Article

Patient Satisfaction with the Mawiidi Hospital Appointment

Scheduling Application: Insights from the Information Systems
Success Model and Technology Acceptance Model in a Moroccan
Healthcare Setting
Abdelaziz Ouajdouni 1, * , Khalid Chafik 1 , Soukaina Allioui 1 and Mourad Jbene 2

1 Management and Information System Research Group, National School of Business & Management Tangier,
Abdelmalek Essaadi University, Tetouan 93030, Morocco; [email protected] (K.C.);
[email protected] (S.A.)
2 SIRC-(LaGeS), Hassania School of Public Works, Casablanca 20230, Morocco; [email protected]
* Correspondence: [email protected]

Abstract: This article aims to find the determinants that affect patient satisfaction regarding the
Mawiidi public portal in Moroccan public hospitals and assess its outpatient online booking system
effectiveness using a model that integrates the Technology Acceptance Model (TAM) with the
Information Systems Success Model (ISSM) while adopting a quantitative research methodology. The
analysis was conducted using 348 self-administered questionnaires to analyze eight key constructs,
such as information quality, patient satisfaction, perceived ease of use, and privacy protection, among
others. The results of PLS-SEM verified six out of eleven hypotheses tested, which reflected that
information quality has a positive influence on perceived ease of use, which again enhances patient
satisfaction. The major factors influencing the satisfaction and trust of patients in online appointment
scheduling systems at public hospitals are highlighted. Indeed, privacy protection enhances patient
Citation: Ouajdouni, A.; Chafik, K.; satisfaction and trust. Service quality positively affects satisfaction but to a lesser degree. Website-
Allioui, S.; Jbene, M. Patient related anxiety impacts perceived ease of use, although it has a limited influence on satisfaction. Such
Satisfaction with the Mawiidi
findings can inform suggestions for the managers of hospitals and portal designers to increase user
Hospital Appointment Scheduling
satisfaction. This study uses a model from the TAM and ISSM frameworks, including cultural and
Application: Insights from the
socioeconomic aspects that apply to Morocco’s healthcare context.
Information Systems Success Model
and Technology Acceptance Model in
Keywords: user satisfaction; system quality; information quality; ease of use; trust; privacy; security;
a Moroccan Healthcare Setting. Big
Data Cogn. Comput. 2024, 8, 180.
e-health; patients; Mawiidi; PLS-SEM; Kingdom of Morocco
https://doi.org/10.3390/
bdcc8120180

Academic Editor: Alberto Fernandez

1. Introduction
Hilario
The adoption of Information and Communication Technology into health is common; it
Received: 23 September 2024 plays a crucial role in this sector as it greatly improves the quality and efficiency of services
Revised: 18 November 2024 offered to health practitioners. Health information systems are commonly adopted today
Accepted: 27 November 2024 in many hospitals because they aid in good recordkeeping and accessibility of important
Published: 3 December 2024
information. Recently, scholars have explored issues of growing concerns about ICT to
strengthen health delivery. This could involve the incorporation of e-health initiatives and
programs on ICT in hospitals, which can lead to enormous benefits that include saving
Copyright: © 2024 by the authors.
costs and enhancing patients’ autonomy. The application of e-health, as a general term of
Licensee MDPI, Basel, Switzerland. hospital-based ICT initiatives, can bring several positive impacts such as cost efficiency
This article is an open access article and patient empowerment [1,2]. Further, elderly patients have used ICT from the comfort
distributed under the terms and of their residences to consult with medical experts and, in turn, minimize going to clinics
conditions of the Creative Commons in urgent and non-urgent settings [3].
Attribution (CC BY) license (https:// The utilization of internet-based systems and the widespread implementation of ICT
creativecommons.org/licenses/by/ have bestowed substantial advantages upon both commercial establishments and con-
4.0/). sumers. These technological advancements have fortified the connections between product

Big Data Cogn. Comput. 2024, 8, 180. https://doi.org/10.3390/bdcc8120180 https://www.mdpi.com/journal/bdcc

Big Data Cogn. Comput. 2024, 8, 180 2 of 38

and service providers and their respective audiences. Within the healthcare sector, exec-
utives are becoming increasingly acquainted with the complexities associated with the
formulation and integration of web-based information systems, as the use of ICT poses
novel challenges for numerous industries. ICT and the internet can have a deep impact
on healthcare facilities by reducing workers’ burdens, increasing the effectiveness of op-
erations, and improving the quality of the services offered. The web-based e-hospital
systems for development and integration have been introduced by medical organizations
regarding their strategic objectives and competitive advantage. In this regard, it is crucial
to mention that the integration of ICTs within the healthcare sector has several benefits, in-
cluding enhanced accessibility and availability, the possibility to ensure more personalized
healthcare services, as well as the potential to provide quality medical attention at lower
financial costs [4].
It has been argued that e-health solutions provide a feasible means of addressing many
challenges facing the management of health systems and the needs for healthcare posed
by health organizations in developing countries [5]. Such technology-based innovations
seek to address issues about the accessibility, affordability, and efficiency of healthcare as a
means of affording opportunities to strengthen healthcare delivery, patient outcomes, and
the overall effectiveness of healthcare systems faced with resource constraints in developing
countries [6]. Nevertheless, notwithstanding their affirmative advantages, research suggests
that the pace of e-health implementation in certain developing countries is either deficient or
underused. This is attributable in part to impediments such as opposition from healthcare
experts, inadequate infrastructure, and low technical proficiency, among other factors [7].
Online appointment scheduling systems, also known as the appointment booking sys-
tem, have been more recognized to deal with the limits and challenges of these traditional
appointment scheduling methods [8–11]. An online appointment system incorporates a
setting where people make their bookings without direct personal communication, but
through some form of communication network [12]. It is a major service that contributes to
the development of the general performance of an organization, making it more efficient
and productive. It also allows a much more orderly and less complicated scheduling process
for both healthcare providers and patients. Indeed, an efficient appointment scheduling
system can reduce waiting times, improving patient satisfaction while optimizing resource
utilization [12–17]. One of the main problems that every healthcare provider and outpatient
service facility faces is no-shows, wherein patients fail to appear at the scheduled time.
All these can have various negative implications in terms of providers, staff, and even the
patients themselves. Given the increasing electronic health data, an enhanced hospital ap-
pointment system can be utilized for the best matching between “Physician-Patient” based
on the constraints of available medical resources by incorporating their matching degree,
compared with the traditional system of appointment [18]. Appointment cancellations and
patient no-shows are relatively well researched in healthcare [19]. It is estimated that about
10% of scheduled physician appointments are either canceled or missed by patients who
do not show up at the scheduled time. Such incidents can have numerous consequences on
healthcare providers, patients, and broadly speaking, the general healthcare system [20–22].
Health organizations often use approaches, for example, appointment reminders [23–25],
overbooking known no-show slots as well as policies put in place to re-schedule miss-
ing appointments in an attempt to cushion against cancellations and no-shows. Some
organizations consider different penalties and charges for the patients who missed their
appointments repeatedly as a way of encouraging consistency [26,27]. The main objec-
tive of these measures is to enhance efficiency in healthcare service provision, minimize
wastefulness of resources, and ensure timely treatment for every patient. There are many
advantages correlated with the use of internet-based systems for scheduling medical ap-
pointments; they effectively help patients a lot in the management and organization of their
visits to physicians. Such systems enable patients to attain maximum productivity levels in
scheduling appointments at any given time and place [28], especially in outpatient clinics
and other healthcare environments.
Big Data Cogn. Comput. 2024, 8, 180 3 of 38

Indeed, previous research has suggested that, at least in Europe, Canada, and the
United States, the majority of healthcare professionals are eager to adopt these plat-
forms [29]. In addition, patients have demonstrated the desire to use online appointment
scheduling systems if made available. It will be therefore a sign of the possible dispersal
of electronic appointment systems among healthcare practitioners and patients. Earlier
investigations have shown that among the most appreciated online customer healthcare
services are these online appointment scheduling systems. Some advantages associated
with this system include convenience, availability as well as effectiveness, thus allowing
for more control over their appointments by the patients while receiving what they need at
their preferred times, even when busy [22].
The level of patient satisfaction is associated with how effectively both general health-
care requirements and specific health condition needs are fulfilled. Consequently, the
assessment of patient satisfaction with healthcare services holds significant clinical im-
portance in modern business practices, marketing strategies, and other related endeavors.
Over time, it has been established that carrying out surveys on patient satisfaction can
reap various advantages that present-day businesses acknowledge. These surveys are
not only tools to elicit patient opinions, but also opportunities to acquaint them with new
information about healthcare organizations or companies, such as innovative changes, and
a means of establishing customers’ viewpoints [30]. Combining the patients’ perspectives
with earlier survey results can yield concrete conclusions, which can be implemented in
various hospitals and levels of healthcare. Patients are well informed regarding the options
available to them and the quality of services they receive, and their expectations increase
with the prominence of service quality [31]. There is utmost relevance in these views,
which shall guide our research, especially in the area of public healthcare. However, it is
important to note that competition implications do not matter much here and are regarded
as irrelevant or insignificant, although enhancing attraction is very crucial.
There exists a dearth of studies on this system evaluation from a user satisfaction
perspective despite its importance. We also found a lack of scientific publications both
indexed in Scopus and/or Web of Science (WOS) as well as experts in the field in Morocco
that are looking into the need for smart systems that would prepare an optimized program
for patients or examine the appointment-making systems of public hospitals. Secondly, it
is appropriate to say that the subject responds to an imminent need of Moroccan public
organizations, in this case, the kingdom’s local, provincial, and regional healthcare struc-
tures, to develop reliable measures for the use of online healthcare platforms, particularly
the Mawiidi platform, on the satisfaction and quality of service delivered to users. Prior
research in this area primarily focused on examining the adoption of e-health systems,
rather than assessing the level of patient satisfaction. Previously, the primary focus of
research in this area was centered on the examination of the adoption of e-health systems
and measuring e-health system success rather than the assessment of the apparent degree of
patient contentment. Consequently, these studies are incapable of presenting an authentic
patient/consumer benchmarking framework. However, there are limited studies in Mo-
rocco that address the need for smart systems to prepare an optimized program for patients
and to investigate the appointment-making system of public physicians’ hospitals. To
improve patient satisfaction and comply with the Ministry of Health and Social Protection
(MHSP) of Morocco, all hospitals have been instructed to implement an online system
for appointment scheduling. Thus, considering the essential infrastructure required for
establishing an online appointment booking system, this study aims to assess the efficacy
of the online outpatient booking system in Moroccan hospitals. The findings from this
study can be used to develop a more effective online appointment scheduling system and
address some of the problems connected with appointments in outpatient clinics.
The remainder of the paper is structured as follows. Section 2 delineates the the-
oretical framework, presenting essential concepts and the development of hypotheses.
Section 3 outlines the materials and methods employed in the research design and data
collection process. Section 4 highlights the results derived from data analysis. Finally,
Big Data Cogn. Comput. 2024, 8, 180 4 of 38

Section 5 provides the discussion and conclusions, drawing insights from the findings and
considering their broader implications.

2. Theoretical Framework
The examination of electronic service quality has gained significant importance, par-
ticularly in light of the substantial transition to online shopping prompted by the global
lockdowns instituted during the COVID-19 pandemic [32]. In this context, it is essential
to comprehend and improve the quality of electronic services. Along with the increase in
dependency on digital platforms, more research is needed to take a critical look into online
service quality and ensure that the business changes according to the ever-changing needs
and preferences of the users. Digital transformation is now a key issue in global health
systems reform, including in the Kingdom of Morocco. Innovation including electronic
patient records (EPRs) and online appointment booking platforms has been accepted slowly
as a result of the increasing public demands and the desire to enhance effectiveness in
health service delivery. They are designed to make the management of patients easier
while making communication among professionals in the care setting more convenient.
With the touch of a few buttons, more and more patients can manage their healthcare more
efficiently. These innovations aim to increase the potential of healthcare systems for their
growing challenges and make care more adaptable.

