Usability Barriers Research Articles

How to overcome barriers to care with digital health applications (DiGA)? Areview of the patient pathway for unipolar depression

Digital health applications (DiGA) can play an important role in the treatment of unipolar depression. In Germany, the demand is high, but less than 1% of patients use DiGA, indicating existing barriers to their use. This article provides an overview of access and usage barriers along the patient pathway and discusses possible solutions to improve the dissemination and use of digital therapies.Based on the National Care Guideline (NVL) Unipolar Depression (2022), apatient pathway with the phases of "decision," "access," and "usage" was developed. Using this structure, existing care barriers were identified based on current literature, and solutions were derived. The narrative review shows that various factors hinder the effective use of DiGA. In the decision phase, lack of knowledge about DiGA and lack of trust in their effectiveness are central challenges. In the access phase, data protection concerns and bureaucratic hurdles are significant barriers. During the usage phase, difficulties in application and low adherence lead to limited effectiveness.Several solutions are proposed to overcome these barriers. Comprehensive education about the effectiveness of digital therapies could strengthen trust in DiGA. Improvements in user-friendliness and greater involvement of healthcare providers could increase acceptance and adherence. Additionally, targeted training for professionals and patients could promote the use of DiGA. These insights are also relevant for other areas of digital therapies.

Green AI Partnerships: Investigating the Interplay of Anthropomorphism and Consumer-Brand Relationships

This study explores the impact of green brand AI anthropomorphism on consumer-brand relationships, focusing on the mediating roles of psychological distance and trust and the moderating role of product usage barriers. It contributes to anthropomorphism theory, construal-level theory, and green branding literature. Data from Indian consumers were analyzed using SPSS PROCESS macro and AMOS 25. The results of the study indicate that brand AI anthropomorphism enhances consumer-brand relationships, with trust playing a significant role. Notably, the product usage barrier does not diminish trust or affect the relationship between brand AI anthropomorphism and consumers via psychological distance. This study extends the literature on anthropomorphism, AI, and product usage barriers in green brand AI anthropomorphic assistants.

Tourism and hospitality SMEs and digital marketing: what factors influence their attitude and intention to use from the perspective of BRT, TAM and IRT

PurposeThe purpose of this study is to investigate the reasons (for and against) affecting owners' attitudes and intentions to use digital marketing (DM) strategies in tourism and hospitality (T&H) small and medium enterprises (SMEs), by employing the behavioral reasoning theory (BRT).Design/methodology/approachA survey method was used to collect data from 306 T&H (SMEs) owners and analyze the data through partial least square structural equation modelling (PLS-SEM).FindingsThe study results indicate that reasons significantly affect owners' attitudes and intentions to use DM in T&H (SMEs). The “RF” was as follows: perceived ease of use (PEU), perceived usefulness (PU), and trust in DM professionals” and the “RA” technological anxiety, usage barriers (UB), and perceived complexity (PC) effect on owners’ attitudes and intentions to use DM. Also, it indicates that openness to change value significantly affects the “RF” insignificant with “RA” and attitude.Practical implicationsThe findings of this study emphasize that if owners/managers, governments, and policymakers overcome the “RA” that discourages and raises the knowledge about the “RF” in the adoption of DM, then the usage intention of DM strategies can rise in T&H (SMEs).Originality/valueThis study is the first to investigate the reasons (for and against) the owner’s attitude and intention to use DM in T&H (SMEs) by utilizing behavioral reasoning theory (BRT), technology acceptance model (TAM), and innovation resistance theory (IRT).

Facilitators and inhibitors of attitude and word-of-mouth intention toward adoption of digital municipal service systems: A stimulus-organism-response approach.

Increased technology adoption has significantly transformed how governments interact with citizens. Today, e-government services and tools are integral to modern public administration. Factors affecting users' adoption of e-government services have been studied in the past. However, this study focuses on citizens' acceptance and resistance to such services, which have not been thoroughly explored. This study addresses the gap by examining the facilitators and inhibitors affecting users' perceptions of the Digital Municipal Service System (DMSS). An integrated research model was developed based on the Stimulus-Organism-Response (SOR) framework. Using Smart-PLS, the study validated 353 respondents' data collected from Bangladesh. The study revealed that platform quality, convenience, social, and inclusiveness values significantly influenced attitudes toward DMSS adoption. On the other hand, tradition and usage barriers significantly negatively impacted attitudes toward DMSS adoption. These findings offer important insights for policymakers involved in developing and implementing e-government services in emerging economies such as Bangladesh. The study also provides a foundation for further research on technology adoption.

