRODUCTION

Today, as we have been going through a period where digital technologies are all around us

(Ekinci et al., 2021), we have been having difficulty following the innovations brought by digital

transformation through Industry 4.0 (Akalın and Veranyurt, 2022). With the emergence of the

Internet age (Wang et al., 2021), digitalization/digital transformation has penetrated all areas

of life, and it has been used for the benefit of humanity in the field of health, facilitating life

(Semiz, 2021; Ekinci et al., 2021). The rapid development of the applications of information

technologies is considered as a key factor in reducing costs, improving quality, increasing

efficiency and effectiveness, and increasing patient or customer satisfaction in health services

(Kho et al., 2020; Jagoda, 2021; AlQudah et al., 2021). With the digitalization and the

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European Journal of Applied Sciences (EJAS) Vol. 11, Issue 1, February-2023

particularly the health services, at an unexpected pace, as it has been the case in the rest of the

world; and the bed occupancy rates of the hospitals increased, resulting in disruption of health

services with the spread of the disease (Cinar et al., 2022). The first COVID-19 cases in Turkey

were confirmed and recorded on 11th of March 2020, and the Turkish government took action

by imposing restrictions and new practices upon the declaration of the pandemic by WHO

(Olcek et al., 2021).

Telemedicine, which has been on the agenda of medical industry since the early 2000s, has

become more popular in both scientific literature and practice with the COVID-19 pandemic,

and its advantages and disadvantages have been discussed. The digitalization of public services

in Turkey has begun in 2006 with the e-government application, and its scope was expanded

over time (Dağdelen, 2021). The Ministry of Health of the Republic of Turkey started

infrastructure studies on telemedicine applications as part of the Health Transformation

Program (HTP) in 2007. The program aimed to collect health-related data throughout the

country, to increase the effectiveness of health services, to take necessary measures against

health threats; to create, store, share and access electronic health records (Korkmaz and

Hoşman, 2018). Also, the Teleradiology System of the Ministry of Health of the Republic of

Turkey has allowed 24/7 access to the images of the radiological examinations on the web

environment, reporting these images, conducting teleconsultation between radiologists, and

evaluation of medical images and reports in terms of quality

(https://www.teletip.saglik.gov.tr/). Finally, works have been started for providing health

services using contemporary medical technology regardless of the place and geographic

location in accordance with the “Regulation on the Delivery of Remote Health Services”

published in the Official Gazette dated 10th of February 2022 and numbered 31746.

Despite its known advantages, various issues prevent the adoption and spread of telemedicine

services (Choi et al., 2019). While the distance from the health center, the cost of telemedicine

technology, reimbursement difficulties, legal liability, data privacy, and data security are the

most significant barriers for healthcare institutions (Alkmim et al., 2015; Xue et al., 2015; Scott

Kruse et al., 2018; Parimbelli et al., 2018; Cobelli et al., 2021), lack of technology and capability,

resistance to change, lack of licensing, lack of interpersonal care, interoperability, and poor

design of the telemedicine systems are the most important obstacles for healthcare

professionals (Alkmim et al., 2015; Scott Kruse et al., 2018), and age, education level, untrust

due to lack of face-to-face interactions, lack of technical skills and resources, telemedicine

ignorance, and resistance to it are the most important obstacles for patients (Velsen et al., 2017;

Scott Kruse et al., 2018; Zhou et al., 2019; Tsai et al., 2019; Al-Samarraie et al., 2020; Oderanti

et al., 2021).

Many studies in the literature have tried to understand why and how various stakeholders

adopt, use, and integrate telemedicine into their lives. For example, Hirani et al. (2017)

examined the user beliefs regarding the acceptance of telehealth and reported that enhanced

care and increased accessibility, benefits of telehealth to patients, privacy and discomfort, and

concerns of healthcare professionals were the reasons that prevent the acceptance of

telehealth. An et al. (2021) aimed to determine the factors affecting telehealth acceptance after

the rapid spread of the COVID-19 disease in South Korea and reported that increased

accessibility, improved care, usefulness, ease of use, and privacy/discomfort were the