Affordance Types and Their Determinants in Patient Mobile Health Portals Use: An Empirical Investigation

Mobile health portals (MHPs) are becoming increasingly important and prevalent among health care organizations for engaging and retaining patients. However, their success hinges on patient adoption and usage. Organizations face ongoing challenges with high adoption but low usage of MHPs. While affordance theory offers a valuable theoretical perspective for exploring patient perceptions and uses of MHPs, there is a gap in research that empirically investigates the distinct types of affordances and their determinants.

This study develops and empirically evaluates an integrated sociotechnical research model and hypotheses to bridge the literature gap by connecting theoretical constructs with empirical evidence and practical guidelines, thereby enhancing the understanding of patient MHP use. We extend the existing literature by differentiating 3 MHP affordance types: general, contextual, and behavioral. We examined the effects of patient absorptive capacity and hospital MHP innovativeness on the 3 types of affordances and their relationships. Based on the integrated sociotechnical research model and empirical results, we provide theoretical insights and practical guidelines on how organizations may enhance patient MHP use by enhancing patient absorptive capacity and improving patient-centered designs.

We evaluated our research model and hypotheses using survey data from 401 patients regarding a WeChat-based MHP platform in 4 large urban hospitals in China. We pretested the measures via 3 rounds of Q-sorting, supplemented by field observations, expert reviews, and patient pilot tests. We tested the research model and hypotheses with partial least squares-structural equation modeling using the SmartPLS software.

General affordance was significantly affected by patient absorptive capacity (b=.191, P<.001) and MHP innovativeness (b=.567, P<.001). Contextual affordance was influenced significantly by patient absorptive capacity (b=.148, P<.001) and general affordance (b=.484, P<.001), but not by MHP innovativeness (b=.036, P=.564). Behavioral affordance was significantly influenced by contextual affordance (b=.430, P<.001) and general affordance (b=.140, P=.014). General affordance and contextual affordance mediate the effects of patient absorptive capacity and the innovativeness of hospital MHPs on behavioral affordance.

Patient absorptive capacity and the innovativeness of MHPs in hospitals play distinct roles in predicting the 3 types of affordances. While the technology innovativeness of MHPs affects only general affordance but not contextual affordance, patient absorptive capacity affects both. Yet, contextual affordance is 3 times more effective in explaining behavioral affordance than general affordance. An unexpected finding related to the only unsupported hypothesis suggests that while the technology innovativeness of MHPs is necessary for general affordance, it does not directly influence MHP use; rather, it is indirectly and fully mediated by contextual affordance. Understanding and appropriately managing the contextual affordance of MHPs is critical in enhancing patient MHP use. To achieve the benefits of investing in MHPs, organizations must holistically understand and manage the 3 types of affordances, their determinants, and the relationships between them.