Ultrasound education, competencies and expected future use among medical interns in Denmark: a national cross-sectional study

BackgroundPoint-of-care ultrasound is increasingly used across medical specialties, calling for timely and relevant ultrasound education in specialty training. To enable customizing such education, we aimed to explore medical interns’ received ultrasound education during medical school and internship, perceived scanning competencies, evaluation of received education, future expectations for using ultrasound, and tendencies for perceiving ultrasound competence.MethodsThis was a national cross-sectional study. We developed a questionnaire based on a theoretical conceptual model, individual interviews with medical interns and focus groups with medical students, followed by pilot testing. The questionnaire was distributed to all medical interns in Denmark (N = 1231). Data were summarized with descriptive statistics. Differences between universities and tendencies for perceiving ultrasound competence were analyzed with Fisher’s exact tests and modified Poisson regression, respectively.ResultsResponses from 420 (34.1%) interns were included. Although varying across medical schools, 95.7% received formal ultrasound training and 86.0% encountered ultrasound examinations through clinical rotation. During internship, 44.2% received formal training, while 68.5% had to pursue it independently. Ultrasound examinations during clinical work were observed by 73.2% and performed by 47.6%. Common ultrasound usage barriers were insufficient scanning routine, supervision, knowledge, confidence and mental surplus. Ultrasound competence gain from medical school and internship was reported by 75.2% and 55.3%, respectively, but mainly to lesser/some extent. Most desired more training, expected to use ultrasound in the future (71.0%) and considered it a core competence (73.0%). Perceived ultrasound competence was significantly associated with receiving practical (RR: 4.08) or both practical and theoretical education (RR: 4.34) in medical school, and practical training on patients (RR: 1.09), required number of performed scans (RR: 1.06), competence test(s) (RR: 1.07), and/or consulting books/encyclopedia (RR:1.07) during internship.ConclusionsUltrasound training is part of medical school curricula but varies in type and extent. While most encounter and many use ultrasound during internships, formal training is less integrated. Most desire more training and attitudes towards future ultrasound usage are positive. Filled curricula pose dilemmas for prioritization and several barriers prevail for using ultrasound, representing missed opportunities for competence development and maintenance. Training governance and scaffolding continuous learning may be needed.Trial registrationNone.

Barriers to shippers’ resistance in adopting truck-sharing services

PurposeTruck-sharing stands out as an impactful strategy for minimizing emissions and optimizing the streamlined transport of goods. This study seeks to address a gap in understanding by investigating the barriers shippers face in adopting truck-sharing services.Design/methodology/approachThis study employs the innovation resistance theory to examine a range of potential barriers. A total of seven potential barriers are included in the investigation. Survey data from Bangladeshis are analyzed using an artificial neural network.FindingsThe barriers, ranked in importance, include image, tradition, value, usage, risk, psychological ownership and privacy concerns. Thus, psychological barriers (image and tradition) mostly underpin resistance to change, showing that the issue is more rooted in shippers' perceptions than operations. Also, they often do not find a financial cause to use truck-sharing services. Usage barriers, explicitly addressing the practical application of truck-sharing services, have now assumed the third position, underscoring their significance in overcoming the barriers.Research limitations/implicationsThe findings provide valuable insights for policymakers to reconsider their approaches in addressing the most formidable truck-sharing barriers.Practical implicationsThis insight holds implications for shippers and transport companies, offering strategic guidance to optimize their engagement with and support for such services.Originality/valueTo the best of our knowledge, this study examines shippers' reluctance to adopt truck-sharing services in a developing country.

