Role of Technology Acceptance in the Telerehabilitation of Patients With Metabolic Syndrome: Longitudinal Study

The advent of telerehabilitation has created new opportunities for the care of patients with metabolic syndrome. In distant rehabilitation, technology acceptance is particularly important because home-based projects are based on digital devices, and many patients are less familiar with their use.

Our aim was to explore technology acceptance among patients undergoing a 3-month complex, telemedicine-supported metabolic rehabilitation. We were curious to see how different factors influence the intention to use rehabilitation technologies and how this changes through the telerehabilitation process.

Participants were selected from patients in the metabolic telerehabilitation program at the university. Our model was based on the unified theory of acceptance and use of technology 2, which we supplemented with various other constructs. A paper-pencil questionnaire survey was administered on the last day of the preparatory week of the rehabilitation program (T1, n=145) and at the follow-up visit after the closing (T2, n=139). We used structural equation modeling with the least squares method to explore the relationships between model variables. Respondent segments were also identified by performing a hierarchical cluster analysis using Ward's method.

Facilitating conditions (FC) have the greatest impact (0.366) on the behavioral intention (BI) to use technology. Effort expectancy has no direct effect on BI; it operates only through performance expectancy (PE), which may be because, in telerehabilitation settings, patients are more goal-driven than experience-driven. The analyses of the T2 data show that the direct impact of social influence on BI has disappeared by the end of the rehabilitation process. This can be explained by the fact that during device use, it becomes clear that the devices are secure and the data are safe, making this factor implicit in the patient's behavior. Only 2 constructs appeared in both the T1 and T2 models: PE and FC. By comparing the 2 datasets, we have provided empirical support for an old hypothesis: the experience of using the tool for a time has led to a significant reduction in the impact of FC and a corresponding increase in the dominance of PE, which has "absorbed" the impact of some other constructs. Based on respondents' attitudes, we found 3 clusters. The telerehabilitation program itself has a significant impact on patients' BI, as the relative share of "enthusiastic users" (73/145, 50.3%) increased by about 20%, while the share of "distrustful reluctants" (25/145, 17.2%) decreased to a quarter by the end of the program.

This behavior-based functional approach enables treatments to be tailored to actual technology-use demands rather than to presumptive societal features. This means that before beginning rehabilitation, attempts should be undertaken to identify patients' clusters in clinical practice, and rehabilitation should be planned according to the individual's attitude toward technology.