2.1. Electronic Service Quality in Healthcare Sector

The quality of an electronic service is usually defined as the extent to which one uses a
website effectively and efficiently for the shopping, purchasing, and delivery of products
or services [33]. In other words, the smoothness and efficiency involved in shopping,
making purchases, or receiving goods through a website is an indicator of how good its
electronic service quality is. On the contrary, the absence of face-to-face interaction often
characterizing e-services makes them less efficient since this kind of relationship building
and nurturing is considered essential [34].
In the past, receiving help involved making appointments with primary care physi-
cians, waiting for specialist referrals, and physically visiting health facilities. However,
today’s healthcare scene is different due to the introduction of e-appointment systems as
well as appointment scheduling portals. Convenience is made available for patients by
such online platforms to make appointments and access other services. The phenomena at
hand put people in charge of their own healthcare experiences. Furthermore, this novel
method could improve the availability of these services thereby boosting health results,
enhancing patient satisfaction, and increasing efficacy in providing medical attention.
The use of health information technologies and digital resources has the potential to
enhance the quality of care. Many medical institutions have established patient portals
to facilitate online access to resources [35]. Electronic health record portals have greatly
expanded their functionality to include such tasks as scheduling appointments, improving
communication between patients and providers, displaying laboratory test results, access-
ing physician encounter notes [36], managing bill payments, providing cost estimates for
ambulatory services [37], and offering family records access. Based on the findings of the
California Health Care Foundation (CHCF) Health Policy survey, individuals, particularly
those with lower incomes, show increased interest and engagement in their healthcare
when they have convenient online access to their health information [35].
According to the Medical Group Management Association (MGMA), in certain health-
care organizations, patient access rates to these web-based patient portals have surged
to as high as 90% [38]. However, there is a difference between patient portal adoption
and patient portal use. Even though approximately 90% of healthcare providers make
patient portals accessible to their patients and patients initially enroll in these systems, the
active engagement level is notably lower, with only around 30% of patients regularly using
the portal [38].
Big Data Cogn. Comput. 2024, 8, 180 5 of 38

2.2. Mawiidi Online Appointment System in Morocco: A Mainstay for Years

The COVID-19 pandemic can be seen not only as a turbulent and challenging time but
also as a period marked by the rapid adoption and integration of digital technologies [39].
It made digital transformation an urgent and pressing priority [40]. Nonetheless, numerous
countries, particularly emerging ones, face ongoing challenges in the maturation of their
digital economies, particularly within the healthcare sector.
The existing healthcare situation in Morocco continues to face numerous challenges.
Nevertheless, the healthcare sector has undertaken various initiatives that underscore a
genuine dedication to progress toward smart healthcare. Morocco has initiated a variety
of projects designed to bolster this vital sector. These efforts include a diverse array of
improvements, such as the digital transformation of several healthcare services and the
development of numerous novel platforms [41]. Additionally, Morocco has prioritized the
implementation of electronic appointment systems. Preceding the COVID-19 outbreak,
the MHSP, which has adopted a legal framework for telemedicine (law 131-13 and decree
no. 2-18-378, amended and supplemented by decree no. 2-20-675), has also launched an
online appointment system (www.mawiidi.ma (accessed on 2 September 2024)), facilitating
physician appointments, offering healthcare guidance, and thereby reducing wait times.
Additionally, Morocco launched a digital platform for remote COVID-19 self-diagnosis.
Shortly thereafter, the MHSP unveiled the “Wiqaytna” tracking app, which utilizes Blue-
tooth technology to alert users to potential contact with individuals who have tested
positive for COVID-19. Notably, the application was developed in partnership with the
newly established Digital Development Agency and the National Telecommunication Reg-
ulatory Authority (ANRT). It has also received approval from the Moroccan Data Protection
Authority (CNDP) [42].
Our study will center on the evaluation of Morocco’s implementation of a computer-
ized appointment management system (www.mawiidi.ma (accessed on 2 September 2024)).
The digital platform “Mawiidi” is designed for appointment management and serves to
streamline appointment booking for citizens while enhancing the overall appointment
management process. This platform offers a compilation of all available healthcare facili-
ties, including those at the local, provincial, and regional levels. It also provides contact
details for these hospitals. Moreover, users have the option to locate these facilities on
“Google Maps”.
In 2022, Khalid Ait Taleb, the Minister of Health and Social Protection indicated that the
digital platform “Mawiidi” facilitated the scheduling of almost two million appointments
in public hospitals. He also stated that these appointments represented 34% of all bookings,
which reflects the increase in the reliance on digital health services (MHSP, 2023).
The following figures below (Figures 1–3) illustrate the interface of the “Mawiidi”
appointment management application in public hospitals in the Kingdom of Morocco,
highlighting its main functionalities, such as online appointment booking and management
of existing appointments, and the desired medical specialty.
However, an innovative application intended to complement the “Mawiidi” platform
is presently being deliberated among stakeholders in the Moroccan healthcare sector and is
expected to be launched in the forthcoming months. This application, following the new
reform of the Moroccan healthcare system, seeks to enhance the efficiency, effectiveness,
and integration of healthcare services.
It is relevant to underline that the healthcare system in Morocco is currently under-
going a gradual move into digital modernization, placing much emphasis on the fluidity
and accessibility of care. This development occurs within a more general frame of modern-
ization of the healthcare framework in which the EPR and electronic medical records are
expected to be an integral part and contribute to moving such a health reform process.
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Big Data Cogn. Comput. 2024, 8, 180 and accessibility
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Figure 1. Home interface for the online appointment booking and management application for public
Figure1.1.Home
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2.3. The Electronic Patient Record (EPR) in the New Reform of the Moroccan Health System:
A Key Tool for the Integration of Care and the Modernization of Health Services
The importance of the EPR as a critical tool for healthcare institutions is growing
globally. With this system in place, medical professionals may quickly obtain patient data,
facilitating effective decision-making and long-term care [43]. Numerous nations, Morocco
among them, are incorporating this technological advancement into their initiatives aimed
Big Data Cogn. Comput. 2024, 8, 180 7 of 38

at modernizing medical infrastructure and enhancing healthcare quality. Morocco’s Health

Plan 2025, led by the MHSP, aims to implement EPR systems across all public hospitals
by 2025. Once fully operational, physicians and other medical practitioners will be able
to access patient records securely and instantly, streamlining treatments and reducing
unnecessary procedures. The first very helpful aspect is the development of new tools
that will enable seamless access to medical knowledge across both time and space and,
subsequently, enhance continuity of care while minimizing medical errors, particularly
those concerning the use of prescription drugs [44].
Nevertheless, this technology also has a darker side that presents serious difficulties.
The system is frequently underutilized or poorly accepted, and adoption rates vary sub-
stantially [45]. Furthermore, new kinds of medical blunders have surfaced [46–50], and
they typically endure over time [51,52]. This side of the EPR highlights risks associated
with workarounds [53–56], longer times required to input information [57–59], which
can lead to increased stress among healthcare personnel [60–63], and reduced clarity of
medical data [64].
Faced with the exponential increase in the amount of digital medical data, ref. [65]
believes that EPRs should be seen first and foremost as business tools, with the ability to
transform data into information, then into useful knowledge in a given context, reducing the
cognitive load on the practitioner, guaranteeing the coordination of players, and reducing
risks. The EPR compiles a patient’s medical history, medications, test results, and surgical
data into one centralized system, promoting better coordination among healthcare teams.
This system facilitates smoother care and information sharing, which is crucial for more
accurate diagnoses.
This global shift toward EPR systems reflects a larger trend toward standardizing
diagnostic and therapeutic processes. By supporting more accurate diagnoses and con-
tinuous care, EPR systems are raising the quality of healthcare delivery on a national and
global scale.
Within the framework of health reform in Morocco, the integration of EPRs, illustrated
in the following figure, is an essential component of the Health Plan 2025, representing
the keystone in the modernization of the healthcare system. This diagram clearly shows
how the EPR centralizes and coordinates medical information across different hospital
departments to improve the quality of care and reinforce the continuity of medical services.
The illustration shows instant access to patient data from admissions, emergency hospital-
ization, and the operating room, right through to outpatient services such as pharmacy and
ambulatory consultations. Once fully operational in Morocco, this type of system will give
healthcare professionals secure, real-time access to critical medical information, facilitating
faster, more accurate patient care.
Figure 4 depicts the steps of the treatment pathway from admissions to operations.
The reform’s specific goals are to lower medical errors and enhance this flow. Data integra-
tion guarantees improved coordination between the many players involved in treatment,
whether during hospitalization, consultations, or surgery, by optimizing every interaction
between healthcare services. In this way, Morocco aspires to modernize its healthcare
infrastructure, reducing the cognitive load on practitioners while increasing the quality
of care provided, a move that is supported by the implementation of such innovative
technologies. The image thus perfectly reflects the MHSP’s vision of making Moroccan
hospitals more efficient and equitable.
Big
Big Data
Data Cogn.
Cogn. Comput.
Comput. 2024,
2024, 8,
8, x180
FOR PEER REVIEW 8 8ofof 38
38

Figure 4. Integration scheme of the EPR in the hospital care pathway: own compilation adapted by
Figure 4. Integration scheme of the EPR in the hospital care pathway: own compilation adapted by
the authors to the Moroccan context, based on an infographic by the Assistance Public–Hôpitaux de
the authors to the Moroccan context, based on an infographic by the Assistance Public–Hôpitaux de
Paris (AP-HP), with substantial modifications.
Paris (AP-HP), with substantial modifications.
2.4.
2.4. Theory,
Theory, Hypotheses
Hypotheses Development,
Development, and and Research
Research Model
Model
This
This segment intends to carry out an in-depth appraisal
segment intends to carry out an in-depth appraisal of of previous
previous research
research thatthat
investigated
investigated what influences patient satisfaction concerning booking appointments on
what influences patient satisfaction concerning booking appointments on the
the
web.
web. InIn the
the present
present investigation,
investigation, aa concept
concept hashas been
been suggested
suggested which
which covers
covers thethe parts
parts of
of
Davis’s
Davis’s Technology Acceptance Model
Technology Acceptance Model (TAM)
(TAM)[66],
[66],asaswell
wellasasDeLone
DeLoneand and McLean’s
McLean’s In-
Infor-
formation
mation Systems Systems Success
Success ModelModel (ISSM)
(ISSM) [67],[67],
that that are related
are related to thetoquality
the quality of infor-
of information,
mation,
quality of quality
service,of and
service, and satisfaction.
satisfaction. This method Thisviews
method theviews
qualitytheofquality of thequality
the system, system,of
quality of information, and service quality as the major factors that drive
information, and service quality as the major factors that drive user satisfaction. This model user satisfaction.
This model
is also is also
extended byextended
incorporatingby incorporating additional
additional variables variables
relevant relevant
to patient to patientsuch
satisfaction, sat-
isfaction,
as privacysuch as privacy
protection, protection,
perceived perceived
security (PSec),security
and trust, (PSec), and trust,
to provide to provide a
a comprehensive
comprehensive
analysis of patient analysis of patient
satisfaction withsatisfaction
the Mawiidiwith the Mawiidi
application application
in a public hospital in setting.
a public
hospital
Thesetting.
inclusion of the website anxiety and privacy protection constructs is based on
previous studies that
The inclusion demonstrate
of the their relevance
website anxiety and privacyin assessing
protectionsatisfaction
constructsand intention
is based on
to use online systems in the healthcare domain. To enhance the
previous studies that demonstrate their relevance in assessing satisfaction and intention theoretical framework,
weuse
to have enriched
online systemsthe in
discussion of these
the healthcare constructs
domain. with a more
To enhance thoroughframework,
the theoretical review of prior we
studies,
have demonstrating
enriched the impact
the discussion of these
of these factors on
constructs withsatisfaction and perceived
a more thorough review security in
of prior
e-healthdemonstrating
studies, systems. This method the impact guarantees
of these enhanced
factors onconceptual
satisfactionprecision and delineates
and perceived security
explicit
in e-healthconnections
systems. Thiswithmethod
the current literature.
guarantees Moreover,
enhanced their distinct
conceptual rolesand
precision anddeline-
effects
are analyzed in later parts, offering a more profound comprehension
ates explicit connections with the current literature. Moreover, their distinct roles and ef- of their importance
within
fects the
are suggested
analyzed in paradigm.
later parts, offering a more profound comprehension of their im-
portance within the suggested paradigm.
Big Data Cogn. Comput. 2024, 8, x FOR PEER REVIEW 9 of 38

Big Data Cogn. Comput. 2024, 8, 180 9 of 38

The TAM has been widely extended, integrating various variables. It has also been
successfully
The TAMusedhas
to explain perceived
been widely ease ofintegrating
extended, use (PEOU), perceived
various usefulness
variables. It has(PU),
alsoand
been
use in different contexts, including digital health and hospital e-appointment
successfully used to explain perceived ease of use (PEOU), perceived usefulness (PU), systems
such
andas Mawiidi
use [68–70],
in different beingincluding
contexts, one of the mosthealth
digital widelyandused theories
hospital in research on
e-appointment the
systems
acceptance
such as Mawiidi [68–70], being one of the most widely used theories in research onac-
of digital technologies. However, the TAM seeks to determine and explain the
ceptance and use
acceptance but does
of digital not directly assess
technologies. userthe
However, satisfaction.
TAM seeks Forto
this reason, we
determine andpropose
explain
a acceptance
theoretical model
and use that
butintegrates
does not the constructs
directly assessofuser
the satisfaction.
TAM, namelyFor PEOU, with the
this reason, we
constructs of the ISSM, such as IQ, service quality, and satisfaction, as illustrated
propose a theoretical model that integrates the constructs of the TAM, namely PEOU, with in Figure
5. the constructs of the ISSM, such as IQ, service quality, and satisfaction, as illustrated in
Figure 5.

Figure 5. The proposed conceptual model.

Figure 5. The proposed conceptual model.
2.4.1. Information Quality (IQ)
2.4.1. Information Quality (IQ)
The most important aspect is the quality of information spread through a portal. It
hasThebeen evaluated along
most important aspect different
is the dimensions for its utility,
quality of information clarity,
spread relevance,
through reliabil-
a portal. It
ity, completeness, and timeliness [71]. All these together measure the extent
has been evaluated along different dimensions for its utility, clarity, relevance, reliability, to which
the information
completeness, and meets user [71].
timeliness needs Alland enables
these themeasure
together making the of decisions based on
extent to which thegood
in-
knowledge [71].
formation meets user needs and enables the making of decisions based on good
The estimation
knowledge [71]. of IQ will be based on items emanating from scholarly articles such
as [72–74].
The estimation of covering
The items IQ will beallbased
the dimensions of IQ will critically
on items emanating assess the
from scholarly information
articles such
provided through the websites.
as [72–74]. The items covering all the dimensions of IQ will critically assess the infor-
mationIn Indonesia,
provided ref. [75]
through thepointed
websites. out that the quality and relevance of IQ significantly
influenced
In Indonesia, ref. [75] pointed out information
users’ online behavior. Full should
that the quality andberelevance
provided,of such
IQ as descriptions
significantly
and images,
influenced since
users’ incomplete
online information
behavior. can destroy
Full information the credibility
should of the
be provided, online
such platform.
as descrip-
High-quality information not only builds up users’ trust but also enhances
tions and images, since incomplete information can destroy the credibility of the online the browsing
experience of the users [75].
platform. High-quality information not only builds up users’ trust but also enhances the
Information quality assurance can be regarded as vital to influence user satisfaction
browsing experience of the users [75].
and the overall effectiveness of the portal [71]. High-quality information makes it more
Information quality assurance can be regarded as vital to influence user satisfaction
useful, reliable, and relevant to users’ needs. In this light, quality information also gives
and the overall effectiveness of the portal [71]. High-quality information makes it more
users the privilege of easier navigation options that help them engage with and explore
useful, reliable, and relevant to users’ needs. In this light, quality information also gives
products that fascinate them. Consequently, the usability improves user experience, hence
users the privilege of easier navigation options that help them engage with and explore
supporting decision-making based on knowledge [75]. This leads to a higher degree of
products that fascinate them. Consequently, the usability improves user experience, hence
satisfaction, level of involvement, and frequency of usage [71]. Hence, we suggested that:
supporting decision-making based on knowledge [75]. This leads to a higher degree of
satisfaction,
Hypothesis level of involvement,
1 (H1). and influence
IQ has a positive frequency onof usage [71]. Hence, we suggested that:
PEOU.

