Article Type : Research Article
Authors : Pham Van Tuan, Hoang Khanh Linh, Dinh Tran Ngoc Huy, Nguyen Thu Thao, Nguyen Ha Le and Nguyen Hoang Quan
Keywords : Home healthcare service; Medical services; Family doctors
The authors’ research article is about the perception of
quality and attitude towards the intent to use home healthcare services of
individuals in Hanoi. The study was implemented with 426 observations, using
the partial least square (PLS) analysing method and obtained several results.
In particular, perception of quality as well as attitude had a strong and
multidimensional impact on behavioural intention, with levels of impacts of
0.57 and 0.469 respectively. In addition, the group study further examined the
effect of health consciousness on the corresponding low level of 0.132. From
there, the importance of prefixes in promoting opinion is: perception of
quality, attitude and health consciousness. Through this result, the research
can propose a number of strategic solutions for service providers, for state
management agencies on appropriate health insurance policies and curative care
management, thereby contributing to promoting development of a service type
which has many economic as well as social meanings.
Medical overcrowding
has been a common problem in almost all hospitals in Hanoi, especially large
ones at higher levels. The people's needs for curative care have been
constantly increasing while medical facilities cannot keep up, leading to many
shortcomings in the healthcare sector. In addition, for many patients, direct
visits to medical services face many difficulties due to both subjective and
objective reasons. From the above situations, the homecare service appeared and
became an effective solution with high economic and social significance because
it helps to solve many difficult problems. In 2013, the project "Building
and developing the model of family doctor clinic for the period 2013-2020"
was also approved and put into practice by the Ministry of Health, which proved
the importance as well as the consider this service in the future. Especially
in 2020, when the Covid-19 epidemic began to break out and spread, the majority
of Vietnamese people would not go to medical facilities for medical examination
and treatment because of concern that hospitals were places with high potential
of community infection, therefore, the demand for home medical care has
increased significantly. However, the number of people using this service is
still limited. In order to help develop better services and become an effective
support solution for curative care in hospitals, research on the intention to
use the home healthcare services is necessary.
Theoretical
basis
Health care services: According to L. Tuan, medical examination and
treatment services include medical care, medicine, nursing, hospital services,
dentistry, ophthalmology, with the aim of preventing and mitigating, healing,
or trauma, or physical disability [1]. Combining the above definition with the
concept provided by the World Health Organization, the home healthcare service
is a collection of curative healthcare services, medical and social support
services for customers in their own place of residence.
The
impact of quality perception on attitude and intention: Service quality is an important factor
determining competitiveness, demonstrating the ability of a service to satisfy
the needs of customers. And perception is the direct and immediate awareness of
things through many different receptors. Combining these two concepts,
perception of quality can be understood as customers 'thoughts, beliefs and
views on the ability to satisfy customers' needs from medical service.
