# The impact of confidentiality and privacy concerns on behavioral intention to adopt electronic personal health records among chronic patients in southwest Ethiopia in 2023: an application of the UTAUT2 model

## TL;DR

This study examines how privacy and confidentiality concerns affect chronic patients' willingness to use electronic health records in Ethiopia.

## Contribution

Applies the UTAUT2 model to show how privacy concerns and social influence impact e-PHRS adoption in a low-income setting.

## Key findings

- Confidentiality and privacy concerns significantly reduce behavioral intention to adopt e-PHRS.
- The extended UTAUT2 model explains 75% of the variance in e-PHRS adoption intentions.
- Social influence and facilitating conditions mediate the relationship between confidentiality concerns and adoption.

## Abstract

The use of electronic personal health record systems (e-PHRS) is essential for chronic patients as they help to improve self-care management and communication between caregivers. However, when implementing e-PHRS, patients often express their concerns regarding privacy and confidentiality issues. Therefore, this study aimed to assess the impact of confidentiality and privacy concerns on the level of intention to use e-PHRS among chronic patients in southwest Ethiopia in 2023.

A cross-sectional study was conducted among 680 chronic patients from 24 July to 17 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 the study participants. The impact of confidentiality and privacy concerns on the patients' intentions regarding e-PHRS adoption was examined using the extended Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model. We used measurement and structural model statistics to assess the validity of the proposed model. All the hypotheses were tested using structural equation modeling and presented using SPSS AMOS version 23. Standardized regression coefficients (β), 95% CIs, and p-values < 0.05, indicating significance, were used to examine the association between the exogenous and endogenous variables.

A total of 680 chronic patients, with a response rate of 87.3%, were included in the study. In total, 288 participants (42.4%) intended to adopt e-PHRS (95% CI: 39.0, 46.2). The results show that the extended UTAUT2 model explained approximately 75% of the variance in 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) were significantly associated with adopting e-PHRS. Social influence and facilitating conditions were found to mediate confidentiality and behavioral intention, with a p-value < 0.001, while only social influence mediated the privacy concern and behavioral intention to adopt e-PHRS, with a p-value < 0.001.

Less than half of the surveyed patients intended to use e-PHRS. The result confirmed the significant impact of confidentiality and privacy concerns on e-PHRS adoption. As a result, this study demonstrates that confidentiality and privacy concerns are two main challenges that stakeholders and program developers should consider during the implementation of e-PHRS in low-income countries.