Virtual antenatal consultation service in Malaysian primary care: acceptance and barriers to consumer digital health

Abstract

The integration of digital health technologies, such as virtual consultation (VC) services, into antenatal care, holds significant potential to enhance accessibility and efficiency in maternal healthcare delivery. VC services were introduced in Malaysian public primary care clinics in 2019, initially focusing on chronic disease management, health education, smoking cessation programs, and follow-ups on investigation results and appointments. In response to the COVID-19 pandemic, these services were expanded in 2022 to include maternal and child healthcare, offering antenatal care through virtual consultations. This study investigates the determinants influencing the acceptance of VC services and identifies barriers to their adoption among healthcare providers (HCPs) and antenatal mothers with prior experience using the VC service in primary health clinics in Malaysia. Guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) framework, the research explores the impact of individual factors such as performance expectancy (PE), effort expectancy (EE), social influence (SI), health literacy (HL), and user satisfaction (SAT) alongside organisational factors like facilitating conditions (FC) and technological factors such as system and service quality, on behavioural intention (BI) to use VC services. Moderating variables, including income, education level, and training, were analysed to understand their role in shaping these relationships. A mixed-methods approach was employed, combining quantitative data from structured surveys with qualitative insights from in-depth interviews to provide a comprehensive understanding of the determinants and barriers to VC adoption. The findings revealed that, for HCPs, the overall model explained 64% of the variance in BI (R² = 0.64), with facilitating conditions (β = 0.59, p < 0.001) emerging as the strongest determinant. Among antenatal mothers, the model explained 62% of the variance in BI (R² = 0.62), with health literacy (β = 0.202, p < 0.001) being the most influential determinant. Technological factors significantly influenced user satisfaction, which in turn strengthened the intention to use VC services. User satisfaction contributed 42% to BI among HCPs and 17% among antenatal mothers and mediated the relationship between system and service quality and BI in both groups. Training was identified as a significant moderator in the relationships between PE, EE, FC, SI, and BI among HCPs, with more substantial effects observed in those who received training. For antenatal mothers, education and income levels moderated the relationships between PE, SI, HL, and BI. The barriers to VC adoption were predominantly linked to technological constraints, limitations in remote monitoring that undermined confidence, fear of misjudgement, and insufficient knowledge or empowerment, particularly among antenatal mothers. These findings provide valuable insights for policymakers and healthcare providers in designing and implementing effective, user-centred VC solutions to strengthen maternal healthcare delivery.