According to world health organization (WHO) mobile health care (M-health) is defined as “a medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices. M-Health also involves the use and capitalization on a mobile phone’s core utility of voice and short messaging service (SMS) as well as more complex functionalities and applications including general packet radio service (GPRS), third and fourth generation mobile telecommunications (3G and 4G systems), global positioning system (GPS), and Bluetooth technology”. Istepanian and Pattichis(2003) made a general definition assuming that M-health is covering a wide range of areas of networking, mobile computing, medical sensors, and other communication technologies within healthcare. On the other hand Lester et al. (2011) and Rai et al. (2013) defined M- health as a clinical services that patient can access through mobile devices, where blaya et al. (2014) found M-health as a tool used by health workers to track patients with chronic dieses. Deng (2014) said that M-health is a tool for information and guidance for people in general. Akter et al. (2013) and Mechael (2009) described the M-health as a technological supporter for healthcare from a distance in order to monitor and improve the health status of users. For this research M-health will be defined as a novel and new system empowered by using smart phones, personal digital assistants (PDAs), and any other mobile technology to attain a wide range of healthcare and preventive health services (Singh et al.,2017).
In general M-health enable users to access a personalized and interactive health services effectively because of their mobility and ubiquity (Deng et al., 2014). M-health offers preventive health services, help with treatment schedule, facilitate faster healthcare delivery, provide a relatively lower healthcare cost and achieve wider healthcare access (Chatterjee et al., 2009;Khan et al.,2010; Lee et al.,2015).Using healthcare apps _as the latest method for M-health_ enable people to manage and track their health personally like :heart rate, calories burned, distance walked , and tracking health related information. It meant to be used for better understanding for personal health goals (Vincze, 2017). According to Pew Research Center’s Internet & American Life Project (2012); there is 69% of U.S. adults keep track of at least one health apps – weight, diet, exercise, or routine(Fox &Duggan, 2013).
While in developed countries M-health is another luxuries improvement in health care services, it has an essential need to make the basic health care services available for the widest possible areas in developing countries. In 2009 the United Nations Foundation, Vodafone Foundation Technology and WHO published a report which profile more than 50 M-health projects taking place in the developing world. The main goal was to make healthcare more effective, and have a significant positive impact on clinical outcomes such as reduced infant mortality, longer life spans, and decreased the growth of contagious diseases. The report showed a promising support from the governments, institutions and people, for example using free SMS to quiz citizens in their knowledge about HIV/AIDS and the location of the nearest testing center, surprisingly the project get popular in short time(Vital wave,2010). Another report was published by WHO in 2011; the report found that governments in low and middle income countries had interest in M-health technology, the projects made a noticeable improve in reducing the diseases that mainly linked with poverty like HIV,TB, and Malaria. The project also affected the timing in emergency protocol, the drug shortage in clinics, the health workers training and the diagnosis procedures (Kay, 2011).
The rough list of basic branchs in healthcare services has a different aspect. For developed countries M-health concentrate on personal health improvement, chronic disease (diabetes, blood pressure), old age health services, reduce the common protocol steps in using paper work through health care services, and personal health improvement and wellness (fitness activity, diet assistance, weight coaching, stress reduction, smoke quitting) .
In the other hand developing countries are in a mission to spread the basic healthcare servicesand concentrate on covere the access to medical information, the access to healthcare providers, online support groups for contagious diseases, and health alerts and reminders (doctor’s appointment reminders, medication adherence).
“We live the Apps Culture” (Do, 2011, P.353) where everything is available on the apps (work, home, health and entertainment). The latest development in M-health came along with smart phone and apps rising. Gill (2012) reported that when the word (medical) was searched on iphone apps store there were 9000 apps, for android the same word gained around 5000 apps.
Going back to WHO report in 2011, there were surprises in the result, first developing countries is not far behind in the level of using smart phone, according to the report developing countries reached 77% while developed countries reached 86%. Second there is an exponential growth in the use of smart phone where the main reason is the relatively low-cost. WHO and the other global institutions recommendations revolve around the idea of seizing the moment to make huge steps in the process of public health improvement.
1.2 Research Problem:
The main challenge for any health care apps is how to attract people to accept and adopt M-health systems especially in developing countries. Where there will be problems in delivering healthcare services with a defect of 2.4 million health worker to cover remote areas(Vital Wave Consulting,2009). The urgent need for an effective tool, method or strategy to overcome the problem had been guided to use the electronic health service (e-health), which refers to “the set of software applications that deliver tools, processes, and communication systems to support healthcare practices”(Chauhan,2017,P.345 ), E-health enabled a full management of healthcare related information, however it requires an active wired network, hardware’s and it was hardly attached to the patients themselves(Sun et al.,2013). According to Akter et al. (2010); M-health is a logical extension to e-health as mobile technology innovations continue to accelerate. The mobile devices make it easy to reach people and deliver health care when necessary. It is also more convenient when it comes to the emergency situation.