The Utilization of Maps in Geographic Citizen Science: A Preliminary Analysis of Usability and User Experience Issues and Opportunities

The rapid proliferation of geospatial technologies and the widespread utilization of Web and mobile maps by nonexpert audiences spurred new perspectives and research paradigms within geography. One area affected by this transformation is citizen science, where geospatial technologies facilitated its more widespread use and revolutionized the way scientific knowledge is coproduced, especially in the environmental context. Geographic citizen science is widely used to support the collection and analysis of geolocated scientific data, extend existing geographic data coverage, and enable communities to address local issues. The inherent complexity of geospatial interfaces and data is widely recognized and there is a wealth of geographic research focusing on improving human–map interactions, with less emphasis, nevertheless, given to citizen science. Not only do these applications have their unique characteristics, but inclusiveness is paramount, which further adds to these complexities. Through an investigation of 229 geographic citizen science applications, we provide an overview of how geographic interfaces are currently employed in citizen science. We then evaluate a selection of applications to identify critical usability barriers, which might have a detrimental impact on the overall user experience and the success of these projects. Among others, we found that geographic citizen science applications need to better support visual thinking and leverage participants’ geographic knowledge. We subsequently provide a set of recommendations for map design and functionality and identify opportunities for future geovisualization research.

SMEs and digital marketing: A perspective of behavioral reasoning theory

This study explores the reasons (for/against) affecting Malaysian SMTHEs owners' attitudes and intentions to use digital marketing strategies using the BRT. The data was collected via a survey questionnaire, and PLS-SEM was used to assess the research model. The result shows that reasons significantly affect Malaysian SMTHEs owners' attitudes and intentions to use digital marketing. Similarly, both “RF” such as (perceived ease of use, perceived usefulness, relative advantage, and trust) and “RA” (technology usage barrier, technology anxiety barrier, and technology complexity barrier) were identified as influencing Malaysian owners’ attitudes and intention to use Digital marketing. Furthermore, Malaysian SMTHEs owners’ attitudes positively affect intentions to use digital marketing. Also, the result showed that the value open to change significantly affects the “RF”. Lastly, attitude significantly mediates the relationship between reasons and intention. The novelty of this study lies in its exploration of the reasons influencing Malaysian SMTHEs owners’ attitudes and intentions toward adopting digital marketing strategies.

A Study on the Barriers in Usage of Formal Financial Products/ Services by Women in the Rural Area of Kabrai Block of Mahoba District of Uttar Pradesh

A Study on the Barriers in Usage of Formal Financial Products/ Services by Women in the Rural Area of Kabrai Block of Mahoba District of Uttar Pradesh

Characteristic of mental health app usage: a cross-sectional survey in the general population

BackgroundMental health apps (MHA) have gained popularity in recent years. Most freely available apps are of low quality and lack evidence for effectiveness. Yet, download rates indicate high usage. MHA are potentially beneficial for individuals with no/low symptom severity as prevention, or as an option to reach underserviced populations. However, currently very little is known about the characteristics of MHA users in the general population, about the kind of MHA used, or the motivation behind MHA usage.MethodsWe collected survey-data from N = 1,247 individuals from the general population to investigate MHA usage.ResultsDescriptive statistics revealed that 41% had used MHA in the past 12 months; prescription app-use however was low (1.5% of MHA users). Mindfulness, moodtracking, and relaxation were the most popular categories of MHA. Perceived helpfulness, fun, and availability were the top reasons for MHA usage. Non-users reported distrust, lack of perceived need, and data security concerns as usage barriers. MHA users and non-users did not differ regarding sociodemographic variables. Multiple regression analyses revealed that sub-threshold symptoms of psychological disorders as well as higher levels of anxiety and stress were linked to higher probability of MHA usage. Higher levels of depression were associated with lower likelihood of MHA usage in general, but increased likelihood of usage of self-help apps specifically for depression.ConclusionsIt follows that MHA use is common in the general population independent of sociodemographic characteristics. MHA can reach people who might benefit, but more awareness and better structure of the market is needed to reduce distrust, increase usage of high-quality MHA, and improve the fit between app and user.