According to, service quality is measured by 5 main groups of factors
including: reliability, availability responsiveness, assurance, empathy and
tangible factor. In this research, authors will apply the Servqual Scale to
assess the level of perception of quality. Many previous scholars have
mentioned the positive relationship between perception of quality and attitude
towards the use of products or services [2,3]. It can be mentioned as, said
that perception of product quality had an impact on attitude towards
businesses; also concluded that perception of the quality of organic foods had
an important effect on consumers' attitudes towards this product; asserted that
the positive impact of perception about the quality of electronic services on
both attitudes and intention to use services on the Internet; also according to
perception of quality affected attitude towards buying through both direct and
online channels. Besides, there are also studies on the direct effects of
perception of quality on consumers' intention to use services [4,5]. Specifically,
built a model to evaluate the impact of perception about health care service
quality on behavioural intention, in which the author measured quality over the
years through 5 factors: tangibility, reliability, responsiveness, empathy and
assurance; emphasized that: improving quality, increasing service value had a
positive effect on the behavioral intention of the patients undergoing physical
therapy; showed a positive relationship between the quality of service
perceived by the patient, intention to use and reuse when studying at Minsheng
Hospital, Taiwan [6-8];
Synthesizing a number
of studies, the authors said that perception of quality can affect both
attitude and intention to use services, so two hypotheses were proposed to
re-test for medical services:
H1: Perception of
quality has a positive effect on attitudes towards home healthcare services
H2: Perception of
quality has a positive impact on the intention to use home healthcare services
The impact of health consciousness on attitude and intention: In the study of, health consciousness
measures readiness to perform take action related to health, are always mindful
of your health and mentally improve or maintain health and quality of life, as
well as prevent disease by taking healthy actions [9,10]. In this study, health
consciousness is understood as the level of consumer concerns about
health-related issues, as shown by their tendency to act or use products,
service that is conducive to their health. Several researchers have
demonstrated the relationship between health consciousness to attitudes with
certain products or services: applying the Theory of planned behavior
demonstrated that a sense of health had a positive effect on intent to use
organic food; concluded that the relationship between perception of the
importance of health influenced attitudes and intention to use health-related
products and services on mobile to improve quality of life [11]. Not only that,
but health consciousness also has a direct impact on the intention to use products
or services. Some of the studies that can be mentioned here are as follows:
confirmed the role of health consciousness in attitudes and intentions of
organic food consumption; both showed that the sense of health would have a
positive effect on intentions as well as habits to use mobile services and
applications related to health care and protection; From the reference models
from the above studies, the research group found that there was a correlation
between health consciousness to attitude and intention with the field of
curative care services, so the research group proposed 2 more hypothesises
[12,13]:
H3: Health
consciousness has a positive influence on attitude towards home healthcare
services
H4: Health
consciousness has a positive influence on the intention to use home healthcare
services
The theory of planned behaviour: Besides, this research also inherited
the Theory of planned behaviour to come up with the model. Suppose individuals
have a positive attitude towards behaviour, and their essential people expect
them to behave in specific ways, they will have a higher probability of doing
that behaviours. It has also been proved in many previous research pieces,
stating the relationship between attitudes towards behavioral intention and
executing it. Many scholars in the health-related field have also confirmed
this relationship, for example, “The theory of planned behaviour: a review of
its applications to health-related behaviours”. Therefore, in this research,
the theory of planned behaviours was applied to build the hypothesis:
H5: Attitude towards home healthcare service positively influences intention to use home healthcare service (Figure 1).
Figure 1: Proposed conceptual framework.
The target of this
research is residence living and working in Hanoi. The group of authors has
conducted the official quantitative study by questionnaire surveys. The total
number of responses was 450; after filtering, the number reduced to 426 valid
surveys, including 32 face-to-face responses and 394 online responses). The
data was analyzed with SPSS 26 and SmartPLS-SEM 3.0 by PLS Method.
Table 1: Reliability and factor analysis results.
No |
Component |
Number
of items |
Cronbach’s
Alpha |
Total
variance explained |
Conclusion |
1 |
Reliability (DTC) |
5 |
0,847 |
62,523% |
Accepted |
2 |
Availability responsiveness (DU) |
6 |
0,869 |
60,706% | |
3 |
Assurance (DB) |
5 |
0,909 |
73,329% | |
4 |
Empathy (TC) |
4 |
0,926 |
81,964% | |
5 |
Tangibles (HH) |
5 |
0,896 |
70,969% | |
6 |
Health Consciousness (SK) |
5 |
0,844 |
62,983 | |
7 |
Attitude (TD) |
6 |
0,850 |
58,319% | |
8 |
Intention (YD) |
4 |
0,861 |
70,913% |
Table 1 provided Cronbach’s Alpha values and exploratory factor analysis
(EFA) results. The Cronbach’s Alpha results for all constructs were above the
recommended level of 0.6 (Hair & ctg), and total variance explained results
were above 50%. Simultaneously, the authors created average values representing
quality perception factors, using for analysing exploratory factor EFA and
valid SEM model in the following steps. The group of factors needed to create
new identity values was as follows: Reliability (DTC), Availability
Responsiveness (DU), Assurance (DB), Sympathy (TC), Tangible Factor (HH).
