Motivation Outweighs Barriers in Predicting Perceived Effectiveness of Virtual Home Health Care for Chronic Disease...

Adoption of Virtual Home Health Care (VHHC) for chronic disease is shaped by competing motivations and barriers, yet these multi-select factors are rarely analyzed alongside effectiveness evaluations. Whether high trust in the clinician can coexist with doubt about the virtual format has not been examined in VHHC populations.

To characterize the motivation and barrier endorsement patterns of VHHC users and their demographic correlates, and to determine the relative contribution of motivations and barriers to perceived effectiveness. A secondary aim examined provider-modality trust discordance (simultaneously trusting one's clinician while doubting the virtual modality) and its demographic correlates.

This was a secondary analysis of cross-sectional data from a previously published study of 517 chronic disease patients in Saudi Arabia. Four motivation items and four barrier items (multi-select) were recoded into binary variables. Each of the 8 items was cross-tabulated with 4 demographic variables (gender, age, education, disease duration), yielding 32 chi-square tests. Perceived effectiveness was operationalized as the mean of 11 Likert-scaled items (Cronbach's α = 0.870). Hierarchical regression tested the incremental prediction of effectiveness by barrier count and motivation count, with non-parametric and ordinal sensitivity analyses. Trust discordance was operationalized as high provider trust (E2 ≥ 4) combined with accuracy-doubt endorsement.

Speed of access (69.4%) was the top motivation; accuracy doubt (63.4%) was the top barrier. Of the 32 chi-square tests, 11 reached statistical significance. The strongest association was between quality concern and education (Cramér's V = 0.243, p < 0.001), with postgraduates endorsing quality concerns at double the rate of high-school patients (68.4% vs 33.3%). In hierarchical regression, barrier count added negligible variance (ΔR² = 0.0004), whereas motivation count added 12.8% (B = 0.225, p < 0.001); the association was confirmed by bootstrap, rank-based and ordinal sensitivity analyses. Provider-modality trust discordance affected 41.2% of the sample.

VHHC adoption among chronic disease patients is associated with motivation intensity rather than barrier absence. The high prevalence of trust discordance (41.2%) suggests that provider trust and modality trust operate independently, with implications for targeted, multidisciplinary communication strategies.