Sounds Good? Fast and Secure Contact Exchange in Groups

Trustworthy digital communication requires the secure exchange of contact information, but current approaches lack usability and scalability for larger groups of users. We evaluate the usability of two secure contact exchange systems: the current state of the art, SafeSlinger, and our newly designed protocol, PairSonic, which extends trust from physical encounters to spontaneous online communication. Our lab study (N=45) demonstrates PairSonic's superior usability, automating the tedious verification tasks from previous approaches via an acoustic out-of-band channel. Although participants significantly preferred our system, minimizing user effort surprisingly decreased the perceived security for some users, who associated security with complexity. We discuss user perceptions of the different protocol components and identify remaining usability barriers for CSCW application scenarios.

Identifying barriers of financial app usage and their impact on negative emotions, customer ratings and recommendation intention: a text-mining based approach

PurposeLimited studies in the mobile payment segment have attempted at understanding the factors that resist customers from using financial apps or mobile payment services (MPSs). This study aims at identifying the barriers from online customer reviews and examine how these barriers affect customers’ negative emotions (anger, fear, sadness), customer ratings and recommendation intentions.Design/methodology/approachThis study, divided into three phases, has adopted a text-mining based mixed-method approach on 14,043 reviews present in Google PlayStore or App Store pages about financial apps used in India.FindingsPhase 1 identified barriers like, “bad user experience”, “UPI failure”, “trust issues”, “transaction delays” from the reviews. Phase 2 found that “bad user experience” and “UPI failure” trigger both “anger” and “sadness”. “Transaction delays” and “money lost in transaction” stimulate “fear”. From the IRT stance, in Phase 3 this study has found that barriers like, “transaction error”, “UPI failure” (usage), “bad user experience” (image) and “trust issues” (tradition) have a significant negative impact on both customer ratings and recommendation intention.Originality/valueThe current study contributes to the existing literature on MPSs by identifying barriers from user generated content. Additionally, this study has also examined the impact of the barriers on customers’ negative emotions and recommendation intention.

Consumer resistance to WhatsApp payment system: integrating innovation resistance theory and SOR framework

PurposeDespite an exponential rise in the frequency of online payments in India, the cause of consumer resistance towards the WhatsApp payment system (WPS) remains unexplored. This research is aimed at exploring the barriers to the adoption of WPS.Design/methodology/approachA research model was proposed using stimulus-organism-response framework and innovation resistance theory. Data were collected from 392 users of the WhatsApp application using the mall intercept technique, which also utilizes digital payment platforms. A co-variance based structural equation modelling was employed to test proposed relationships in this cross-sectional study.FindingsThe study findings indicate that personal innovativeness as a personal stimulus negatively influences the usage and value barrier, while negative word of mouth (NWOM) increases the intensity of tradition and the image barrier. Additionally, value barrier, usage barrier, risk barrier and tradition barrier were found to have a negative influence on the intention to adopt the WhatsApp payment system.Originality/valueThis research is an initial endeavour that sheds light on the consumer cognition resisting the adoption of the WPS.

Metaverse in tourism: tourist involvement as a moderator

ABSTRACT This paper aims to identify barriers and enablers of the growing use of Metaverse in tourism by examining users’ intention in selecting a tourist location and hotel for vacation. It employs a mixed methods approach conducted in two phases, namely exploratory and confirmatory. The grounded theory’s twin slate approach allows extracting the factors in the first exploratory phase. The second (confirmatory) phase employs structural equation modeling to analyze the data. The results show that the Perceived Usage Barrier, Perceived Risk Barriers, and Perceived Value Barriers pose as significant barriers to the adoption of the Metaverse.

Layperson-Administered Naloxone Trends Reported in Emergency Medical Service Activations, 2020-2022

