Predicting primary care physicians' intentions to use e-health - a survey study based on the theory of planned behavior

Veronica Milos Nymberg, Miriam Pikkemaat, Hans Thulesius

Keywords: survey, primary health care, e-health, theory of planned behavior


While e-health is remodeling health care worldwide we know little about primary care physicians’ attitudes and expectations of e-health. Research about primary care physicians’ use of e-health, i.e. digital contacts, digital tools or artificial intelligence (AI) may be useful for planning educational efforts and future implementation of digital technology in health care.

Research questions:

The aim of this study was to explore the experiences and behavioral intentions of Swedish primary care physicians towards e-health in primary care with a focus on behavioral predictors derived from the theory of planned behavior.


We designed a web-based survey with focus on attitudes, subjective norms and perceived behavioral control. The survey was sent to 1100 primary care physicians in two Swedish regions, from May to August 2019.
Main outcome measures were scores for intentions to use e-health. Multiple regression analyses were made to study the correlation between predictors for using e-health derived from the theory of planned behavior.


Total response rate was 18%, 198 returned surveys of which 134, 154, 161 and 171 respondents reported no use of e-mail (68%), video consultations (78%), chat (81%), or SMS (86%) in their everyday patient work. Yet, most respondents described positive intentions to use e-health in patient care for all three studied domains: digital contacts, chronic disease monitoring and AI. Attitudes and perceived behavioral control were significant predictors (p<0.01) for intentions to use digital contacts (R2 = 0.54), monitoring disease with digital tools (R2 = 0.47) and AI (R2 = 0.54).


Swedish primary care physicians reported high behavioral intentions to utilize e-health. Attitudes, subjective norms and perceived behavioral control were strong predictors for using digital contacts. Social pressure translated into subjective norms was not correlated with intentions to use digital tools for chronic disease monitoring or AI, probably due to their current low use in primary care.

Points for discussion:

How do we overcome the challenge with low response rates in web-based surveys?

Do cognitive behavioral theories have a role in describing behavioral intentions and designing interventions in primary care?