Hypothesis 1 (H1). IQ has a positive influence on PEOU.

Big Data Cogn. Comput. 2024, 8, 180 10 of 38

2.4.2. Perceived Ease of Use (PEOU)

The model of acceptance of technology proposed by Davis in 1989 based on concepts
developed by Fishbein and Ajzen in their Theory of Reasoned Action (TRA) states that the
best predictor for actual use of any system is the intention to use it. The model indicates
that PEOU in a system leads to greater task efficiency, which in turn raises the PU of the
system [76].
Two primary perceptions lead to the intention to use a system: the concept of PU,
on one hand, delineates the extent to which an individual feels that implementing the
system will optimize their work performance [66], while PEOU meanwhile provides the
predicted difficulties or efforts required in utilizing it [66]. It evaluates how much users
believe specific technologies are effortless to handle.
PEOU is closely linked to usability, emphasizing how user-friendly and simple a
system or technology appears to be [66]. While ease of use refers to how effortlessly a system
can be navigated, usefulness highlights the extent to which it enhances performance [66,73].
At its core, PEOU refers to the level at which users believe that using the website or
digital platform involves simplicity. Even when a system is deemed beneficial, perceived
complexity might decrease its advantages in situations where users believe that the required
effort would outweigh the value derived from using the system [66].
The level of satisfaction a patient feels would be mediated by many factors relating
to the quality of care provided, the communication skills and interpersonally competent
healthcare providers, the convenience and accessibility of services available, and, gener-
ally, the experience of the healthcare. Such satisfaction is also an important measure in
understanding the quality and effectiveness of healthcare delivery because it determines
the loyalty of patients, compliance with the treatment regimen, and ultimately impacts
their health outcomes [77].
PEOU denotes a person’s conviction that employing a specific system or technology
will be straightforward and assist in optimizing tasks [78]. This approach is important in
understanding why people choose to accept or reject technologies, especially with respect
to the use of them in the area of e-healthcare [79].
The study according to [80] showed that individual intention of persistently using
e-government services is influenced by factors like computer self-efficacy, PU, and PEOU.
There is also evidence that both PEOU and PU tend to have a positive effect on patient
satisfaction based on user experience [81]. Correspondingly, research conducted in India
by [82], using a specifically designed questionnaire, indicated that website design elements
and PEOU were significant in improving consumer satisfaction. Similarly, ref. [83] recorded
analogous outcomes in their research regarding electronic satisfaction (E-Satisfaction).
Perceived Trust is defined as the willingness to place oneself in a vulnerable position
by depending on another party to act in the trustor’s best interests, even without full
oversight or control over that party’s actions [84]. The general dimensions of trust are said
to be based on four facets, which are ability, benevolence, integrity, and predictability. The
ability dimension deals with the trustee’s competency in discharging duties; for example, it
involves a retailer’s capability to honor commitments made through a digital environment.
The genuine interest of the trustee in the well-being of the trustor, such as making quality
attempts to serve, is referred to as benevolence. In simple terms, integrity refers to a
measure of the extent to which the trustee adheres to moral codes, which guarantee that
one’s actions are right and just. In this way, predictability implies that there is a pattern or
consistency in actions of a given trustee, which makes it possible for the trustor to rely on
these behaviors in the future [84]. A study by [85] showed a positive relationship between
trust and PEOU. When users perceive that a system is easy to use, it reduces their feelings
of vulnerability and uncertainty, thereby strengthening their trust in the system. PEOU
enhances the system’s predictability and the perception of competence, two key dimensions
of trust [76]. Consequently, we propose the following hypotheses:

Hypothesis 2 (H2). PEOU has a positive influence on PS.

Big Data Cogn. Comput. 2024, 8, 180 11 of 38

Hypothesis 3 (H3). PEOU has a positive influence on TRUST.

2.4.3. Perceived Security (PSec)

Concerns surrounding the security of online transactions have intensified due to the
open and unrestricted nature of the internet [86]. From a consumer’s viewpoint, PSec
in e-commerce refers to the confidence that personal and financial information will be
protected from unauthorized access, both during transmission and storage, in line with
their expectations of confidentiality [87]. Although providers could offer guarantees,
consumers frequently possess differing views on online privacy and security [87]. Despite
stringent security protocols, individuals may have divergent opinions concerning the safety
of online transactions.
PSec represents the trust and confidence consumers place in the security protocols
implemented by web retailers when engaging in online transactions [88]. The ability to
protect personal information, avoid unlawful access and ensure privacy as well as honesty
are subjectively evaluated by this [89]. Consequently, it influences greatly how much trust
consumers have in it and how eager they are to engage in electronic business [88].
PSec has a strong impact on the confidence and adoption of e-commerce websites by
customers. Users’ opinions about any website security attributes are raised or reduced
by information openness, accessibility of the site, and user-friendliness [89]. On the other
hand, even with increased internet users, many are still hesitant to share highly private
personal data due to fears of e-commerce security [90].
Although, technically, measures like encryption and digital signatures could make
online transactions more viable [91], consumer perceptions of security are a different story
altogether. Ref. [92] cited the lack of research on consumer perceptions of online security,
and despite the growth in e-commerce, people are still very hesitant to divulge their
personal, sensitive information [93,94]. Particular concerns include the security of online
transactions, the credibility of an organization, and the lack of explicit privacy policy [95].
Therefore, we propose that:

Hypothesis 4 (H4). PSec has a positive influence on TRUST.

2.4.4. Privacy Protection (PP)

As per www.privacyalliance.org (accessed on 2 September 2024), privacy refers to
guarding personally identifiable data shared over the internet and entails confidentiality
regulations, alerts, and exposures, as well as obtaining user approval. For this reason,
websites need to enhance their operational effectiveness as well as user confidence [89].
By limiting unauthorized access, privacy protection is crucial in e-commerce to ensure the
security and dependability of all sensitive data collected from customers during transac-
tions [90]. Similarly, maintaining confidentiality and safeguarding personal information
have long been considered essential medical ethics, particularly in the context of the health-
care industry [96]. Patients are more inclined to connect positively with the service and
experience greater satisfaction when they trust that their personal and sensitive information
is safely protected. In light of technical advancements, the utilization of computers for data
storage, and growth in medical research, the imperative to uphold privacy and secrecy
has become increasingly critical [97]. These responsibilities are now being extended to
online platforms, where the reliability of privacy safeguards, positive perceptions of an
institution’s credibility, and user satisfaction are decisive factors in how people perceive
the handling of their personal data [98].
In e-government services, privacy pertains to individuals’ perspectives on the man-
agement of their data, specifically in relation to data collection, accuracy, and safeguarding
against unauthorized access [99]. Robust privacy protections improve consumers’ percep-
tions of service quality, whereas insufficient privacy measures may deter users from sharing
personal information, thereby limiting the utilization of online services [100]. Patients’
impressions of their own privacy have a significant impact on the overall satisfaction they
Big Data Cogn. Comput. 2024, 8, 180 12 of 38

feel [96]. According to the authors, the fact that a strong privacy defense makes people feel
more secure and develops trust among those in health systems positively influences their
happiness. In another study, a strong association was found to exist between patient privacy
and patient satisfaction, which indicated that secrecy enhances satisfaction in patients [101].
Trust in digital contexts is mainly built on privacy [102]. In the contemporary digital
environment, companies have the technological capacity to collect and disseminate per-
sonal information, which creates substantial privacy concerns and has led to the enactment
of regulatory constraints. For some, this is a violation of privacy [103]. The PP requires
the implementation of security protocols to safeguard databases from unauthorized ac-
cess to personal information, while maintaining data accuracy and integrity throughout
transmission [90]. Ref. [104] emphasize that end users must decide whether to trust online
environments, despite potential vulnerabilities that may even be unknown to experts.
Similarly, Ref. [105] describe consumer trust as the readiness to depend on a partner in an
exchange, based on the confidence one has in that partner. The way in which privacy is
perceived on websites mitigates the sense of risk that users feel when exchanging personal
information online, thereby strengthening the relationship of trust and promoting online
transactions [106,107]. Ref. [108] has shown that security and privacy features play an
important role in the development of online trust. Ref. [109] emphasized that privacy is
particularly critical for websites where personal information is at risk, compared with other
types of sites. A wealth of research has shown that perceived privacy positively affects
consumer trust in online transactions [110–112]. In light of these observations, we propose
the following hypotheses:

Hypothesis 5 (H5). PP has a positive influence on PS.

Hypothesis 6 (H6). PP has a positive influence on TRUST.

2.4.5. Service Quality (SQ)

SQ is generally understood as the degree to which a service aligns with or surpasses
customer expectations, determined by comparing what the customer expects to their
experience [113,114]. According to [115], service quality can be described as the provider’s
ability to promptly address user needs and the precision with which they fulfill promised
services. Ref. [116] further defines it as the extent to which services meet or exceed customer
expectations, emphasizing the gap between anticipated and actual experiences.
In healthcare, how individuals perceive sensory information is influenced by their
attitudes, values, motivations, and previous experiences [117,118]. Ref. [115] presented the
information system continuity expectations confirmation model (ECM-ISC) for mHealth
services, which includes three key dimensions: the individual, the technology, and the
environment. Perceived service quality is a critical element of mHealth system success,
reflecting both responsiveness (timely addressing of user needs) and reliability (accurate
fulfillment of promised services). Thus, it was concluded in their study that the impact
of service quality perceived from the confirmation of expectations in mHealth services by
users is positive [115].
In marketing, it is an established fact that high-quality services are necessary for
prosperity, especially in the current competitive markets [119]. Service quality, essential for
business success, is particularly crucial in digital environments. Delivering quality services
through websites is considered more important than low prices or mere online presence. To
achieve this, organizations must understand how customers perceive and evaluate online
customer service. While research on this topic is emerging, a comprehensive synthesis is
still needed [33]. Moreover, the strong relationship between service quality and customer
satisfaction is well established, making service quality a crucial and fundamental dimension
of marketing strategies [120]. This connection further underscores the importance of
prioritizing high-quality service delivery to meet customer expectations.
Big Data Cogn. Comput. 2024, 8, 180 13 of 38

SQ, according to [121], in e-government websites is the measure of excellence for

service delivery where individual features like responsiveness, reliability, efficiency, and
effectiveness are put into consideration. E-government websites with augmented quality of
services have a direct relationship with heightened citizen happiness and a better online
experience [121]. In light of these data, we offer the subsequent hypotheses:

Hypothesis 7 (H7). SQ has a positive influence on PS.

Hypothesis 8 (H8). SQ has a positive influence on PEOU.

2.4.6. Trust in Government Website (TRUST)

As society increasingly embraces digitalization, access to healthcare data and services
has expanded through a number of online platforms and technologies. The ability to
find, understand, evaluate, and leverage digital health literacy and culture is essential to
enable individuals to effectively manage their health and well-being [122]. The success
of digital health literacy improvement initiatives inherently depends on the credibility of
the information and sources used by an individual, where trust is considered a critical
component of health literacy itself [123]. Trust is a critical factor in the adoption and usage
of digital health tools, which in turn affects engagement with technologies.
Accordingly, understanding the role of trust as related to digital health literacy is an
important issue for facilitating user involvement and fostering health equity [124]. Trust
has been defined in various ways within various contexts. Ref. [125] built on previous
studies and developed a framework for understanding consumer behavior in e-commerce,
identifying four primary aspects of trust: an overall tendency to trust, trust in institutions,
specific trusting beliefs, and trust-driven intentions.
Ref. [123] discovered that individuals with greater trust in the internet are about
32% less likely to be concerned about the security of their health data. Furthermore,
heightened trust in online platforms reduces anxieties about the accuracy and reliability of
health information. Optimizing the quality of material on government websites and forums
can considerably enhance public access to, and trust in, health information. Moreover,
confidence in e-government services is associated with an enhanced perception of security
and data protection [123]. The potential of e-government websites rests largely on the trust
that users place in these platforms to conduct themselves in a reasonable manner during
interactions or transactions [121]. The reliability of technology such as the internet also
influences trust [126]. Public trust in the government influences confidence in government
websites, as people expect that if the government operates efficiently and in their best
interest, its websites will meet their needs [121].
Ref. [127] identified a robust correlation between trust in government and satisfaction
with e-government services. Ref. [128] contended that public contentment, intrinsically
linked to trust, is influenced by both expectations and perceptions of governmental effi-
cacy. Their concept elucidates the reciprocal relationship between trust and satisfaction:
trust engenders satisfaction, while heightened satisfaction fortifies trust. In light of this
perspective, we suggest the subsequent hypothesis:

Hypothesis 9 (H9). TRUST has a positive influence on PS.