Layperson-administered naloxone (LAN) is a powerful but incompletely characterized intervention to prevent opioid-related overdose mortality. LAN trends are relevant to policy and strategic planning in naloxone distribution initiatives. To assess the 2-year LAN trend for persons in the United States receiving naloxone during emergency medical services (EMS) activations. This retrospective cross-sectional study was conducted in the United States from June 2020 to June 2022 among 65 621 195 EMS activations from 911 responses, EMS standbys, or when EMS crews functioned in an ambulance intercept role or during mutual aid to another ambulance response. Activations within health care settings and interfacility or medical transports were excluded. Data are from the National Emergency Medical Services Information System (NEMSIS), the national EMS patient care record database. From June 2020 to June 2022, NEMSIS included more than 96 million EMS activations from nearly 14 000 agencies across 54 states and territories. EMS clinician-reported LAN. The primary outcome was the trend of receiving LAN, measured by EMS clinician documentation. From June 2020 to June 2022, EMS reported 744 078 patients receiving naloxone, with 24 990 (3.4%) involving LAN. Patients were predominantly male (17 331 [69.4%]) and had a median (IQR) age of 42 (31-56) years, with the majority treated in urban homes or residences (21 692 [86.8%] urban; 13 223 [52.9%] in-home or residence). Of the total naloxone recipients, 243 985 patients (32.8%) had suspected drug overdose documentation as either the primary or secondary impression. Overall, the percentage change in naloxone administration rates decreased 6.1% over the study period (from 1140.1 [95% CI, 1135.1-1145.1] per 100 000 EMS activations to 1070.1 [95% CI, 1064.9-1075.3] per 100 000 EMS activations), while the percentage change of persons receiving LAN increased 43.5% (from 30.0 [95% CI, 29.2-30.8] per 100 000 EMS activations to 43.1 [95% CI, 42.0-44.1] per 100 000 EMS activations). In this cross-sectional study, the LAN rate increased from June 2020 to June 2022 as reported in the national EMS database. These findings help inform policies and practices aimed at mitigating the devastating impacts of the opioid epidemic and saving lives. Novel public health strategies are needed to measure the effects of this intervention nationally, evaluate approaches to expand naloxone distribution, and address naloxone usage barriers.

Barriers to the Adoption of Sharing-Based Accommodations: The Role of Personal Innovativeness and Compatibility

Sharing-based accommodations services are experiencing rapid global growth, driven by their inherent advantages. Nevertheless, alongside the benefits, these services are also accompanied by costs and potential risks. Intriguingly, the factors impeding or restricting consumer adoption of sharing-based accommodations have not been comprehensively investigated thus far. This study utilized innovation resistance theory (IRT) to investigate the influence of various barriers on the intention to use sharing-based lodgings services. Additionally, this study extended IRT by examining the impact of personal characteristics (innovativeness and compatibility) on consumers’ perceived resistance and intention to use sharing-based accommodations services. A quota sample included 493 individuals who were aware of sharing-based accommodations services and had traveled within the past 6 months. Path analysis utilizing structural equation modeling was used to test the research hypotheses. The study’s findings demonstrated that several barriers have a detrimental impact on individuals’ intentions to engage in sharing-based accommodation, except for image barriers and usage barriers. In addition, consumers’ innovativeness and compatibility characteristics negatively impact barriers and positively impact intention to use sharing-based accommodations. Based on these findings, sharing-based accommodations providers, individuals or businesses providing accommodations, and localities providing tourism services can design more effective strategies to attract users.

Navigating barriers to organic food purchase intention: a mixed method longitudinal approach in emerging market

PurposeThis study investigates barriers to consumers’ organic food purchasing. It identifies the factors and the extent to which they influence their purchase behaviours and future purchase intentions (i.e. continuance purchase intentions).Design/methodology/approachIt combines qualitative and quantitative methods across two phases. Longitudinal research was carried out in two phases. It involved a thematic analysis and a covariance-based structural equation modelling approach. During Phase-1 and Phase-2, responses were collected from 376 and 351 respondents, respectively.FindingsPhase 1 found the value barrier was significantly affecting the consumers’ purchase intention, while Phase 2 identified the impacts from both image and value barriers on purchase intentions. Notably, purchase intention affected continuance intention in both phases, while ethnocentrism showed no influence.Originality/valueUsing the innovation resistance theory, this study sheds light on the factors that prevent purchase intention. It offers valuable insights for policymakers and for the marketers of organic foods. This contribution implies that value and usage barriers were affecting the consumers’ purchase intentions in the short as well as in the long term. In sum, it suggests that consumers were not purchasing organic food as they felt it was either overpriced, not available in the market or because they were sceptical about its organic labelling.

