Exploring and Understanding the Factors Affecting the Adoption and Continued Use of an Integrated Personal Health Record Application in Saudi Arabia

Abstract

Despite the potential of electronic personal health records (ePHRs) to improve patient care, they face low adoption rates globally. This challenge is particularly relevant for Saudi Arabia, where rapid healthcare digitisation initiatives under Vision 2030 create both opportunities and unique implementation considerations for ePHR. This study aimed to identify the factors influencing the adoption and continued use of the integrated ePHR within the Saudi context. The research used a mixed-methods approach. It began with semi-structured interviews with users and non-users of the “Sehhaty” integrated ePHR application. Qualitative analysis revealed several barriers to adoption, including limited awareness of the app's features, low e-health literacy, and good health status. Cultural factors were also significant, notably the tendency for some women to rely on male family members in using such applications. Conversely, factors like user trust, performance expectancy, and perceived improvements in patient safety facilitated usage. Based on these qualitative insights, employing a theoretical framework grounded in the Unified Theory of Acceptance and Use of Technology (UTAUT) and refined through existing literature, a quantitative questionnaire was developed and collected 556 responses from the Sehhaty app users and 98 from non-users. Quantitative analysis showed that for the users trust, female empowerment, performance expectancy, and digital capabilities significantly influenced their intention to continue using the integrated ePHR. Social influence, service quality and behavioural intention were also key drivers of actual usage behaviour. For the non- users, female empowerment and performance expectancy were the primary factors affecting their behavioural intention. In addition, service quality demonstrated a statistically significant relationship with trust across both models. This thesis makes a significant contribution by identifying culturally relevant factors influencing the integrated ePHR acceptance in Saudi Arabia. The findings provide actionable recommendations for developers and implementers to improve adoption rates and enhance patients’ engagement.