2.4.7. Web Anxiety (WA)

Anxiety can be categorized into three types: trait, state, and concept-specific. Trait
anxiety is a chronic, generalized form of anxiety that individuals encounter in multiple
life areas, frequently associated with personality traits and possibly hereditary [129]. State
anxiety, by contrast, is situation-dependent, fluctuating over time and shaped by prior
experiences. Concept-specific anxiety occupies a middle ground, emerging in response to
specific situations [130]. In the domain of information systems, anxiety is acknowledged as
a personality trait that can impact an individual’s use of technology.
Big Data Cogn. Comput. 2024, 8, 180 14 of 38

In the digital era, it is essential to possess internet literacy. Technical skills that are
crucial include knowledge of operating systems, the ability to use word processing software,
databases as well as communication tools, and effective internet navigation [131]. When
people go online or engage in various forums online, they can experience anxiety which is
described as WA [132]. It emerges as numerous unpleasant feelings, including technical
apprehension, apprehensions over privacy and security, and anxiety or dread of online
errors [132]. Bolliger’s and Ouajdouni’s studies identified a substantial inverse correlation
between computer anxiety and satisfaction, indicating that users with heightened worry
around technology are distinctly disadvantaged relative to their peers. This may have a
negative effect on their satisfaction with the course material and its method of presentation.
Results indicate that increased technological anxiety significantly affects overall course
satisfaction and learning experience [133,134].
WA can significantly affect an individual’s likelihood to use the internet and engage
in online activities, thereby limiting their access to the vast knowledge and opportunities
present in the digital domain [132]. Hermawan’s study argued that trust, technology anxiety,
and customer support services collectively influence customer satisfaction. Specifically,
55% of customer satisfaction during online purchases is explained by these variables,
while the remaining 45% is attributed to factors not explored in the study. These results
underscore the significant impact of WA on user satisfaction in the context of online
purchasing [135]. This underscores how anxiety affects the broader user experience.
Anxiety itself can be classified into three forms: trait, state, and concept-specific. Trait
anxiety is a pervasive and enduring form of anxiety that individuals encounter across
diverse circumstances, frequently associated with personality characteristics [129]. State
anxiety is contingent upon situational factors and influenced by prior experiences, while
concept-specific anxiety arises in reaction to particular circumstances [130]. In the domain
of information systems, anxiety is acknowledged as a personality trait that can impact
an individual’s use of technology [136]. Studies further indicate that anxiety serves as an
antecedent to users’ perceptions of a system’s usefulness and ease of use [137]. Thus, we
propose the following hypotheses:

Hypothesis 10 (H10). WA has a negative influence on PS.

Hypothesis 11 (H11). WA has a negative influence on PEOU.

Based on the above-mentioned literature review and hypotheses, Figure 5 depicts the
proposed conceptual model and hypothesized relationships.

3. Materials and Methods

As shown in Figure 6, the various procedures that were carried out in order to create
and validate the research model by utilizing the PLS-SEM methodology are explained.
Big Data Cogn. Comput. 2024, 8, x FOR PEER REVIEW 15 of 38
Big Data Cogn. Comput. 2024, 8, 180 15 of 38

Figure
Figure 6. Steps
6. Steps of of
thethe research
research method
method adapted
adapted and
and inspired
inspired byby [138],
[138], with
with thethe original
original data.
data.

3.1. Study Questionnaire

3.1. Study Questionnaire
The latent variables in our research model (Figure 2) were operationalized using
The latent variables in our research model (Figure 2) were operationalized using
measurement scales adapted from prior empirical studies. IQ was evaluated through six
measurement scales adapted from prior empirical studies. IQ was evaluated through six
items sourced from earlier research [71]. PEOU was measured with six items from [66,76,90].
items sourced from earlier research [71]. PEOU was measured with six items from
The PSec was assessed using three items from [88,139,140], while PP was evaluated with
[66,76,90]. The PSec was assessed using three items from [88,139,140], while PP was eval-
five items from [90,139]. SQ was measured through five items adapted from [115,121].
uated with five items from [90,139]. SQ was measured through five items adapted from
TRUST was gauged with four items from [121,126], and WA was assessed through four
[115,121]. TRUST was gauged with four items from [121,126], and WA was assessed
items from [132]. Lastly, the PS was measured using three items [77]. These scales were
through four items from [132]. Lastly, the PS was measured using three items [77]. These
chosen for their relevance and utility, ensuring comprehensive and accurate research results
scales were chosen for their relevance and utility, ensuring comprehensive and accurate
(Table A1, Appendix A).
research results (Table A1, Appendix A).
3.2. Measurements
3.2. Measurements
We adopted and adjusted previously validated measures for the research variables,
Wecomprising
each adopted and adjusted
multiple previously
items, using validated
a five-point measures for the
Likert scale (1 research variables,
= strongly disagree,
each comprising multiple items, using a five-point Likert scale (1 = strongly
5 = strongly agree). Given that the measurement scales we used in this study are mature disagree, 5=
strongly
and wellagree). Given and
established that have
the measurement
been extensivelyscales we used
validated inin this study
a variety are mature
of contexts, we and
opted
well established
to directly and have
generate been of
a sample extensively validated
items without in a variety
engaging of contexts,
in exploratory we opted
qualitative to
contex-
directly generate
tualization. a sample
These scalesof items
are without engaging
acknowledged in exploratory
in the literature, qualitative
and their robustcontextu-
validation
alization. These scales
across various studiesare acknowledged
negated in the
the need for literature,
adaptation andspecific
to our their robust validation
local context. This
across various studies negated the need for adaptation to our specific local
approach enabled us to make effective use of existing scales to operationalize our vari- context. This
approach
ables ofenabled
interest,us to make effective
reinforcing the rigoruse
ofof
ourexisting
study scales
while to operationalize
optimizing our variables
the research process
of and
interest, reinforcing
focusing on the the rigor ofofour
collection thestudy while optimizing
quantitative the research
data essential process
for empirical and
analysis.
focusing
Appendixon the collection
A provides of the quantitative
a detailed overview of data
theessential
items forfor empirical
each construct,analysis.
along Appen-
with their
dixcorresponding measurement
A provides a detailed overviewsources.
of the items for each construct, along with their corre-
sponding measurement sources.
Big Data Cogn. Comput. 2024, 8, 180 16 of 38

3.3. Data Collection and Sampling Technique

We adopted a mixed sampling approach, combining convenience and snowball sam-
pling, widely used methods in health research and social sciences, particularly in the field
of information systems management [141–144]. According to [145], convenience sampling
allows participants to self-select into the study after the researcher announces the opportu-
nity, making these methods non-probabilistic but very practical. Snowball sampling, on
the other hand, involves participants referring others to the researcher, creating a chain
of recruitment.
This methodology was selected due to specific practical and contextual constraints in
Morocco, particularly the digital divide. According to the Moroccan Court of Accounts’ an-
nual report for 2022–2023 (Court Of Accounts (2023). Annual Report 2022–2023. Kingdom
Of Morocco. https://www.courdescomptes.ma [accessed on 1 September 2024]), 17% of the
population does not own a smartphone, and 56% struggles with digital illiteracy. Unequal
access to the internet, caused by connectivity issues in certain regions, low bandwidth, or
high costs, further complicates the use of online services for many citizens.
We note that the digital divide in Morocco may result in the under-representation of
groups with restricted internet access or inadequate technological skills, thereby affect-
ing the representativeness of our findings. Despite employing a hybrid data gathering
method to partially alleviate this limitation, caution is warranted when extrapolating the
conclusions to the broader Moroccan population. To enhance the inclusion of these groups,
we advise that future studies implement offline, field-based data collection techniques to
engage less-connected people.
However, we acknowledge that the use of convenience and snowball sampling may
introduce biases that limit the generalizability of our results. While these non-probabilistic
methods are practical in the context of limited resources and digital constraints in Morocco,
they do not ensure the same level of representativeness as probabilistic sampling techniques.
In future studies, we plan to adopt probabilistic sampling methods, such as stratified
random sampling, to enhance the robustness and general applicability of the results. This
approach would allow us to target a more representative and diverse sample, better
reflecting the broader population.
While convenience and snowball sampling methods were chosen due to the constraints
mentioned earlier, we implemented a hybrid data collection process to further mitigate
these challenges, combining online dissemination via social networks to reach connected
users with direct data collection from patients in public hospitals. This approach allowed
us to cover a wide range of participants, including those with limited access to digital
platforms. In collaboration with healthcare professionals, we facilitated the understanding
and dissemination of the questionnaire, ensuring a higher quality of data collection and
increasing participant engagement. Patients were interviewed during their consultations,
allowing us to respect time and resource constraints while ensuring a diverse sample.
First, a pre-test of the questionnaire was conducted with a subgroup of twenty patients
and the regional director of the MHSP. This pilot phase ensured the clarity and compre-
hension of the questionnaire, leading to refinements in the wording of certain questions.
These adjustments were essential to ensure that the final version of the questionnaire was
accessible and easily understandable to all participants. According to [146], the experts
were asked to evaluate the items that correlate to each element in terms of how easy it is to
comprehend, how clear they are, and how relevant they are to the aims of the study.
Additionally, to confirm the accuracy and consistency of the translated versions, the
Arabic and French questionnaires were translated back into English. This back-translation
process allowed us to verify that the translated items accurately reflected the intention and
content of the original English version. This step was crucial to guarantee the quality and
comparability of responses across the different language versions, fostering participation
from a more diverse population.
To expand the sample beyond the initial network, we employed snowball sampling,
encouraging participants and healthcare professionals to refer the questionnaire to other
Big Data Cogn. Comput. 2024, 8, 180 17 of 38

patients. This method increased both the sample size and diversity, allowing us to reach a
broader range of respondents [147]. Data were collected during the months of April, May,
and June 2024.
The sample size was estimated based on the number of variables included in the
analysis, following the recommendations of [148], who suggest a ratio of 5 to 8 observations
per variable to ensure robust statistical analysis. With 36 indicators used in this study, a
minimum sample size of 180 to 288 participants was required to ensure sufficient adequacy
for the planned analyses. Thus, the number of samples of 348 complies with the minimum
sample requirement, which fulfills the minimum sample as suggested by [148].
Although this mixed approach is non-probabilistic and may introduce certain selection
biases [147], it was particularly well suited to our context. The constraints related to
Morocco’s digital culture and the specific needs of our study justify the use of these
methods to collect relevant data on patient satisfaction. We have taken these limitations
into account when interpreting the results, emphasizing the need for caution in generalizing
conclusions [149].
Informed consent was obtained from all patients participating in the survey, whether
through online or face-to-face methods, ensuring their voluntary involvement in the study.
Participants were given the option to withdraw from the survey at any time. Additionally,
the online survey was completely anonymous and did not collect any personally identifiable
information. As a result of these efforts, 348 valid responses were collected, providing
valuable data for the study.
In terms of the demographic profile of the present study’s participants, the majority of
respondents were male, comprising 59.2% of the sample. The age distribution showed a
strong concentration in the 38–47 age group, representing 58.3% of participants. Other age
groups were less represented, with 19.8% falling into the 28–37 range, and only 12.1% of re-
spondents aged 18–27. A significant portion of the sample held a university degree (60.3%),
making it the largest educational category. The majority of participants were married
(67.8%), with a smaller proportion being unmarried (25.9%) or widowed/divorced (6.3%).
In terms of computer literacy, a notable 31.0% of respondents identified as beginners, while
29.0% reported professional-level skills, indicating a diverse range of technological profi-
ciency among participants. A summary of the demographic information of respondents in
the sample is given in Table 1.

Table 1. Demographic characteristics (n = 348).

Profile Category Frequency Percentage (%)

Male 206 59.2
Gender
Female 142 40.8
18–27 42 12.1
28–37 69 19.8
Age 38–47 203 58.3
48–57 20 5.7
>57 14 4.0
Unmarried 90 25.9
Marital Status Married 236 67.8
Widow or Divorced 22 6.3
No Education 20 5.7
Primary 13 3.7
Education Level Secondary 44 12.6
University 210 60.3
Vocational Training Diploma 61 17.5
Big Data Cogn. Comput. 2024, 8, 180 18 of 38

Table 1. Cont.

Profile Category Frequency Percentage (%)

No 65 18.7
Student 74 21.3
Private Sector Employee 162 46.6
Occupation
Government Employee 9 2.6
Retired 31 8.9
Own Business 7 2.0
No Computer Literacy 70 20.1
Beginners 108 31.0
Computer Literacy
Advanced 69 19.8
Professional 101 29.0

3.4. Data Analysis

In order to facilitate further analysis using SPSS Statistics 25, which provided de-
scriptive statistics and the application of Harman’s single-factor test, the data that were
collected were entered into a spreadsheet that was created in Microsoft Excel (XLSX).
Additionally, SmartPLS 4 software was used for a comprehensive analysis of the data
through partial least squares structural equation modeling (PLS-SEM). This methodology
has garnered a significant amount of attention in research pertaining to information systems
management, education, entrepreneurship, technology adoption, and other topics that are
related [134,138,150–152]. For the purpose of predicting the impacts of dependent variables,
ref. [153] advised utilizing PLS-SEM. As [153] recommended, this approach is particularly
advantageous for exploratory investigations since it facilitates the modeling of intricate
concepts and the incorporation of latent variables, while imposing less stringent require-
ments on the normalcy of the data. This decision is warranted by our moderate sample
size and the characteristics of our latent variables, which correspond effectively with the
advantages of PLS-SEM, optimizing explanatory power while enabling the examination of
behavioral models related to satisfaction and usage intention.
In a similar vein, ref. [154] argued that this method is appropriate for simultaneously
forecasting a group of equations for the given research model, and that it also builds the
relationship between variables. This method involves a two-step evaluation process, ensur-
ing a thorough examination of the data. As part of the initial phase, the outer model was
evaluated to determine whether or not it possessed convergent and discriminant validity.
This was accomplished by analyzing many parameters, including loadings, Cronbach’s
alpha, composite reliability, and average variance extracted (AVE). The inner model was
evaluated in the second stage by examining the coefficients of determination (R2 ) for en-
dogenous latent variables, the effect size (f2 ), and the predictive power (Q2 predict). This
was carried out in order to determine the performance of the inner model. Additionally,
the testing of hypotheses, which was based on t-values and p-values, was incorporated
(Figure 6).
Prior to beginning the analysis of the data, we carried out Harman’s single-factor test
in order to determine whether or not there was a reasonable possibility of common method
variance (CMV).
Evidence implies that CMV is likely to be a problem in research when a self-administered
survey is used as a technique of data collection [155]. This is the case because of the
widespread nature of the problem. The data are subject to method variance, particularly in
situations when the participant responds to items contained inside a single questionnaire
at a single point in time. Method variance and approaches to account for it have been
of interest to researchers from a wide range of fields such as psychology studies and
information systems research [156,157]. This is due to the fact that a self-administered
survey is the most prevalent type of data collecting in behavioral research.
According to the findings of the analysis, the first component is responsible for
33.56% of the variance, which is lower than the threshold of 50% that is generally ac-
Big Data Cogn. Comput. 2024, 8, 180 19 of 38

cepted. The fact that this is the case suggests that CMV is not going to be a major worry for
this trial. In addition, the second component accounts for 9.366% of the variance, which
brings the total amount of variance that can be attributed to the first two factors to 42.931%.
The fact that there is no one factor that predominates the variance lends credence to the no-
tion that the CMV does not have a substantial impact on the data, which in turn strengthens
the validity of the measurements that were utilized in this study. In other words, a single
factor was responsible for explaining 33.56% of the overall variance, which indicates that
the CMV is not a serious problem [158,159]. Table 2 illustrates the results of the Harman
test, showing the proportion of variance explained by the main factor and the other factors.