Exploring the Impact of Technology Readiness and Innovation Resistance on User Adoption of Autonomous Delivery Vehicles

Advancements in technology have made autonomous delivery vehicles (ADVs) a feasible option for “last-mile” delivery, improving logistic efficiency in the global digital age. The promotion and popularization of ADVs must be based on widespread user acceptance. This study combines the technology readiness theory and innovation resistance theory to construct a research model to explore the key factors influencing users’ use and recommendation of ADVs. We collected 349 valid samples through a questionnaire survey and used partial least squares-based structural equation modeling (PLS-SEM) to validate the model. The results showed that (1) positive technology readiness reduces users’ perceptions of value barrier, tradition barrier, and image barrier, while negative technology readiness increases users’ perceptions of the five categories of innovation barriers: usage barrier, value barrier, risk barrier, tradition barrier, and image barrier; (2) users’ intention to use and recommend ADVs is negatively affected by the usage, value, and tradition barriers; (3) users of different genders have varying perceptions of the relationship between technology readiness, barrier factors, and the decision to use ADVs. This study reveals the influencing factors that hinder users from using and recommending ADVs and their functioning mechanisms from the perspective of barriers and examines the impact of gender differences between males and females. The study enriches the empirical research in ADVs, providing theoretical support and practical guidance for logistics companies and the government to develop autonomous delivery technology and publicize and promote ADVs.

Unveiling the influencing mechanism underlying users’ adoption and recommend intentions of central bank digital currency: A behavioral reasoning theory perspective

Despite the enormous benefits of the implementation of central bank digital currency (CBDC), the realization of these anticipated benefits depends on users' adoption and recommendations resulting from the consideration of both facilitators and inhibitors. Drawing on the behavioral reasoning theory (BRT), this study endeavors to unveil the influencing mechanism underlying users' CBDC adoption and recommend intentions using a hybrid approach integrating qualitative study (i.e., thematic analysis) and quantitative study (i.e., PLS-SEM). The qualitative research results indicate that relative advantage, incentive measures, government support, compatibility, and convenience are the “reasons for” users' CBDC adoption and recommend intentions, while tradition barrier, risk barrier, usage barrier, and image barrier are the “reasons against” users' CBDC adoption and recommend intentions. Further, the quantitative analysis of 638 pilot CBDC users suggests that users' CBDC adoption intentions positively influence their CBDC recommend intentions. “Reasons for” positively influence both users' attitudes and adoption intentions toward CBDC, whereas “reasons against” only negatively influence users' adoption intentions toward CBDC. Values (openness to change) positively influence users' “reasons for” and attitudes toward CBDC, and negatively influence users' “reasons against” adopting CBDC. Financial literacy strengthens the paths between “reasons for” and adoption intentions and weakens the paths between “reasons against” and adoption intentions. Theoretically, this study contributes by providing a thorough knowledge of users’ values, reasons, attitudes, and adoption and recommend intentions toward CBDC. Practically, this study renders insightful policy implications for central banks worldwide to promote CBDC applications.

Estimating the Determinants of Consumers' Electric Vehicle Purchase Intentions: Empirical Evidence from Türkiye

In the present era, environmental concerns like air pollution, the decrease of natural resources (which has led to increased oil prices) and climate change have led to a shift in consumer preferences towards electric vehicles (EVs). The use of electric vehicles is regarded as an effective technology for reducing greenhouse gas emissions from road transportation using fossil fuels. Despite the recent influx of worldwide automotive brands into the Turkish market, the apportion of EV in the developing Turkish automobile market remains limited. It is crucial to identify the variables that influence consumers' intentions to purchase electric vehicles. The objective of this study is investigating the influence of environmental concern, environmental perception, social impact, performance and usage barriers on Turkish individuals' intentions to purchase EV. A survey was conducted online with 340 participants to test the research model and hypotheses derived from the literature. Once the data had been collected using the snowball sampling method, it was analyzed using the SPSS and SmartPLS software packages. The findings of the research indicate that consumers' environmental concerns and environmental perceptions have a significant effect on their purchasing intentions. On the other hand, while social influence and performance had a significant positive impact on the intention to purchase an EV, usage barriers did not have a significant impact.