2型糖尿病患者使用E-health管理疾病意愿与影响机制

doi:10.19723/j.issn.1671-167X.2025.03.016

摘要/Abstract

摘要：

目的: 探讨2型糖尿病患者对于E-health技术，如应用程序(application, APP)或微信小程序的使用意愿及其影响因素，分析具体的作用机制。方法: 使用扩展的技术接受模型为理论依据，于2024年11—12月选取全国东中西部地区6省或直辖市的2型糖尿病患者559例进行横断面问卷调查，调查患者使用APP或微信小程序的意愿及影响因素，使用相关分析和结构方程模型分析患者的使用意愿影响因素，并探究影响机制。结果: 共调查559例患者，平均使用意愿得分为10.68分(总分15分)，年龄与文化程度是使用意愿的影响因素，年龄较低、文化程度为高中/大专者使用意愿更强，差异有统计学意义(P < 0.05)；Spearman相关性分析显示感知有用性、感知易用性、疾病感知、社会支持、自我效能、外部线索均与使用意愿正相关，感知障碍与使用意愿呈负相关，差异均有统计学意义(P < 0.05)。结构方程模型显示感知有用性(β=0.375, P < 0.001)、疾病感知(β=-0.240, P < 0.001)、自我效能(β=0.313, P=0.019)、社会支持(β=-0.336, P=0.042)、外部线索(β=0.609, P < 0.001)对于患者的使用意愿有直接影响。感知易用性以感知有用性为中介，对使用意愿有间接影响，总效应为0.374；自我效能通过疾病感知的部分中介效应影响使用意愿；外部线索通过感知有用性的部分中介效应影响使用意愿；感知障碍以感知有用性为中介影响使用意愿；以上差异均有统计学意义(P < 0.05)，对使用意愿的影响总效应最高为外部线索(β=0.672)。结论: 2型糖尿病患者对于E-health技术如APP或微信小程序有较高的使用意愿，年龄较低、文化程度为高中/大专者使用意愿更强，患者感知有用性、自我效能、外部线索的增加有利于提升使用意愿，而高疾病感知与高社会支持者的使用意愿有所下降，感知易用性、自我效能等也可通过多重机制影响使用意愿。

关键词: 糖尿病, E-health, 使用意愿, 结构方程模型, 技术接受模型

Abstract:

Objective: To comprehensively investigate how the willingness of patients with type 2 diabetes mellitus to use E-health technologies, such as the application (APP) or Wechat mini-programs and the underlying influencing factors works for its mechanisms. Methods: Based on the extended technology acceptance model, a cross-sectional questionnaire survey was conducted among 559 patients with type 2 diabetes from six provinces or municipalities in the eastern, central, and western regions of China from November to December 2024. The survey aimed to investigate the patients' willingness to use APP or Wechat mini-programs and the influencing factors. Correlation analysis and structural equation modeling methods were used to analyze the influencing factors of patients ' willingness to use and to explore the mechanisms. Results: A total of 559 patients were surveyed, with an average willingness score of 10.68 (out of a total score of 15). Age and education level were found to be influencing factors of willingness to use, younger age and higher education (high school/college) were significantly associated with stronger willingness to use (P < 0.05). Spearman correlation analysis revealed that perceived usefulness, perceived ease of use, disease perception, social support, self-efficacy, and external cues were positively correlated with willingness to use, while perceived barriers were negatively correlated (all P < 0.05). Structural equation modeling demonstrated direct effects of perceived usefulness (β=0.375, P < 0.001), disease perception (β=-0.240, P < 0.001), self-efficacy (β=0.313, P=0.019), social support (β=-0.336, P=0.042), and external cues (β=0.609, P < 0.001) on willingness to use. Perceived ease of use indirectly influenced willingness through perceived usefulness (total effect=0.374). Self-efficacy affected usage intention partially mediated by disease perception, external cues influenced intention through perceived usefulness, and perceived barriers impacted intention via perceived usefulness, with external cues exhibiting the strongest total effect (β=0.672). All these effects were statistically significant (P < 0.05). Conclusion: Patients with type 2 diabetes mellitus have a high willingness to use E-health technologies like APP or Wechat mini-programs, particularly younger individuals and those with high school/college education. Increasing perceived usefulness, self-efficacy, and external promotion can enhance willingness to use. However, higher disease perception and higher social support are associated with decreased willingness to use. Perceived ease of use and self-efficacy can also affect willingness to use through multiple mechanisms.

Key words: Type 2 diabetes mellitus, E-health, Willingness to use, Structural equation model, Technology acceptance model

中图分类号:

R193.3

陈子砚, 张晓悦, 顾亦梧, 常春. 2型糖尿病患者使用E-health管理疾病意愿与影响机制[J]. 北京大学学报（医学版）, 2025, 57(3): 522-528.

Ziyan CHEN, Xiaoyue ZHANG, Yiwu GU, Chun CHANG. Type 2 diabetes patients use E-health to manage disease willingness and influence mechanisms[J]. Journal of Peking University (Health Sciences), 2025, 57(3): 522-528.