Table 2. Harman single-factor test.

Total Variance Explained

Initial Eigenvalues Extraction Sums of Squared Loadings
Component % %
Total Cumulative % Total Cumulative %
of Variance of Variance
1 13.762 33.565 33.565 13.762 33.565 33.565
2 3.840 9.366 42.931

4. Results
4.1. Results of Outer Model Evaluation
This subsection presents the findings that were obtained from evaluating the outer
model through analyzing the convergent and discriminant validity characteristics. The
components of the model that had a cross-loading value that was not particularly strong
were eliminated.
Considering the purpose of determining the constructs’ reliability, composite reliability
(CR), and average variance extracted (AVE), the current study conducted an analysis of
the measurement model approach. Cronbach’s alpha (CA) and composite reliability (CR)
were the methods that we utilized in order to evaluate the reliability. The results for CA
and CR are presented in Table 3 for IQ (0.850, 0.857), patients’ satisfaction (0.862, 0.862),
PEOU (0.854, 0.857), PSec (0.802, 0.976), PP (0.875, 0.879), service quality (0.796, 0.816), trust
(0.809, 0.847), and website anxiety (0.845, 0.862), respectively. The values of CA and CR
should be greater than 0.70, as stated by [148]. The results of this study showed that all of
the values were within the acceptable range, which indicates that there is a high degree
of strong internal consistency and reliability. The convergent validity of the constructs is
further supported by the fact that all of the AVE values, which ranged from 0.625 to 0.784,
were higher than the required threshold of 0.50, as suggested by [151].
Additionally, the collinearity of the items was evaluated in this study by utilizing
the variance inflation factor (VIF), which is shown in Table 4. In order to figure out the
degree to which a model contains multicollinearity, the values of the VIF are extremely
important. According to [148,160], the VIF values should ideally be below 5 in order to
avoid substantial multicollinearity difficulties. Values that are above 10 indicate that there
is severe collinearity. According to this analysis, the VIF analysis reveals that the items
in this measurement model do not suffer from multicollinearity, ensuring the reliability
of the regression coefficients and boosting the validity of the findings from the structural
equation modeling (SEM). As a result, the model can be interpreted without any concerns
regarding the inflation of standard errors that are caused by collinearity.
Big Data Cogn. Comput. 2024, 8, 180 20 of 38

Table 3. Construct reliability and validity.

Average
Cronbach’s Composite Reliability Composite Reliability
Variance
Alpha (rho_a) (rho_c)
Extracted (AVE)
Information Quality (IQ) 0.850 0.857 0.892 0.625
Patient Satisfaction (PS) 0.862 0.862 0.916 0.784
Perceived Ease of Use (PEOU) 0.854 0.857 0.896 0.632
Perceived Security (PSec) 0.802 0.976 0.878 0.707
Privacy Protection (PP) 0.875 0.879 0.915 0.728
Service Quality (SQ) 0.796 0.816 0.879 0.708
Trust in Govt. Website (TRUST) 0.809 0.847 0.869 0.625
Website Anxiety (WA) 0.845 0.862 0.895 0.681
Note: average variance extracted (AVE); Cronbach’s alpha (CA); composite reliability (CR).

Table 4. Collinearity statistics.

Items VIF Items VIF Items VIF Items VIF

ANX1 1.576 PEOU1 1.786 PS1 2.476 TRUST1 1.937
ANX2 1.875 PEOU2 1.827 PS2 2.230 TRUST2 1.672
ANX3 2.010 PEOU3 2.108 PS3 2.018 TRUST3 1.401
ANX4 2.670 PEOU4 2.565 PP5 2.353 TRUST4 1.919
IQ1 1.589 PEOU5 1.670 PSec1 1.985 SQ2 1.729
IQ2 2.041 PP2 2.239 PSec2 1.728 SQ3 1.688
IQ3 2.025 PP3 2.037 PSec3 1.615 SQ4 1.665
IQ4 1.649 PP4 2.806
IQ5 1.899 PP5 2.353
Note: information quality (IQ); patient satisfaction (PS); perceived ease of use (PEOU); perceived security (PSec);
privacy protection (PP); service quality (SQ); website anxiety (ANX); variance inflation factor (VIF).

The second step in the outer model’s examination involves assessing discriminant
validity. To achieve this, we employed the Fornell–Larcker criterion and the heterotrait–
monotrait ratio of correlations (HTMT). The findings, summarized in Tables 5 and 6,
indicate that the square roots of the AVEs for each latent construct surpass their highest
correlation with any other latent variable. For instance, the AVE square root for IQ (0.790)
was higher than its correlations with other constructs, such as 0.551 with PS and 0.265 with
PSec, satisfying the Fornell–Larcker criterion. In addition, the HTMT analysis shows that
the highest HTMT value (0.896 between PS and PP) remained below the recommended
threshold of 0.90 [161], further confirming discriminant validity. Most HTMT values
were well below 0.85, reinforcing the model’s robustness. These results confirm that the
constructs are distinct and demonstrate adequate discriminant validity, ensuring that the
model effectively captures the unique aspects of each construct.

Table 5. HTMT (heterotrait–monotrait ratio).

IQ PS PEOU PSec PP SQ TRUST WA

IQ 1
PS 0.633 1
PEOU 0.839 0.804 1
PSec 0.326 0.539 0.492 1
pp 0.595 0.896 0.798 0.571 1
SQ 0.419 0.511 0.399 0.628 0.499 1
TRUST 0.155 0.201 0.173 0.217 0.266 0.307 1
WA 0.277 0.445 0.378 0.539 0.578 0.747 0.311 1
Note: information quality (IQ); patient satisfaction (PS); perceived ease of use (PEOU); perceived security (PSec);
privacy protection (PP); service quality (SQ); Trust (TRUST); website anxiety (WA).
Big Data Cogn. Comput. 2024, 8, x FOR PEER REVIEW 21 of 38
Big Data Cogn. Comput. 2024, 8, 180 21 of 38

TRUST 0.155 0.201 0.173 0.217 0.266 0.307 1

WA Table
0.277 6. Fornell–Larker
0.445 criteria.
0.378 0.539 0.578 0.747 0.311 1
Note: information quality (IQ); patient satisfaction (PS); perceived ease of use (PEOU); perceived
IQ PS PEOU PSec PP SQ TRUST WA
security (PSec); privacy protection (PP); service quality (SQ); Trust (TRUST); website anxiety (WA).
IQ 0.790
PS 0.551 0.885 6. Fornell–Larker criteria.
Table
PEOU 0.722 0.700 0.795
PSec 0.265 IQ 0.433 PS 0.406PEOU 0.841PSec PP SQ TRUST WA
pp
IQ 0.524 0.790 0.791 0.702 0.476 0.853
SQ 0.349 0.428 0.344 0.508 0.418 0.842
PS
TRUST 0.116
0.551 0.189 0.885 0.145 0.168 0.244 0.249 0.791
PEOU
WA 0.247 0.722 0.387 0.700 0.3320.795 0.470 0.508 0.619 0.241 0.825
PSec 0.265 Note: information
0.433 0.406
quality (IQ); patient 0.841
satisfaction (PS); perceived ease of use (PEOU); perceived security (PSec);
pp 0.524 privacy 0.791
protection 0.702 quality0.476
(PP); service 0.853 website anxiety (WA).
(SQ); Trust (TRUST);
SQ 0.349 0.428 0.344 0.508 0.418 0.842
TRUST 0.116 Table
0.189A2 (Appendix
0.145 B) presents 0.168 the cross-loadings
0.244 of items and constructs,
0.249 0.791 illustrating
WA 0.247 the extent
0.387to which each
0.332 item is associated
0.470 with
0.508 its assigned
0.619 construct as
0.241 well as with
0.825other
constructs. This approach verifies discriminant validity by assessing the distinctiveness
Note: information quality (IQ); patient satisfaction (PS); perceived ease of use (PEOU); perceived of
each construct inside the measurement model.
security (PSec); privacy protection (PP); service quality (SQ); Trust (TRUST); website anxiety (WA).
Results of outer model’s discriminant validity assessment.
Figure
Figure 77 presents
presents aa summary
summary of of the
the results
results from
from the
the assessment
assessment of of the
the measurement
measurement
model,
model, focusing
focusing onon reliability,
reliability, convergent
convergent validity,
validity,and
anddiscriminant
discriminantvalidity
validityverification.
verification.

Figure 7. Outer model assessment results.

Figure 7. Outer model assessment results.

4.2. Results of Inner Model Evaluation

The inner model evaluation consisted of checking the relevancy of various metrics
(R22,, Q
Q22,, ff22, ,and
andthe
themodel
modelfitness)
fitness)based
basedononexpert-specified
expert-specifiedthresholds.
thresholds.
AsAs illustrated
illustrated in
in Table
Table 7, the7, the R-square
R-square scores
scores forthree
for the the three endogenous
endogenous latent constructs,
latent constructs, namelynamely
PS, PEOU,PS,
PEOU,
and TRUST, and TRUST,are 68%,are
55%,68%,
and55%, and 7%, respectively,
7%, respectively, reflecting areflecting a varying
varying degree degree of
of determina-
determination for these constructs. Patient satisfaction (R 2 = 0.680) showed a strong result,
tion for these constructs. Patient satisfaction (R = 0.680) showed a strong result, with the
2

with the model explaining 68% of the variance, which is very good. 2 = 0.546)
model explaining 68% of the variance, which is very good. PEOU (R2 PEOU
= 0.546)(Rreflected a
reflected
moderateabut moderate butresult,
acceptable acceptable result,ofwith
with 54.6% 54.6% ofexplained.
the variance the variance explained.
Trust Trust
in government
in government website (R2 = 0.065) had a very low result, explaining only 6.5% of the
variance, which is weak and likely requires improvement [162].
Big Data Cogn. Comput. 2024, 8, 180 22 of 38

Table 7. R-square and adjusted R-square.

R-Square R-Square Adjusted

Patient Satisfaction (PS) 0.680 0.675
Perceived Ease of Use (PEOU) 0.546 0.542
TRUST 0.065 0.056

It is crucial to examine the noted low R2 value for the construct trust, which was
7% in our model. R2 values between 0.10 and 0.25 are regarded as low, however they
are not inherently devoid of significance. In behavioral research, R2 values as low as
0.07 are occasionally deemed acceptable, particularly when the model investigates intricate
constructs such as trust, contentment, or attitudes. This is especially pertinent to our study,
as trust is affected by various external factors that are challenging to fully include in a
model. Consequently, even minimal R2 values can yield significant insights into these
intricate dynamics.
Moreover, refs. [153,163] highlight the difficulty of defining a general standard for
acceptable R2 values, as these are contingent upon the model’s complexity and the particular
research domain. For example, R2 values about 0.20 are typically deemed acceptable in
fields such as consumer behavior, although research on success variables, including user
happiness, may anticipate R2 values of 0.75, 0.50, or 0.25, classified as substantial, moderate,
or low, respectively. This framework corresponds to an R2 score of 7% for “Trust” in
our research. Although this value is minimal, it aligns with anticipated outcomes for
intricate constructions within the e-health sector, where multiple external factors, such as
institutional backing and source reliability, may affect user trust.
The lowered R2 value for trust indicates that extraneous factors absent from our
model may significantly influence trust perceptions. Subsequent research may investigate
variables such as source credibility, institutional support, or other external factors to provide
a more thorough comprehension of trust dynamics within digital healthcare systems.
This would enhance the model’s precision and provide a more precise depiction of the
interactions among constructs.
The Q2 predictive values of the constructs were 0.436, 0.540, 0.445, 0.414, 0.536, 0.407,
0.376, and 0.464, respectively, indicating an acceptable predictive power of the research
model (Table 8). Likewise, Table 9 displays model fit indices, such as the Standardized
Root Mean Square Residual (SRMR) and the Normed Fit Index (NFI), which assess the
model’s adequacy. The SRMR for the saturated model was 0.071, which is below the
widely recognized threshold of 0.08, signifying a favorable match. The estimated model
had an SRMR of 0.086, which, although marginally beyond 0.08, remained below 0.10,
indicating a borderline yet acceptable match. The NFI values for both the saturated (0.946)
and estimated (0.939) models were close to the threshold of 0.95, indicating an acceptable to
near-excellent fit. Overall, these indices indicate that both models had an acceptable level
of fit, with the saturated model marginally outperforming the other in terms of SRMR and
NFI [151,164].

Table 8. Q2 predictive relevance.

Constructs Q²
Information Quality (IQ) 0.436
Patient Satisfaction (PS) 0.540
Perceived Ease of Use (PEOU) 0.445
Perceived Security (PSec) 0.414
Privacy Protection (PP) 0.536
Service Quality (SQ) 0.407
TRUST in Govt. Website (TRUST) 0.376
Website Anxiety (WA) 0.464
Big Data Cogn. Comput. 2024, 8, 180 23 of 38

Table 9. Model fitness.

Saturated Model Estimated Model

SRMR 0.071 0.086
NFI 0.946 0.939
Note: Standardized Root Mean Square (SRMR); Normed Fit Index (NFI).

