A Mixed-Methods Design for Analyzing Telemedicine Adoption: An Information Systems Approach Integrating TAM–ISS, Digital Literacy, and Usability

Abstract

This research employs a mixed-methods design to analyze telemedicine adoption in rural Indonesia by integrating the Technology Acceptance Model (TAM) and the Information System Success Model (ISS), extended with digital literacy and usability. A quantitative survey of 314 respondents was complemented by in-depth interviews with 50 participants and demographic analysis using chi-square and logistic regression. The quantitative findings reveal that the primary adoption construct is Usability → Perceived Ease of Use (PEOU) → Perceived Usefulness (PU) → Intention to Use (ITU) → Net Benefit (NB). Perceived usefulness emerged as the strongest predictor of both satisfaction and intention. Information Quality significantly influenced satisfaction, whereas System Quality did not, indicating that clear medical information outweighs technical system performance in shaping satisfaction. Similarly, usability directly did not affect PU but indirectly through PEOU, and digital literacy influenced PU but not PEOU. Demographic analysis confirmed that occupation was significant—students and healthcare workers acted as early adopters—while age and prior training were not, suggesting that adoption transcends generational boundaries due to the widespread penetration of the JKN Mobile platform. Qualitative insights enriched these findings by highlighting key barriers and enablers such as inconsistent interfaces, infrastructure limitations, privacy concerns, community-based socialization, and expectations for adaptive features like AI diagnostics and pharmacy integration. Overall, the research confirms that telemedicine adoption in rural Indonesia is shaped by the synergy of usability, digital literacy, information quality, and social context rather than by training or demographic variables alone.