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Currently accepted at: Journal of Medical Internet Research

Date Submitted: Nov 26, 2019
Open Peer Review Period: Nov 26, 2019 - Jan 20, 2020
Date Accepted: Apr 12, 2020
(closed for review but you can still tweet)

This paper has been accepted and is currently in production.

It will appear shortly on 10.2196/17221

The final accepted version (not copyedited yet) is in this tab.

Patients’ Perceptions of Barriers and Facilitators to the Adoption of e-Hospitals: Cross-sectional Study in Western China

  • Peiyi Li; 
  • Yunmei Luo; 
  • Xuexin Yu; 
  • Jin Wen; 
  • Elizabeth Mason; 
  • Weimin Li; 
  • Mohammad Jalali; 



As an innovative approach to distributing online healthcare services from physical hospitals to patients at a distance, e-hospitals, i.e., extended care hospitals through the Internet, have been extensively developed in China. This closed healthcare delivery chain was developed through combining e-hospitals with physical hospitals; treatments begin with an online consultation and registration, then patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of healthcare. However, there is limited research on end-users’ acceptance of e-hospitals, nor the effectivity of strategies aimed to prompt the adoption of e-hospitals in China.


To provide insight regarding the adoption of e-hospitals, this study investigated patients’ willingness to use e-hospitals, and analyzed barriers and facilitators to the adoption of the technology.


We administered a pretested self-administered questionnaire and performed a cross-sectional analysis including 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients’ sociodemographic characteristics, medical history and current disease status, proficiency with electronic devices, previous experience with online health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify potential predictors of willingness to use e-hospitals.


Overall, it was found that 65.6% of patients were willing to use e-hospitals. Employment status (P =.019), living with children (P <.001), education level (P =.046), IT skills (P <.001), and prior experience with online healthcare services (P <.001) were statistically significant predictors of willingness to use e-hospitals; while age, income, medical insurance, and familiarity with e-hospitals were not. Also, the prominent facilitators of e-hospitals were convenience (95%) and accessibility to skilled medical experts (72%). The most frequently perceived barrier varied between age groups: seniors most often reported their inability to operate technological devices as a barrier (87%), while young respondents most often reported that they avoided of e-hospital services because they were accustomed to face-to-face consultation (75%).


We identified variables, facilitators, and barriers that play an essential role in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on accustoming target populations with online healthcare services while maximizing ease of use and providing assistance for technological inquiries.


Please cite as:

Li P, Luo Y, Yu X, Wen J, Mason E, Li W, Jalali M

Patients’ Perceptions of Barriers and Facilitators to the Adoption of e-Hospitals: Cross-sectional Study in Western China

Journal of Medical Internet Research. 12/04/2020:17221 (forthcoming/in press)

DOI: 10.2196/17221


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