Patients' compliance behavior in a personalized mobile patient education system (PMPES) setting: Rational, social, or...

With the advancement of mobile technologies, patients can access medical and patient educational information anytime and anywhere. Computer-aided patient education has been advocated as a key means of interventions for improving patient knowledge and compliance (i.e., adherence). However, evidence of the efficacy of computer-aided patient education remains relatively limited. For example, little is known about how the latest mobile technologies influence patients' compliance intention and their actual compliance behavior. The objective of this study is to investigate patients' compliance intention and behavior using a personalized mobile patient education system (PMPES) as a novel technological intervention for patients based on rational choice theory (RCT) and the theory of planned behavior (TPB).

We conducted a field survey with 125 actual patients in U.S. who obtained their patient education through PMPES while seeking medical treatment advice from their doctors. We used partial least squares (PLS) regression path modeling to test our model.

We found that, based on RCT, the benefits of compliance and cost/threat of noncompliance positively influenced intention toward treatment compliance; in contrast, costs of compliance negatively influenced intention toward treatment compliance. However, the benefits of noncompliance had no effect on intention toward treatment compliance. The results also indicated that intention toward treatment compliance, response efficacy, and self-efficacy related to TPB jointly influenced the degree of actual compliance behaviors. Social influence factors including subjective norms and descriptive norms had no influence on patients' actual treatment compliance behavior.

Overall, the research model explains 69.2 % of the variance in patients' actual compliance behavior. We find our model robust in using RCT as a key theoretical lens for the assessment of patients' compliance intention to follow medical recommendations enabled by the PMPES and delivered to mobile devices. The factors associated with RCT and TPB jointly influence patients' actual compliance behavior. Future mobile patient education programs should consider patients' age groups, mixed-gender groups, different medical settings, and cross-cultural contexts.