In recent years, the use of mobile phones has exponentially multiplied until it reached the developing countries which are characterized by its problems in technologies and have significant scares in important facilities. These countries experienced a sudden increase in mobile phone usage; for example in 2015 the mobile usage percentage arrived 179% in Arab Gulf region, 113% in Egypt and 84% in Lebanon (Digital, 2018). This diffusion has a potential to improve health care by using M-health. in Jordan the mobile usage percentage achieved 201%, where the use of internet through smart phones reach 135% in 2017. Which make Jordan one of the fastest growing countries in mobile and telecommunication technology sectors in the countries in the Middle East (statista, 2018).In addition there are three mobile and internet providers which cover the twelve governorates.
At the end of 2016 there were 2.1 billion using smart phones worldwide, it’s about 91% from the all the people who use mobile phones (statista,2018), smart phone is a “mobile phone that has addi¬tional functions similar to personal digital assistant devices, for examples :iphone 3G, 3GS, 4 and 4S” (Gill,2012,332). There were small software applications that run on smart phone or other portable device (apps). At the beginning the popular cat¬egories of smart phone apps include games, music, social networking, news, weather, maps/navigation, and then it became more essential in health care, communication, banking/finance, shopping, productivity, and lifestyle. In 2017 there were 3.7 billion M-health apps downloads worldwide,(statista,2018),Statista Global Consumer Survey in 2017 reported that the download of at least one M-health apps were 45%, 33%, and23%, in India, China, and Bangladesh respectively.
Jordan located in the Middle East, it is a developing country with population of 7.3 million (statista, 2017). Health care in Jordan essentially depends on the governmental services; 78.6% from the total health care cost in Jordan sponsor by the government as a medical insurance which is 9.6% from the total national budget (Tammime, 2015). Taking into considerations the recent reports regarding the risk factors like smoking, obesity, unhealthy diet, and physical activities, the health care cost is expected to increase. In details; smoking prevalence was found to be very high 33% mainly in adult males, and 6% of adult female, with a risk of cardiovascular disease and cancer, another problem is rise from the unhealthy diets; 57% of Jordanians consumed less than five servings of fresh fruits and vegetables in daily basis. A third issue is coming from Physical inactivity; half of Jordanians are engaged in physical activities with less than 10 minutes daily. Another significant problem appeared with 1.5 million Syrian refugees came to Jordan in 2013. The cost of the health care sector is estimated to be 93 million US$ per one million Syrian refugees (Tammime, 2015).
In the light of the facts mentioned above, we can understand the need for an effective method to improve healthcare in Jordan with what we already have, the mobile apps, however persuading customers to adopt the M-health is not an easy process, especially as there is a lack of understanding what exactly the benefits of M-health from the customers’ perspective (Curran and Meuter, 2007). Indeed, There is very little research on this subject in the Arab region about the potential of adoption M-health. Thus, there is a need to understand and study the main factors that affect behavioural intention to adopt the M-health by Jordanian people.
1.3 Research aim& objective:
The aim of this study is to examine the factors that affect t behavioral intention to adopt the M-health by Jordanian people. Based on the current study aim, the objectives that this study hopes to achieve the following:
1- Reviewing the main body of literature which covers that main studies that discuss M-health issues to identify and understand that main aspects that shape the customers’ intention and acceptance of M-health.
2- Developing a conceptual model which covers the main factors that could predict the behavioral intention and adoption of M-health in Jordan. Selecting the suitable research method to collect data from the Jordanian people. Then analyzing the collected data using appropriate statistical technique.
3- Offering guidelines and recommendations for community.
1.4 Research Approach:
For the data collecting instrument, a self-administered questionnaire is developed. this tool is best for the field survey by provide the ability to access a large number of people in different places, (Bhattacherjee, 2012).
A convenience sample of Jordanian people will be used from different cities in Jordan: Amman, Irbid and Aqaba. Indeed, a convenience sample a is a non-probability sampling technique and was selected as there is no full and reliable list of all the Jordanian people who has interest in smart phone which could help to use any kind of probability sampling methods. The two-stage approach of structural equation modeling (SEM) will be used to analyze the data collected in the current study.
1.5 Structure of Dissertation:
This study contains six chapters including this chapter; chapter two will introduce an overview of the main studies in M-health through the technology acceptance models. .
Chapter three will introduce the conceptual model for this study and propose the hypotheses .Chapter four will explain the methodology which this study will follow. Chapter five will provide results from the field survey in a statistic and descriptive way. There will be a present of the analysis results of the SEM, which are particularly associated with the validation of the conceptual model and the verifying of its hypotheses. Chapter six will discuss thoroughly the fitness of the conceptual model and the hypothesis significant result. This chapter will contain a final conclusion, any research limitations, and suggestion, which direct further research that future studies may wish to consider.