Exploratory
Factor Analysis (EFA) results
EFA results stopped at the third time with KMO statistics at 0.878 and Bartlett test value with Sig. = 0.000 (<0.005). This demonstrated that observed variables generally correlate. Specifically, in the first attempt, Factor Loading of TD1, TD2, SK5 did not appear, therefore, the authors eliminated these variables from the model. In the next attempt, Factor Loading of TD3 did not appear so they were eliminated from the model either. After eliminating those unqualified variables, there were four groups of factors left, including 16 observed variables. The Eigenvalue was 1.129, and the Total Cumulative Variance explained was 67.677% (Above 50%), which meant at the value of Eigenvalue of 1,129, these 4 components could explain 67,677% of variance of data collected (Table 2).
Table 2: EFA results.
Component |
Items |
Perception of quality
(NTCL) |
DTC, DU, DB, TC, HH |
Health consciousness
(SK) |
SK1, SK2, SK3, SK4 |
Attitude (TD) |
TD4, TD5, TD6 |
Intention (YD) |
YD1, YD2, YD3, YD4 |
Table 3: Measurement Model analyzing results.
Component |
Cronbach’s Alpha |
Composite Reliability |
Average variance
extracted (AVE) |
NTCL |
0.906 |
0.930 |
0.727 |
SK |
0.848 |
0.898 |
0.687 |
TD |
0.866 |
0.918 |
0.788 |
YD |
0.863 |
0.906 |
0.708 |
Structural
Equation Modelling (SEM) analysis
Measurement model testing (Table 3): In order to test the scale’s
reliability, the research use Composite Reliability (CR), Average variance
extracted (AVE), Outer loading. The Composite Reliability and outer loading
must be above 0.7 and 0.4 respectively [15]. Besides, according to, the average
variance extracted must be above 0.5 to prove the reliability and Convergent
validity [16]. The minimum value is 0.687 from the Health Consciousness. The
results indicated satisfactory of all the values in measurement model.
Structural model testing: SEM results in image 4 illustrated that model had Chi-Square Test at 1072,1493 with p-value = 0.000 < 0.005. However, according to, if the model has the SRMR value <0.1, then it will be considered appropriate for the real data. Hence, SRMR = 0.079 < 0.1, the model was considered appropriate with the data collected in Hanoi [17] (Figure 2).
Figure 2: PLS-SEM Results analysis.
According to the result, perception of quality and health consciousness
only explained 35,9% of attitude variation, at the same time, perception of
quality, health consciousness, and attitude explain 55.9% of intention variation,
at the meaning level of 5%. However, according to Chin and associates (1996),
when analysing the effect of independent variables towards dependent variable,
the researcher not only consider the relationships of meaning level but also analyse the effect level. Therefore,
this study continued to test bootstrapping [18].
Bootstrapping
testing
From 5000 observations, all the original weights are in the range of 95%. Therefore, the estimates in the model were considered to be reliable (Table 4)
Table 4: Bootstrapping structural model testing.
|
Original
Sample (O) |
Sample Mean (M) |
Standard Deviation
(STDEV) |
5% |
95% |
NTCL -> TD |
0.363 |
0.363 |
0.000 |
0.277 |
0.448 |
NTCL -> YD |
0.570 |
0.568 |
-0.002 |
0.503 |
0.636 |
SK -> TD |
0.327 |
0.329 |
0.002 |
0.232 |
0.406 |
SK -> YD |
0.132 |
0.133 |
0.001 |
0.050 |
0.209 |
TD -> YD |
0.469 |
0.470 |
0.000 |
0.384 |
0.553 |
Table 5: Hypothesis testing results.