Based on Table 10, the PLS analysis revealed that most hypotheses were validated,
with some exceptions. Specifically, the association between PEOU and TRUST (β = −0.062,
t = 0.863, p = 0.388, ƒ2 = 0.002) and the association between PSec and TRUST (β = 0.074,
t = 1.235, p = 0.217, ƒ2 = 0.004) were not significant. Similarly, the relationship between
SQ and PEOU (β = 0.008, t = 0.121, p = 0.904, ƒ2 = 0.000) and TRUST and PS (β = −0.008,
t = 0.263, p = 0.793, ƒ2 = 0.000) were also found to be non-significant.

Table 10. Hypotheses testing results.

Standard
Sample Mean
Hypotheses β-Value Deviation T Statistics p-Value f2
(M)
(STDEV)
H1 IQ -> PEOU 0.679 0.679 0.042 16.187 0.000 0.891
H2 PEOU -> PS 0.266 0.267 0.042 6.283 0.000 0.110
H3 PEOU -> TRUST −0.062 −0.062 0.072 0.863 0.388 0.002
H4 PSec -> TRUST 0.074 0.091 0.060 1.235 0.217 0.004
H5 PP -> PS 0.591 0.591 0.044 13.357 0.000 0.453
H6 PP -> TRUST 0.252 0.252 0.077 3.260 0.001 0.032
H7 SQ -> PS 0.148 0.145 0.049 3.040 0.002 0.040
H8 SQ -> PEOU 0.008 0.013 0.069 0.121 0.904 0.000
H9 TRUST -> PS −0.008 −0.007 0.030 0.263 0.793 0.000
H10 WA -> PS −0.091 −0.089 0.053 1.725 0.085 0.014
H11 WA -> PEOU 0.158 0.157 0.064 2.462 0.014 0.034
Note: information quality (IQ); patient satisfaction (PS); perceived ease of use (PEOU); perceived security (PSec);
privacy protection (PP); service quality (SQ); Trust (TRUST); website anxiety (WA).

Conversely, the results of the current study support several significant relationships.
For instance, IQ demonstrated a strong and positive effect on PEOU (β = 0.679, t = 16.187,
p = 0.000, ƒ2 = 0.891), as well as PEOU having a positive and significant influence on PS
(β = 0.266, t = 6.283, p = 0.000, ƒ2 = 0.110). Additionally, PP showed a significant impact on
both PS (β = 0.591, t = 13.357, p = 0.000, ƒ2 = 0.453) and TRUST (β = 0.252, t = 3.260, p = 0.001,
ƒ2 = 0.032). Moreover, the SQ to PS path was also significant (β = 0.148, t = 3.040, p = 0.002,
ƒ2 = 0.040), confirming a positive and moderate effect. Finally, the effect of WA on PEOU
(β = 0.158, t = 2.462, p = 0.014, ƒ2 = 0.034) was supported, while its relationship with PS
(β = −0.091, t = 1.725, p = 0.085, ƒ2 = 0.014) was marginally insignificant, yet approaching
significance (Figure 8).
Big Data Cogn. Comput. 2024, 8, 180
x FOR PEER REVIEW 2424of
of 38
38

Figure
Figure 8.
8. Structural
Structural model
model evaluation.
evaluation.

5. Discussion and Conclusions

Measuring PS with information systems helps to identify dysfunctions in the social
sector, including
sector, including the thehealthcare
healthcarefield. field.This
Thisstudy
studyproposed
proposeda amodel
modeltotoanalyze
analyze and andevaluate
evalu-
the factors
ate influencing
the factors patients’
influencing overall
patients’ satisfaction
overall with the
satisfaction Mawiidi
with application
the Mawiidi developed
application de-
by the MHSP
veloped by theof the Kingdom
MHSP of the Kingdomof Morocco, which which
of Morocco, is usedisfor
usedmanaging
for managing appointments
appoint-
in public
ments hospitals
in public and for
hospitals and tracking and tracing
for tracking and tracingappointments.
appointments.OurOur model modelfocuses
focuseson
testing the relationships between concepts based on the model
on testing the relationships between concepts based on the model design and 11 hypoth- design and 11 hypotheses
formulated
eses formulatedto study these
to study relationships.
these relationships. AA model
modelfor formeasuring
measuringuser usersatisfaction
satisfaction with
the application
the application is is proposed
proposed in in this
this study.
study. The
The discussion
discussion of of the
the relationships
relationships between
between the the
concepts of
concepts of the
the proposed
proposed modelmodel is is based
based onon the
the hypotheses
hypotheses formulated
formulated in in this
this study.
study. The
The
discussion of
discussion ofthe
thehypotheses
hypothesesis is based
basedononthethe
relationships between
relationships the eight
between key constructs
the eight key con-
of the model.
structs of the model.
The support
The support of of only
only sixsix outout ofof eleven
eleven hypotheses
hypotheses indicates
indicates that
that certain
certain theoretical
theoretical
relationships require further investigation. This observation may indicate
relationships require further investigation. This observation may indicate context-specific context-specific
characteristics associated
characteristics associated withwith our our sample
sample or or the
the distinctive dynamics of
distinctive dynamics of the
the Moroccan
Moroccan
healthcare system. In the discussion, we examined these findings
healthcare system. In the discussion, we examined these findings to identify alternative to identify alternative
explanations and
explanations andpropose
proposethat thatadditional
additional variables,
variables, suchsuch as digital
as digital literacy
literacy and social
and social sup-
support, should be integrated into future studies to more accurately
port, should be integrated into future studies to more accurately capture the dynamics of capture the dynamics of
satisfaction and intention to use. This is particularly relevant for assessing
satisfaction and intention to use. This is particularly relevant for assessing how individu- how individuals
perceive, utilize, and engage with digital technologies, as well as the influence of social
als perceive, utilize, and engage with digital technologies, as well as the influence of social
support in facilitating the use of these services, especially in contexts where social support
support in facilitating the use of these services, especially in contexts where social support
is essential for overcoming technological obstacles.
is essential for overcoming technological obstacles.
IQ has a positive and significant effect on the PEOU of online service such as Mawiidi
IQ has a positive and significant effect on the PEOU of online service such as Mawiidi
application. This means that the more accurate, reliable, and relevant the information
application. This means that the more accurate, reliable, and relevant the information is
is judged to be, the easier users perceive the system to be to use. This result highlights
judged to be, the easier users perceive the system to be to use. This result highlights the
the importance of high-quality information in digital systems, which is consistent with
importance of high-quality information in digital systems, which is consistent with classic
classic models such as TAM, which emphasizes PEOU as a key determinant of technology
models such as TAM, which emphasizes PEOU as a key determinant of technology ac-
acceptance. These results are supported by earlier empirical studies such as [165], who
ceptance. These results are supported by earlier empirical studies such as [165], who dis-
discovered that the quality of information (IQ) positively influences users’ perceptions
covered that the quality of information (IQ) positively influences users’ perceptions of
of easiness. Additionally, [166] revealed that if users are satisfied with the quality of in-
easiness.
formationAdditionally,
produced by[166] revealed that
the information if users
system, are satisfied
then, based onwith
PEOU, thethey
quality
are of infor-
likely to
mation producedand
feel comfortable by the information
secure system,the
while utilizing then, basedhence
system, on PEOU, they are
enhancing likely
their to feel
ability to
comfortable and secure while utilizing the system, hence enhancing their ability to do
Big Data Cogn. Comput. 2024, 8, 180 25 of 38

do tasks effectively. These findings corroborate the results of our study. Furthermore, in
practical terms, to improve the adoption of online services, it is essential that government
portals provide clear and detailed information. In addition, the quality of information is
an important factor to be taken into account if organizational functions are to be carried
out effectively. The effectiveness of organizational decisions and actions is determined
by IQ [167]. On the other hand, because of the strategic role of information in achieving
organizational goals and also in decision-making, poor IQ can have far-reaching conse-
quences [168]. The quality of information is a crucial determinant of user satisfaction
with systems, especially e-health. The model of information systems success proposed
by [67] asserts that IQ directly influences a system’s PEOU and utility. The significant
impact that IQ has on our model implies that providing patients with information that is
trustworthy, pertinent, and easy to understand improves the system’s accessibility, which
in turn leads to an improvement in the patients’ perception of how easy something is to
use. The findings of our research are consistent with the findings of previous studies, such
as the one conducted by [169], which highlight the value of high-quality information in
information systems for the purpose of increasing satisfaction and acceptability.
The study found that PEOU has a positive influence on PS. The ergonomics of an
e-health portal significantly affect PS. An accessible solution that mitigates inconvenience
and aggravation during appointment scheduling can substantially improve the entire
user experience. Our results confirmed previous studies, which demonstrated that PEOU
positively affected PS [82,83]. According to [170], the results indicate a positive correlation
between PEOU, PU, and satisfaction among mobile users. The correlation between PEOU
and PS within e-health services is essential for comprehending the dynamics of technology
adoption. In our model, PEOU directly affects PS, indicating a robust positive and statis-
tically significant correlation. This indicates that when patients find the e-health system
more accessible, their overall satisfaction increases.
The literature, particularly the TAM, strongly reinforces this relationship, highlighting
PEOU as a crucial determinant of technology acceptance. The research of [66,137] demon-
strated that users are more inclined to embrace and express satisfaction with technology
perceived as intuitive and straightforward. Ref. [171] identified perceived complexity as
a barrier to the adoption of online banking services in their study on customer resistance.
When users regard a technology as intricate, it results in resistance to its use. This dynamic
is evident in our model: an intuitive interface and seamless navigation diminish patients’
cognitive load, hence alleviating WA and enhancing their pleasure.
It is possible that users’ faith in the online platform could be further increased if it is
seen to be easy to use. A website that is perceived to be simple to use enhances the whole
experience, reduces the incidence of frustration, and cultivates trust in the government
website, all of which contribute to a positive impact on satisfaction. The findings are
consistent with the studies like [171], indicating that diminishing perceived complexity
enhances consumer confidence in online services, including banking and healthcare. The
data indicate that PEOU is crucial in enhancing PS. To optimize satisfaction, it is crucial
to guarantee that the e-health portal is ergonomic and user-friendly, as this diminishes
psychological barriers, enhances user confidence, and promotes service uptake, as noted
by [171] in the realm of online banking.
Users’ perception of a website or portal security is often an important factor in deciding
the level of trust they place in websites, particularly in the field of online public services.
Research led by [172] indicates that the feeling of security is the most essential aspect in
generating trust. This is particularly true in digital environments, where customers attach
great importance to protecting their personal information and privacy when browsing the
internet. Furthermore, our results are not corroborated by an earlier study by [93], which
indicates that perceptions of internet structural features, such as security, can influence
trust beliefs and intentions toward an institutional environment offering online services.
Although the effect is relatively weak in our model, perhaps due to social idiosyncrasies
and cultural differences specific to the Moroccan context, it shows that patients do not
Big Data Cogn. Comput. 2024, 8, 180 26 of 38

attach a certain importance to security when interacting with online healthcare systems,
even though other factors such as service quality or ease of use may be more decisive.
This may be justified by the fact that safety may not be a major concern for them in this
context, especially if they feel that using the online service provides them with important
health benefits, such as rapid access to care or ease of booking appointments. Therefore,
while PSec. is important in other contexts, in that of online health services, users might
trust the platform more if it effectively meets their immediate medical needs, regardless of
safety concerns.
This study focuses on the Mawiidi application in the context of public health in
the Kingdom of Morocco, which may restrict the direct applicability of the results to
other health systems or cultural environments. The discussion section elucidates these
results, highlighting their significance and importance in the Moroccan context and for
patients using public online appointment booking systems. To validate and generalize
these findings, comparative research in different cultural contexts and healthcare systems is
imperative. In addition, the inclusion of elements such as digital accessibility and technical
disparities, which are highly context-dependent, would enable a deeper understanding of
the aspects affecting patient satisfaction with digital healthcare systems.
According to the findings of our research, making sure that users’ privacy is protected
greatly increases the level of trust that they have in online businesses. According to
the findings of research conducted by [173], concerns over privacy provide a substantial
obstacle for enterprises that engage in e-commerce. It is believed that if these difficulties
are resolved, great progress may be made in the industry. In healthcare, effective PP can
also alleviate patient concerns and improve overall PS, confirming the results of our study
indicating the positive effect of PP on PS. The findings of [174] indicate that users see privacy
as crucial to building trust and are therefore more willing to share personal information
online. Furthermore, when patients feel secure about the confidentiality of their data, their
satisfaction with the service increases, which corresponds perfectly with the results we
obtained. Users may not be willing to share their data if adequate protection measures
are not put in place. This will complicate transactions and hinder the expansion of online
activities. According to [175], protection perceived as adequate reduces users’ concerns
about the security of their personal data, making information sharing more acceptable.
Furthermore, the findings of [125] are confirmed by our results, demonstrating that trust
is a key predictor of information sharing, and that robust PP practices foster this trust. In
this regard, it is imperative for healthcare service providers and government sites to put
in place rigorous PP measures. This not only increases PS and user confidence, but also
contributes to the success of online services in general. Thus, policymakers and regulators
must continue to support and promote high standards of data protection to maintain a
secure and trustworthy online environment.
Furthermore, the results of our study indicate that trust in the government website
has no direct significant effect on PS. This result seems to contrast with the findings
established in the literature, which often emphasizes the importance of trust in online
services. Specifically, ref. [176] explained that the level of pleasure experienced by users can
be influenced by a number of factors, with trust having the ability to exert a more significant
influence on long-term commitment and loyalty than it does on immediate gratification.
Within the sphere of online services, trust may influence users’ decisions regarding whether
or not to continue using the service or to recommend it, despite the fact that it does not
intrinsically influence the customers’ level of contentment while they are using the service.
Furthermore, the outcomes of our research indicate that factors such as usability and SQ
have a more direct influence on the level of satisfaction experienced by each individual
patient. Ref. [176] made the observation that, despite the fact that trust is an important factor,
real and immediately observable characteristics of the service frequently function as more
immediate drivers of client enjoyment. Consequently, our research findings suggest that,
within the field of e-health services, the practical and functional features of the service are
more significant determinants of PS than trust alone. Furthermore, these findings highlight
Big Data Cogn. Comput. 2024, 8, 180 27 of 38