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Variables	Patients, n (%)	Score, ${\bar x}$±s	F/t	P
Gender			1.775	0.077
Male	244 (43.65)	10.87±2.23
Female	315 (56.35)	10.53±2.30
Age/years			5.283	< 0.001^***
18-	60 (10.73)	11.53±2.09
40-	81 (14.49)	11.11±2.07
50-	132 (23.61)	10.42±2.13
60-	173 (30.95)	10.75±2.39
70-	113 (20.21)	10.11±2.31
Domicile			-1.730	0.084
Urban	311 (55.64)	10.53±2.23
Rural	248 (44.36)	10.86±2.32
Area			1.154	0.283
East	177 (31.66)	10.64±2.50
Midland	217 (38.82)	10.53±2.35
West	165 (29.52)	10.91±1.87
Education			4.843	0.028^*
Primary school and below	107 (19.14)	10.09±2.13
Junior high school	187 (33.45)	10.67±2.28
High school or technical school	130 (23.26)	11.00±2.36
Junior college	54 (9.66)	10.94±2.41
University and higher	81 (14.49)	10.75±2.11
Marital status			0.407	0.685
Married	495 (88.55)	10.66±2.23
Single/separated or divorced/widow	64 (11.45)	10.80±2.56
Income per month/yuan			0.180	0.671
≤1 499	146 (26.12)	10.75±2.45
1 500-2 999	160 (28.62)	10.59±2.27
3 000-5 999	160 (28.62)	10.49±2.15
≥6 000	93 (16.64)	10.82±2.20
Course of disease/years			3.627	< 0.001^***
≤5	328 (58.68)	10.97±2.23
>5	231 (41.32)	10.26±2.27
Complication			1.429	0.158
Yes	50 (8.94)	10.26±2.15
No	509 (91.06)	10.72±2.28
Diabetes comorbidities
Yes	242 (43.29)	10.60±2.42	0.652	0.515
No	317 (56.71)	10.73±2.15
Family history of diabetes
Yes	210 (37.57)	10.83±2.38	-1.245	0.214
No	349 (62.43)	10.58±2.20
Total	559 (100.00)	10.68±2.27

Variables	Items, n	Score, ${\bar x}$±s
Perceived usefulness	7	28.23±5.91
Perceived ease of use	3	11.62±2.67
Disease perception	4	15.14±3.15
Perceived barrier	4	12.60±4.10
External clues	4	15.69±3.55
Social support	4	15.48±3.53
Self efficacy	3	11.59±2.67
Willingness to use	3	10.68±2.27

Variables	Perceived usefulness	Perceived ease of use	Disease perception	Perceived barrier	External clues	Social support	Self efficacy	Willingness to use
Perceived usefulness	1.000
Perceived ease of use	0.837^***	1.000
Disease perception	0.615^***	0.637^***	1.000
Perceived barrier	0.121^**	0.091^*	0.335^***	1.000
External clues	0.737^***	0.704^***	0.571^***	0.104^*	1.000
Social support	0.701^***	0.648^***	0.549^***	0.142^***	0.868^***	1.000
Self efficacy	0.738^***	0.814^***	0.635^***	0.094^*	0.772^***	0.726^***	1.000
Willingness to use	0.605^***	0.605^***	0.285^***	-0.224^***	0.593^***	0.531^***	0.594^***	1.000

Path			Estimator	95%CI of estimator	Z	P
Perceived usefulness	→	Willingness to use	0.375	0.250，0.500	5.865	< 0.001^***
Perceived ease of use	→	Willingness to use	0.108	-0.088，0.304	1.078	0.281
Disease perception	→	Willingness to use	-0.240	-0.364，-0.116	-3.792	< 0.001^***
Self efficacy	→	Willingness to use	0.313	0.051，0.575	2.338	0.019^*
Perceived barrier	→	Willingness to use	-0.055	-0.114，0.004	-1.837	0.066
Social support	→	Willingness to use	-0.336	-0.661，-0.012	-2.032	0.042^*
External clues	→	Willingness to use	0.609	0.221，0.997	3.075	0.002^**
Disease perception	→	Perceived usefulness	0.057	-0.014，0.128	1.566	0.117
Perceived ease of use	→	Perceived usefulness	0.708	0.632，0.784	18.245	< 0.001^***
External clues	→	Perceived usefulness	0.169	0.096，0.243	4.517	< 0.001^***
Perceived barrier	→	Perceived usefulness	0.044	0.001，0.088	2.004	0.045^*
Self efficacy	→	Perceived ease of use	0.910	0.885，0.935	71.419	< 0.001^***
Perceived barrier	→	Perceived ease of use	-0.054	-0.105，-0.003	-2.081	0.037^*
Self efficacy	→	Disease perception	0.794	0.729，0.858	24.111	< 0.001^***

Path			Direct effect	Total indirect effect	Total effect
Perceived usefulness	→	Willingness to use	0.375		0.375
Perceived ease of use	→	Willingness to use	0.108	0.266	0.374
Disease perception	→	Willingness to use	-0.240	0.021	-0.219
Self efficacy	→	Willingness to use	0.313	0.166	0.479
Perceived barrier	→	Willingness to use	-0.055	-0.004	-0.059
Social support	→	Willingness to use	-0.336		-0.336
External clues	→	Willingness to use	0.609	0.063	0.672