Influence of Cultural Factors on Wearable Technology Acceptance in Healthcare An empirical study with Chinese and Swiss consumers Author Dong Yang Meier Matrikelnr: 11-186-707 [email protected] Master in Business Administration Major Health Economics und Health Care Management Advisors Dr. Florian Liberatore Dr. Petra Barthelmess A master thesis submitted to Zurich University of Applied Science (ZHAW) School of Management and Law (SML) Winterthur, 13. June 2019 Management Summary The market of healthcare wearables is compelling and expected to reach USD 14.4 billion by 2022 at a CAGR of 18.3%. The term “wearables” refers to “wearable technology or devices”, with computers incorporated into accessories and clothing worn on the body. Healthcare wearables can monitor real-time health vitals, diagnose diseases, and provide reminders for medicine or exercises. They are generally classified into consumer and medical-grade devices, but the distinction is increasingly blurred with advancing sensor technology. Global companies like Apple, Google, Fitbit, Xiaomi etc. developing wearables integrating medical technology aim to target consumers worldwide. The intention to accept these devices varies yet tremendously among people with diverse cultural backgrounds. In this study, certain patterns of influential factors associated with usage intention of healthcare wearables are investigated through comparing essential acceptance motives and usage barriers of Chinese and Swiss consumers. The different perceptions between both groups in view of varied national culture are examined. A conceptual model is established based on an existing framework of wearables acceptance, incorporating predictors adapted from theories of technology acceptance, health behavior, and privacy calculus. “China/Switzerland” distinguished by national culture acts as a moderator, which affect influence degree in the model. A web-based survey translated into Chinese and German is conducted in both countries respectively after modifications through pilot study. Finally, 110 valid Swiss and 201 Chinese respondents are included in data analysis. Statistical analysis suggests the model fits well for the research purpose. Results reveal performance expectancy (PE), social influence (SI), hedonic motivation (HM) and effort expectancy (EE) positively affect behavior intention (BI) of consumers to adopt wearables. Functional congruence (FC), health consciousness (HC), perceived privacy risk (PPR) do not affect BI significantly. Nevertheless, moderating analysis indicates HC is a key factor affecting BI of Chinese positively, and PPR affecting BI of Swiss negatively. Chinese display considerably higher BI than Swiss, which relates to their higher values on PE, FC, EE and SI than Swiss. These differences are explained by II cultural values, e.g. low individualism, low uncertainty avoidance and high power distance of Chinese in contrast to Swiss. This study is one of the first to investigate consumers’ intention to adopt wearables from a cross-cultural perspective, which provides theoretical and methodological foundation for future research with specific wearables or other countries. Practical implications are given to global vendors and insurers for developing and promoting wearables with suitable features in different countries. Positive opinions of physicians, evident measurement accuracy and clear data protection measures would make Swiss in favor of wearables; Involvement of Chinese employers, multifunctional apps providing credible healthcare advices and social interactions would increase Chinese’s interests in wearables. III Table of Content Figures ............................................................................................................................. iii Tables .............................................................................................................................. iv List of Abbreviations ......................................................................................................... v 1. Introduction ................................................................................................................ 1 1.1. Background ........................................................................................................ 1 1.2. Research objective and question ........................................................................ 3 1.3. Research framework and thesis structure .......................................................... 4 2. Literature review ........................................................................................................ 6 2.1. Wearable technology and devices ...................................................................... 6 2.1.1. Wearables in healthcare .............................................................................. 9 2.1.2. Smartwatches ............................................................................................ 12 2.1.3. Wearables in China ................................................................................... 15 2.1.4. Wearables in Switzerland ......................................................................... 17 2.2. Models and theories of technology acceptance ............................................... 20 2.2.1. Technology acceptance............................................................................. 21 2.2.2. Unified theory of acceptance and use of technology ................................ 21 2.2.3. Protection motivation theory .................................................................... 22 2.2.4. Privacy calculus theory ............................................................................. 23 2.2.5. Wearable technology acceptance in healthcare ........................................ 24 2.3. Cultural values and wearable technology acceptance ...................................... 27 2.3.1. National culture & cultural value dimensions .......................................... 28 2.3.2. Cultural differences of China and Switzerland......................................... 31 2.3.3. Moderating effect of national culture on technology acceptance ............. 36 3. Conceptual Model and Hypotheses .......................................................................... 39 3.1. Conceptual model ............................................................................................ 39 3.2. Hypotheses with independent and dependent variables................................... 42 3.3. Hypotheses with moderating variables ............................................................ 43 4. Research Methodology ............................................................................................. 46 4.1. Smartwatch as research example ..................................................................... 47 4.2. Questionnaire ................................................................................................... 48 4.3. Pilot study ........................................................................................................ 52 i 4.4. Data collection ................................................................................................. 55 4.5. Data ordering ................................................................................................... 57 4.6. Data analysis .................................................................................................... 58 5. Results & Discussions .............................................................................................. 60 5.1. Sample characteristics ...................................................................................... 60 5.2. Cultural value difference between Chinese and Swiss .................................... 61 5.3. Usage pattern of smartwatches ........................................................................ 63 5.4. Evaluation of measurement model .................................................................. 66 5.5. Evaluation of structural model and hypothesis testing .................................... 67 5.5.1. Regression analysis .................................................................................. 68 5.5.2. Moderating analysis .................................................................................. 70 5.5.3. T-Test on variables between Chinese and Swiss respondents .................. 74 5.6. Intended type of applications in the future ...................................................... 75 5.7. Moderating role of control variable ................................................................. 76 5.8. Additional remarks of Chinese and Swiss respondents ................................... 77 6. Conclusions and Implications .................................................................................. 79 6.1. Conclusions ...................................................................................................... 79 6.2. Implications ..................................................................................................... 81 7. Limitations and future research direction................................................................. 83 7.1. Variables of conceptual model ........................................................................ 83 7.2. Measuring cultural differences ........................................................................ 84 7.3. Survey methodology .......................................................................................