the importance of conducting additional study into the role of trust in longitudinal research
in order to have a better understanding of the long-term ramifications that trust has on user
loyalty and engagement.
The current result of our study shows that SQ has a positive and significant effect
on PS. This result is consistent with the work of [177], who developed the SERVQUAL
model, emphasizing that SQ is a key predictor of user satisfaction. In the healthcare
sector, SQ is paramount and encompasses features such as reaction time, proficiency, and
problem-solving capabilities for patients. Ref. [178] contended that in online settings,
where physical interaction is constrained, individuals anticipate an elevated standard of
service. It is possible that the provision of high-quality online services that are differentiated
by lightning-fast reaction times and clear, effective communication has the potential to
dramatically increase the levels of PS in our setting. Previous research has shown that high
levels of SQ are closely associated with better levels of PS. The findings of our investigation
reflect the findings of those earlier studies. This highlights the need to maintain great service
standards, particularly in a climate that places a premium on digital communication.
The quantitative approach employed in this study enabled a strong quantification
of the factors influencing patient satisfaction with the Mawiidi application. Nonetheless,
we acknowledge that this approach fails to thoroughly encompass all patient perspectives
and experiences. A complementary qualitative methodology (such as interviews or focus
groups) could be incorporated into forthcoming research to investigate more subjective and
intricate dimensions of user satisfaction, hence enhancing comprehension of the emotional
and contextual factors that affect their experience.
With regard to the PEOU, the findings of our research indicate that the quality of
the service does not have a major impact. This contrasting result implies that, contrary
to expectations, an improvement in SQ does not necessarily transfer into a larger PEOU.
This is the conclusion that emerged from the analysis. According to [177], this may suggest
that the PEOU is more dependent on the particular qualities of the user interface and
the functions of the service than it is on the overall quality of the service. Therefore, it is
essential to concentrate on improving the interface as well as particular functionalities in
order to increase the user’s perception of how easy it is to use.
Lastly, the results of the study reveal that WA has a positive and significant effect
on PEOU, which is somewhat unexpected in view of the literature [179] as it contradicts
the initial hypothesis, which predicted a negative impact of anxiety on PEOU. The main
idea is that worry makes things seem less easy to use. Despite this, there are a number of
psychological and motivational frameworks that help explain these findings. According to
the self-determination theory, individuals who are highly motivated to take control of their
health may have an initial apprehension about technologies but will overcome apparent
obstacles because they are committed to improving their health outcomes [180]. The health
motivation concept asserts that when patients perceive an online tool as essential for
improving their well-being, their motivation to achieve positive health outcomes may lead
to a heightened perception of usability, notwithstanding apprehension [181]. Moreover,
those who have self-efficacy, according to [182], will persevere in the face of worry if
they think they can utilize a tool successfully, which will enhance their PEOU. Therefore,
although anxiety may be expected to impede comfort of use, patients’ motivation and
emphasis on the significance of health management can lessen these challenges, improving
PEOU. Moreover, anxiety regarding the utilization of an online tool frequently results in
heightened tension and unease for patients, hence diminishing their overall satisfaction
with the service. Ref. [179] asserted that technology-related anxiety might adversely
affect users’ attitudes and experiences, resulting in diminished satisfaction. Furthermore,
ref. [183] asserted that heightened anxiety levels may overwhelm users, impairing their
capacity to assimilate information effectively, hence reducing their satisfaction with the
tool. This corresponds with the observations of [184], who noted that increased anxiety can
hinder patients’ ability to properly employ health management tools, hence affecting their
overall satisfaction with the service. This aligns perfectly with our empirical findings.
Big Data Cogn. Comput. 2024, 8, 180 28 of 38

5.1. Study Implications

This study explored what makes patients in Moroccan public hospitals satisfied with
the Mawiidi online booking system. It looked at how well the system works and what
factors contribute to PS. The goal was to understand how people in developing countries
such as Morocco are using healthcare technology. One of the big findings is that PS
is closely tied to how easy the system is to use. The study combined two well-known
models that help explain how people accept new technology: the TAM and the ISSM.
Together, these models showed that when patients find the online booking system easy
to navigate, they are more likely to be satisfied with it. Another important factor was the
quality of information. If the information on the portal was clear and reliable, it made the
system easier to use, which in turn made patients satisfied with their experience. Privacy
emerged as a significant concern. Patients expressed more satisfaction with the system
when they were assured that their personal information was managed securely. It seems
logical because individuals seek assurance that their personal data are safeguarded prior
to placing trust in an online system. Something interesting that came up in the study was
the role of anxiety. One could assume that anxiety around internet usage would diminish
patients’ comfort and satisfaction. However, surprisingly, the study found that patients’
focus on managing their health helped them push through any initial stress. Therefore,
despite their anxiety, they found the system easier to use than expected.
We formulated particular suggestions for system designers and policymakers to en-
hance the user experience with applications such as Mawiidi. For instance, to alleviate
website-related anxiety, it would be advantageous to incorporate streamlined interfaces
and comforting visual elements. Furthermore, to enhance privacy protection, the imple-
mentation of more visible security policies and customizable privacy controls is advisable.
These targeted adjustments aim to enhance user adoption and satisfaction while addressing
the specific needs of patients in digital contexts.
This study presents distinct insights for policymakers, hospital administrators, and
the developers of online solutions. Primarily, it is essential to prioritize the quality of infor-
mation and the protection of privacy. Patients require precise, comprehensible information
and assurance regarding the security of their data. This is essential for building trust and
keeping patients satisfied. Making the system accessible is also crucial. Since ease of use has
such a big impact on satisfaction, hospitals should invest in creating systems that are simple
to navigate. Offering clear instructions, guides, or live help could reduce any confusion or
anxiety patients might feel. This would help them have a smoother experience and feel
more satisfied overall. Even though WA did not have a huge effect on overall satisfaction,
it did help patients find the system easier to use. Future research could explore ways
to further reduce this anxiety, potentially through enhanced design or improved patient
communication. Color can evoke emotions or behaviors. Research led by [185] examined
the impact of color on visitors from different cultures in website design, and consequently,
the influence of color on website user trust, satisfaction, and e-fidelity. The results revealed
that the appeal of a website’s colors is a key determinant of trust and satisfaction with the
website, with differences across cultures.
In conclusion, this study provides valuable insights into how to improve online ap-
pointment systems in Moroccan public hospitals. It also enhances our understanding of
the adoption of healthcare technology in developing countries. Moving forward, future re-
search could build on these findings by obtaining more feedback from patients or exploring
additional factors that affect their satisfaction.

5.2. Limitations
This study offers important perspectives into public services through the Mawiidi
portal and evaluates the efficacy of online appointment scheduling systems in Moroccan
public hospitals; nonetheless, certain limitations must be acknowledged. Initially, we
employed a non-probabilistic method for data collection, which limits the generalizability
of our findings to various contexts or groups. This strategy, however pragmatic, does not
Big Data Cogn. Comput. 2024, 8, 180 29 of 38

guarantee that the results are representative of all users of the online booking system. To
minimize this limitation, we ensured that the sample was diverse in terms of demographic
characteristics, such as age, gender, and education levels. However, we suggest that
future research use probabilistic methods to strengthen the representativeness of the results
and reduce sampling biases, which would provide a more complete picture of patient
satisfaction with Mawiidi.
We also recognize that the sample demographics show a concentration in particular
age and educational levels, which could further restrict how broadly the results can be
applied. The context and limitations of the data gathering process, especially in Morocco,
where the hybrid data collection approach was used to address issues like the digital divide,
led to this concentration. Although these issues were somewhat allayed by this method,
the study’s robustness and representativeness would be improved with a more varied and
balanced sample.
We intend to use a more comprehensive sample approach in subsequent studies to
guarantee more diversity in terms of age, education, and other pertinent demographic
characteristics. To obtain a more representative sample that reflects the larger population, this
may entail focusing on under-represented groups or applying stratified sampling procedures.
The study exclusively employs a quantitative research methodology, utilizing self-
administered questionnaires for data collection. This method facilitates rigorous statistical
analysis with PLS-SEM, although it may inadequately encompass the qualitative dimen-
sions of patients’ feelings and perceptions. Subsequent research may be gained from the
integration of qualitative methodologies, such as in-depth interviews or focus groups, to
yield a more thorough comprehension of PS and the particular difficulties faced with online
booking systems. The study primarily examines a limited range of characteristics within
the parameters of Davis’ TAM and DeLone and McLean’s ISSM. It analyzes critical ele-
ments such as IQ and PEOU, and WA; nevertheless, it neglects other potentially significant
variables such as digital competence, prior experience with online systems, and special
features of the Mawiidi portal. Incorporating these further components into the model may
provide enhanced understanding of the determinants of PS.
Furthermore, the study’s results indicate that although WA substantially influenced
PEOU, its effect on PS was negligible. This result suggests that WA may not be a principal
factor influencing PS in this context, highlighting the need to explore other variables that
could affect contentment more significantly. The study’s context is confined to Moroccan
public hospitals, which may possess distinct cultural and socio-economic attributes affecting
the outcomes. The generalizability of the results to other regions or healthcare systems
may consequently be constrained. Subsequent research may investigate analogous models
across diverse cultural and economic settings to ascertain the generalizability of the findings.
This study offers significant insights into e-health; nevertheless, resolving its shortcomings
through a mixed-methods approach and more expansive research designs could enhance
comprehension of PS with online appointment booking systems across various contexts.

Author Contributions: Conceptualization, A.O.; methodology, A.O. and K.C.; software, A.O. and
M.J.; validation, A.O., S.A. and K.C.; formal analysis, A.O., M.J. and K.C.; investigation, A.O. and S.A.;
resources, A.O., S.A. and K.C.; data curation, A.O., M.J. and S.A.; writing—original draft preparation,
A.O., S.A. and K.C.; writing—review and editing, A.O., S.A., K.C. and M.J.; visualization, A.O., M.J.
and K.C.; supervision, A.O. and K.C.; project administration, A.O. and K.C. All authors have read
and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: All the study participants provided informed consent.
Data Availability Statement: The data can be shared upon request from the corresponding author.
Conflicts of Interest: The authors declare no conflicts of interest.
Big Data Cogn. Comput. 2024, 8, 180 30 of 38

Appendix A

Table A1. Measurement instruments. * Excluded from the analysis owing to their low cross-loading values.

Constructs Measurement Items Sources

IQ1: The information provided by Mawiidi is useful.
IQ2: The information provided by Mawiidi is understandable.
Information IQ3: The information provided by Mawiidi is interesting.
[71]
Quality IQ4: The information provided by Mawiidi is reliable.
IQ5: The information provided by Mawiidi is complete.
IQ6 *: The information provided by Mawiidi is up-to-date.
PEOU1: Mawiidi is easy to use.
PEOU2: It is easy to become skillful at using Mawiidi.
Perceived PEOU3: Learning to operate the Website Mawiidi is easy.
[66,76,186]
Ease of Use PEOU4: Mawiidi is flexible to interact with.
PEOU5: My interaction with Mawiidi is clear and understandable.
PEOU6 *: It is easy to interact with Mawiidi.
PSec1: Mawiidi ensures me of security.
Perceived PSec2: I feel safe when I send personal information to Mawiidi.
[88,139,140]
Security PSec3: I think Mawiidi only collects user personal data that are necessary
for its activity.
PP1 *: Mawiidi will not use my personal information for any purpose
unless I authorize it to do so.
PP2: Mawiidi devotes time and effort to preventing unauthorized access
to my personal information.
Privacy
PP3: Databases that contain my personal information are protected from [90,139]
Protection
unauthorized access.
PP4: Mawiidi will really remove my personal information when I request
it to do so.
PP5: I think that Mawiidi abides by personal data protection laws.
SQ1 *: Mawiidi gives prompt service to citizens.
SQ2: Mawiidi is responsive to citizen’s request.
Service
SQ3: Mawiidi is designed with citizen’s best interests at heart. [115,121]
Quality
SQ4: Mawiidi is designed to satisfy the needs of citizens.
SQ5 *: I will give an excellent evaluation of Mawiidi.
Trust1: Mawiidi is trustworthy.
Trust2: Mawiidi seems to be honest and truthful to me.
Trust [121,126]
Trust3: Mawiidi can be trusted.
Trust4: I trust that my all-personal information will remain in the Mawiidi.
ANX1: Working with a computer would make me very nervous.
Web ANX2: I get a sinking feeling when I think of trying to use a computer.
[132]
Anxiety ANX3: Computers make me feel uncomfortable.
ANX4: Computers make me feel uneasy and confused.
PS1: I am very satisfied with Mawiidi services.
Patient
PS2: I am very satisfied with Mawiidi services experience. [77]
Satisfaction
PS3: In general, I am very satisfied with Mawiidi services.
Big Data Cogn. Comput. 2024, 8, 180 31 of 38

Appendix B

Table A2. Cross-loadings.