|
Original
Sample |
T-value |
P-value |
Hypothesis |
NTCL -> TD |
0.363 |
6.941 |
0.000 |
Accepted H1 |
NTCL -> YD |
0.568 |
14.122 |
0.000 |
Accepted H2 |
SK -> TD |
0.329 |
6.264 |
0.000 |
Accepted H3 |
SK -> YD |
0.133 |
2.715 |
0.003 |
Accepted H4 |
TD -> YD |
0.470 |
9.043 |
0.000 |
Accepted H5 |
Hypothesis
testing (Table 5)
Regression
analysis for hypothesis
In this research, the authors used the standardized regression equation
to test the effect of independent factors on dependent ones because the standardized regression equation
has the economic meaning more rather than mathematical meaning (Table 6).
According to the results, the three factors all
had influences on behavioral intention, specifically, perception of quality was
the most important factor. Besides, p-value was 0.000, indicating that the
estimated data was suitable to real data. R-Square coefficient was 0.513,
showing that these 3 factors explained 51.3% of the variance of use intentions.
The dustbin-Watson = 1,763 and VIF coefficient of the three factors are all
below 5. Therefore, we have the regression equation: YD = 0,532NTCL+0,192TD
+0,102SK. Hence, the importance of each factor on behavioral intention
respectively were: perception of quality, attitude and health consciousness.
Conclusion
Based on the review of the data and analyses
summarized in the previous section, the research team drawn the following
conclusion: the majority (95%) of survey respondents indicated that they had
heard of home care services and the Internet is by far the most popular source
of information. Over four out of ten (45%) respondents have been using it, as
the data indicated that convenience and time saving were the main reasons that
made the respondents think positively of using home health care, while the
remainder still preferred hospitals to provide health care services. At the
same time, based on a review of domestic and foreign research, the team has
constructed a theoretical model for evaluating the study hypotheses about
direct and indirect effects of perceived quality and health consciousness on
attitude and intention to use home medical services. Results indicated that
there was a positive and significant impact of perceived quality on consumers'
attitude and using intention (0.363 and 0.568 respectively), which means that
increasing awareness among consumers can enhance their purchase intention and
attitude towards the home care service. Furthermore, attitude also positively
influenced behavioral intention towards usage (at 0.470). The above results
were consistent with a number of previous studies of the relationship between
perception, attitude and behaviours. It can be inferred that perception is
directly derived from the customer's interaction with the service or from
external sources of information, thus improving quality of service and media
strategy may significantly increase customers' behavioral intentions. In
addition to affecting purchase intentions, health consciousness should also be
considered despite having small beta weight for both attitude and intention,
precisely 0.329 for the former and 0.133 for the latter. This indicated that
individuals with high health consciousness tended to get far more proactive
about searching for health products and services in order to protect their
personal and their family’s health. Therefore, home health aide services are an
alternative to reside at home instead of hospitals and potentially experiencing
discomfort through unfamiliar surroundings [19-21].
Based on the findings of this study, the researchers would like to make
some recommendations to the following parties.
For State
management agencies: This finding suggests that the government
should focus on developing and strengthening the management mechanisms,
policies and organizational systems in order to improve and ensure the quality
of nursing home care services. Additionally, the government should take action
to control price policies along with subsidizing health insurance, as
home-based medical services provide solutions to current healthcare problems.
For hospital managers and healthcare service providers:
The
research team recommends that the hospital managers build a marketing-mix
strategy including products, prices, and promotional techniques to enhance
their public image and distribution methods that must be in sync with one
another. However, above all, health’s moral importance is what makes home
healthcare service distribution special. The application of marketing in the
field of healthcare has to ensure authenticity, making patient health and
safety a top priority. Healthcare managers have to avoid marketing abuse and
exaggeration advertising to increase profit because not only it can violate
medical ethics but also risk directly harming patients. Finally, improving
customer’s perception, thereby improving both attitudes and intentions to use
services are the top objectives of strategic marketing.
Thank you editors, friends and Mr Dinh Tran Ngoc Huy
(dtnhuy2010@gmail.com) to assist this publication.