2.1. Theory of Planned Behavior
TPB is a model that explains and predicts the factors influencing the intention to use, and actual use of technologies, proposed by Ajzen (1991). It is widely used to examine technology adoption behavior (e.g., Ajzen, 2011; Andrews et al., 2014; Bensley et al., 2004; Hsieh, 2015). The theory posits that individuals’ behavioral controls and intentions are strong predictors of their actual performance of the behavior (Ajzen, 1991). The theoretical constructs shaping individuals’ behavioral intentions in the TPB are (1) subjective norm [SN], (2) attitudes [ATT], and (3) perceived behavioral control [PBC]. According to Ajzen (1991), SN is a function of a normative belief to comply with the behavior (i.e., a perceived expectation of others regarding the behavior, which leads to feelings of pressure about whether to follow the perceived expectation of others) and thus, the person is motivated to comply with the behavior. ATT refers to a positive or negative response toward the normative belief. PBC is akin to Bandura’s self-efficacy—“judgments of how well one can execute courses of action required to deal with prospective situations” (Bandura, 1982, p. 122).
Prior studies have found that SN, ATT, and PBC have the predictive power for PHR adoption behavior. Specifically, SN toward ethical and privacy concerns in relation to PHRs was associated not only to intentional behavior (Abramson et al., 2014; Archer & Cocosila, 2014; Li et al., 2014; Patel et al., 2012; Vodicka et al., 2013), but also to actual behavior (Ancker et al., 2014; Ozoka et al., 2014). ATT toward PHRs predicted intentional (Andrews et al., 2014; Li et al., 2014; Kim et al., 2012; King et al., 2012) and actual behaviors (Ancker et al., 2014). PBC also did for intentional (Assadi & Hassanein, 2017; Dutta et al., 2018; Kim et al., 2009; Lober et al., 2006; Noblin et al., 2012) and actual behaviors (Lober et al., 2006; Noblin et al., 2012). However, none of these studies, except for Lober et al. and Noblin et al., have tested in a model both behavioral intentions and actual use from healthcare consumers’ perspective.