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Background <p>Internet hospitals (IHs) have been rapidly scaled up in China to extend hospital-based care online, but their contribution to service delivery depends on whether doctors integrate IHs into routine practice. Building on the Unified Theory of Acceptance and Use of Technology (UTAUT), this study examined how empathy and gendered cognitive load shape doctors’ intentions and use of IHs in a policy-embedded setting.</p> Methods <p>We conducted an explanatory sequential mixed-methods study among doctors from public hospitals across four regions of Guangdong Province (eastern, western, northern and the Pearl River Delta), China. In the quantitative phase, 359 doctors completed an online survey measuring UTAUT constructs (performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, use behavior) and empathy. Structural equation modeling tested direct paths, an empathy-by-social influence interaction, and gender multigroup differences. In the qualitative phase, semi-structured interviews with six purposively sampled doctors were analyzed thematically and used to interpret and extend the quantitative findings.</p> Results <p>The measurement model showed good reliability and discriminant validity. In the structural model, social influence, effort expectancy and empathy were positively associated with behavioral intention, while behavioral intention and facilitating conditions predicted use behavior; bootstrap analyses indicated that paths from social influence, effort expectancy and behavioral intention were most robust. Empathy significantly amplified the effect of social influence on intention. Multigroup analyses supported measurement invariance across gender and revealed a stronger association between effort expectancy and intention among women doctors than men. Thematic analysis corroborated these mechanisms and highlighted empathy-based reframing of organizational cues and gendered differences in workflow burden.</p> Conclusions <p>Doctors’ adoption of IHs is driven less by performance beliefs alone than by social norms, moral meaning and workload realities. Empathy functions as a sense-making amplifier linking social influence to professional duty, while effort expectancy operates as a gender-sensitive threshold, especially for women doctors. For sustainable and equitable IH implementation, policies should pair credible organizational endorsement and feedback that makes patient benefits visible with low-friction workflows that deliberately reduce cognitive load for high-empathy and high-burden groups.</p>

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Empathy-amplified social influence and gender-sensitive thresholds in doctors’ adoption of internet hospitals: a mixed-methods study in China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月17日

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  • Chenxi Zu,
  • Fan Yang,
  • Suying Li,
  • Ting Liu,
  • Xiaohan Liu,
  • Jianping Chen,
  • Carlos Lopes Cruz

摘要

Background

Internet hospitals (IHs) have been rapidly scaled up in China to extend hospital-based care online, but their contribution to service delivery depends on whether doctors integrate IHs into routine practice. Building on the Unified Theory of Acceptance and Use of Technology (UTAUT), this study examined how empathy and gendered cognitive load shape doctors’ intentions and use of IHs in a policy-embedded setting.

Methods

We conducted an explanatory sequential mixed-methods study among doctors from public hospitals across four regions of Guangdong Province (eastern, western, northern and the Pearl River Delta), China. In the quantitative phase, 359 doctors completed an online survey measuring UTAUT constructs (performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, use behavior) and empathy. Structural equation modeling tested direct paths, an empathy-by-social influence interaction, and gender multigroup differences. In the qualitative phase, semi-structured interviews with six purposively sampled doctors were analyzed thematically and used to interpret and extend the quantitative findings.

Results

The measurement model showed good reliability and discriminant validity. In the structural model, social influence, effort expectancy and empathy were positively associated with behavioral intention, while behavioral intention and facilitating conditions predicted use behavior; bootstrap analyses indicated that paths from social influence, effort expectancy and behavioral intention were most robust. Empathy significantly amplified the effect of social influence on intention. Multigroup analyses supported measurement invariance across gender and revealed a stronger association between effort expectancy and intention among women doctors than men. Thematic analysis corroborated these mechanisms and highlighted empathy-based reframing of organizational cues and gendered differences in workflow burden.

Conclusions

Doctors’ adoption of IHs is driven less by performance beliefs alone than by social norms, moral meaning and workload realities. Empathy functions as a sense-making amplifier linking social influence to professional duty, while effort expectancy operates as a gender-sensitive threshold, especially for women doctors. For sustainable and equitable IH implementation, policies should pair credible organizational endorsement and feedback that makes patient benefits visible with low-friction workflows that deliberately reduce cognitive load for high-empathy and high-burden groups.