IQ PS PEOU PSec PP SQ TRUST WA

ANX1 0.190 0.377 0.304 0.476 0.464 0.629 0.207 0.803
ANX2 0.084 0.262 0.172 0.335 0.327 0.370 0.150 0.777
ANX3 0.256 0.275 0.277 0.352 0.398 0.463 0.309 0.825
ANX4 0.260 0.338 0.312 0.365 0.457 0.529 0.133 0.892
IQ1 0.763 0.583 0.613 0.333 0.551 0.365 0.143 0.279
IQ2 0.820 0.417 0.571 0.233 0.339 0.279 0.054 0.129
IQ3 0.820 0.383 0.548 0.120 0.362 0.233 0.121 0.180
IQ4 0.723 0.305 0.445 0.113 0.298 0.250 0.069 0.151
IQ5 0.821 0.453 0.642 0.216 0.479 0.246 0.068 0.221
PEOU1 0.560 0.682 0.794 0.380 0.635 0.328 0.069 0.228
PEOU2 0.588 0.406 0.746 0.245 0.366 0.186 0.090 0.211
PEOU3 0.573 0.486 0.814 0.297 0.496 0.246 0.102 0.300
PEOU4 0.603 0.513 0.851 0.274 0.526 0.261 0.117 0.271
PEOU5 0.548 0.654 0.766 0.397 0.719 0.323 0.191 0.302
PP2 0.473 0.635 0.601 0.425 0.828 0.392 0.137 0.363
PP3 0.352 0.654 0.549 0.363 0.834 0.322 0.231 0.466
PP4 0.496 0.673 0.632 0.414 0.883 0.344 0.209 0.451
PP5 0.466 0.732 0.614 0.423 0.867 0.370 0.245 0.449
PS1 0.462 0.903 0.608 0.371 0.729 0.354 0.220 0.331
PS2 0.511 0.884 0.641 0.376 0.682 0.375 0.159 0.315
PS3 0.492 0.868 0.611 0.403 0.689 0.407 0.122 0.382
PSec1 0.206 0.357 0.353 0.932 0.431 0.477 0.192 0.481
PSec2 0.251 0.383 0.343 0.820 0.383 0.392 0.111 0.331
PSec3 0.250 0.397 0.355 0.762 0.402 0.412 0.085 0.332
SQ2 0.268 0.314 0.224 0.430 0.311 0.821 0.240 0.597
SQ3 0.288 0.362 0.255 0.399 0.376 0.835 0.185 0.541
SQ4 0.320 0.394 0.366 0.452 0.363 0.869 0.209 0.454
TRUST1 0.074 0.121 0.104 0.158 0.183 0.175 0.824 0.181
TRUST2 0.172 0.053 0.131 0.160 0.112 0.169 0.700 0.263
TRUST3 0.087 0.220 0.150 0.086 0.256 0.217 0.805 0.158
TRUST4 0.075 0.144 0.074 0.163 0.171 0.215 0.826 0.213
Note: information quality (IQ); patient satisfaction (PS); perceived ease of use (PEOU); perceived security (PSec);
privacy protection (PP); service quality (SQ); website anxiety (WA).

References
1. Akematsu, Y.; Tsuji, M. An Empirical Approach to Estimating the Effect of E-Health on Medical Expenditure. J. Telemed. Telecare
2010, 16, 169–171. [CrossRef] [PubMed]
2. Chan, A.H.Y.; Reddel, H.K.; Apter, A.; Eakin, M.; Riekert, K.; Foster, J.M. Adherence Monitoring and E-Health: How Clinicians
and Researchers Can Use Technology to Promote Inhaler Adherence for Asthma. J. Allergy Clin. Immunol. Pract. 2013, 1, 446–454.
[CrossRef] [PubMed]
3. de Grood, C.; Raissi, A.; Kwon, Y.; Santana, M.J. Adoption of E-Health Technology by Physicians: A Scoping Review. J. Multidiscip.
Healthc. 2016, 9, 335–344. [CrossRef] [PubMed]
4. Maksimović, M.; Vujović, V. Internet of Things Based E-Health Systems: Ideas, Expectations and Concerns. In Handbook of
Large-Scale Distributed Computing in Smart Healthcare; Khan, S.U., Zomaya, A.Y., Abbas, A., Eds.; Scalable Computing and
Communications; Springer International Publishing: Cham, Switzerland, 2017; pp. 241–280, ISBN 978-3-319-58280-1.
5. Rodrigues, R.J. Opportunities and Challenges in the Deployment of Global E-Health. Int. J. Healthc. Technol. Manag. 2003, 5,
335–358. [CrossRef]
6. Hoque, M.R.; Mazmum, M.F.A.; Bao, Y. E-Health in Bangladesh: Current Status, Challenges, and Future Direction. Int. Technol.
Manag. Rev. 2014, 4, 87–96. [CrossRef]
7. Zayyad, M.A.; Toycan, M. Factors Affecting Sustainable Adoption of E-Health Technology in Developing Countries:
An Exploratory Survey of Nigerian Hospitals from the Perspective of Healthcare Professionals. PeerJ 2018, 6, e4436. [CrossRef]
8. Habibi, M.R.M.; Mohammadabadi, F.; Tabesh, H.; Vakili-Arki, H.; Abu-Hanna, A.; Eslami, S. Effect of an Online Appointment
Scheduling System on Evaluation Metrics of Outpatient Scheduling System: A before-after MulticenterStudy. J. Med. Syst. 2019,
43, 281. [CrossRef]
Big Data Cogn. Comput. 2024, 8, 180 32 of 38

9. Nakhaee, N.; Oroomiei, N.; Amiresmaili, M.R.; Nekooi Moghadam, M.; Mohammadi, B.; Mirzaei, S.; Ghorbaninia, R.; Nakhaee,
M. Challenges of Appointment Fixing in Private Physician Offices from the Viewpoint of Physicians and Secretaries. Health Dev. J.
2012, 1, 207–220.
10. Peter Idowu, A.; Olusegun Adeosun, O.; Oladipo Williams, K. Dependable Online Appointment Booking System for Nhis
Outpatient in Nigerian Teaching Hospitals. Int. J. Comput. Sci. Inf. Technol. 2014, 6, 59–73. [CrossRef]
11. Yeon, N.; Lee, T.; Jang, H. Outpatients Appointment Scheduling with Multi-Doctor Sharing Resources. In Proceedings of the 2010
Winter Simulation Conference, Baltimore, MD, USA, 5–8 December 2010; pp. 3318–3329.
12. Chen, S.-C.; Jong, D.; Lai, M.-T. Assessing the Relationship between Technology Readiness and Continuance Intention in an
E-Appointment System: Relationship Quality as a Mediator. J. Med. Syst. 2014, 38, 76. [CrossRef]
13. Lin, C.K.Y.; Ling, T.W.C.; Yeung, W.K. Resource Allocation and Outpatient Appointment Scheduling Using Simulation Optimiza-
tion. J. Healthc. Eng. 2017, 2017, 9034737. [CrossRef] [PubMed]
14. Lloyd, G. An Appointment System in a Teaching Practice. J. R. Coll. Gen. Pract. 1974, 24, 666–668. [PubMed]
15. Ma, W.-M.; Zhang, H.; Wang, N.-L. Improving Outpatient Satisfaction by Extending Expected Waiting Time. BMC Health Serv.
Res. 2019, 19, 565. [CrossRef] [PubMed]
16. Wang, J.; Fung, R.Y. Adaptive Dynamic Programming Algorithms for Sequential Appointment Scheduling with Patient Prefer-
ences. Artif. Intell. Med. 2015, 63, 33–40. [CrossRef]
17. Yu, W.; Yu, X.; Hu, H.; Duan, G.; Liu, Z.; Wang, Y. Use of Hospital Appointment Registration Systems in China: A Survey Study.
Glob. J. Health Sci. 2013, 5, 193. [CrossRef]
18. Liang, Y.; Zhao, L. Intelligent Hospital Appointment System Based on Health Data Bank. Procedia Comput. Sci. 2019, 159,
1880–1889. [CrossRef]
19. Hua, Y.; Che, T.; Yang, C.; Hu, M. Customer No-Show Reduction in Web-Based Appointment Service: Investigations of
Non-Attendance Behaviors. Serv. Ind. J. 2024, 44, 538–562. [CrossRef]
20. Henderson, R. Encouraging Attendance at Outpatient Appointments: Can We Do More? Scott. Med. J. 2008, 53, 9–12. [CrossRef]
21. Lowes, R. How to Handle No-Shows. Med. Econ. 2005, 82, 62–65.
22. Paré, G.; Trudel, M.-C.; Forget, P. Adoption, Use, and Impact of e-Booking in Private Medical Practices: Mixed-Methods
Evaluation of a Two-Year Showcase Project in Canada. JMIR Med. Inform. 2014, 2, e3669. [CrossRef]
23. Fisher, J.; Clayton, M. Who Gives a Tweet: Assessing Patients’ Interest in the Use of Social Media for Health Care. Worldviews
Evid.-Based Nurs. 2012, 9, 100–108. [CrossRef] [PubMed]
24. Molfenter, T. Reducing Appointment No-Shows: Going from Theory to Practice. Subst. Use Misuse 2013, 48, 743–749. [CrossRef]
25. World Health Organization. Global Diffusion of eHealth: Making Universal Health Coverage Achievable: Report of the Third Global
Survey on eHealth; World Health Organization: Geneva, Switzerland, 2017; ISBN 92-4-151178-8.
26. Bech, M. The Economics of Non-Attendance and the Expected Effect of Charging a Fine on Non-Attendees. Health Policy 2005, 74,
181–191. [CrossRef] [PubMed]
27. Leibner, G.; Brammli-Greenberg, S.; Mendlovic, J.; Israeli, A. To Charge or Not to Charge: Reducing Patient No-Show. Isr. J. Health
Policy Res. 2023, 12, 27. [CrossRef] [PubMed]
28. Nazia, S.; Ekta, S. Online Appointment Scheduling System for Hospitals–an Analytical Study. Int. J. Innov. Res. Sci. Eng. Technol.
2014, 4, 21–27.
29. Kitsios, F.; Kamariotou, M.; Manthou, V.; Batsara, A. Hospital Information Systems: Measuring End-User Satisfaction.
In Proceedings of the Information Systems: 17th European, Mediterranean, and Middle Eastern Conference, EMCIS 2020, Dubai,
United Arab Emirates, 25–26 November 2020; Proceedings 17; Springer: Berlin/Heidelberg, Germany, 2020; pp. 463–479.
30. Ilioudi, S.; Lazakidou, A.; Tsironi, M. Importance of Patient Satisfaction Measurement and Electronic Surveys: Methodology and
Potential Benefits. Int. J. Health Res. Innov. 2013, 1, 67–87.
31. Drosos, D.; Tsotsolas, N.; Zagga, A.; Chalikias, M.S.; Skordoulis, M. Multicriteria Satisfaction Analysis Application in the Health
Care Sector. In Proceedings of the 7th International Conference on Information and Communication Technologies in Agriculture,
Food and Environment (HAICTA), Kavala, Greece, 7–20 September 2015; pp. 737–754.
32. Al-Khayyal, A.; Alshurideh, M.; Al Kurdi, B.; Aburayya, A. The Impact of Electronic Service Quality Dimensions on Customers’
e-Shopping and e-Loyalty via the Impact of e-Satisfaction and e-Trust: A Qualitative Approach. Int. J. Innov. Creat. Chang. 2020,
14, 257–281.
33. Zeithaml, V.A.; Parasuraman, A.; Malhotra, A. Service Quality Delivery through Web Sites: A Critical Review of Extant
Knowledge. J. Acad. Mark. Sci. 2002, 30, 362–375. [CrossRef]
34. Zeithaml, V.A. Service Quality, Profitability, and the Economic Worth of Customers: What We Know and What We Need to Learn.
J. Acad. Mark. Sci. 2000, 28, 67–85. [CrossRef]
35. Emont, S. Measuring the Impact of Patient Portals; California Healthcare Foundation: Oakland, CA, USA, 2011; pp. 1–20.
36. Posada, J.; Potvin, H.; Cookson, C. Opening Up with Open Notes: Writing Notes in the Era of Full Patient Access. Acad. Psychiatry
2022, 46, 259–263. [CrossRef]
37. Stults, C.D.; Li, J.; Frosch, D.L.; Krishnan, H.; Smith-McCurdy, G.; Jones, V.G.; Chan, A.S. Assessment of Accuracy and Usability
of a Fee Estimator for Ambulatory Care in an Integrated Health Care Delivery Network. JAMA Netw. Open 2019, 2, e1917445.
[CrossRef] [PubMed]
Big Data Cogn. Comput. 2024, 8, 180 33 of 38

38. Heath, S. Patient Portal Adoption Tops 90%, but Strong Patient Use Is Needed. Patient Engagement HIT. 2018. Available on-
line: https://www.techtarget.com/patientengagement/news/366585192/Patient-Portal-Adoption-Tops-90-But-Strong-Patient-
Use-Is-Needed (accessed on 28 November 2024).
39. Karabag, S.F. An Unprecedented Global Crisis! The Global, Regional, National, Political, Economic and Commercial Impact of
the Coronavirus Pandemic. J. Appl. Econ. Bus. Res. 2020, 10, 1–6.
40. Lesser, R.; Reeves, M. Leading out of Adversity; The Boston Consulting Group: Boston, MA, USA, 2020; Available online:
https://boston-consulting-group-brightspot.s3.amazonaws.com/img-src/BCG-Leading-Out-of-Adversity-Apr-2020_tcm9-2
43802.pdf (accessed on 28 November 2024).
41. Boudanga, Z.; Benhadou, S.; Medromi, H.; Leroy, J.-P. Development Perspective of a Moroccan Smart City. In Proceedings of the
2019 Third World Conference on Smart Trends in Systems Security and Sustainablity (WorldS4), London, UK, 30–31 July 2019;
pp. 247–254.
42. Nachit, H.; Belhcen, L. Digital Transformation in Times of COVID-19 Pandemic: The Case of Morocco. SSRN J. 2020. Available
online: https://ssrn.com/abstract=3645084 (accessed on 28 November 2024). [CrossRef]
43. Mangalmurti, S.S.; Murtagh, L.; Mello, M.M. Medical Malpractice Liability in the Age of Electronic Health Records.
Surv. Anesthesiol. 2011, 55, 317. [CrossRef]
44. Nuckols, T.K.; Smith-Spangler, C.; Morton, S.C.; Asch, S.M.; Patel, V.M.; Anderson, L.J.; Deichsel, E.L.; Shekelle, P.G. The
Effectiveness of Computerized Order Entry at Reducing Preventable Adverse Drug Events and Medication Errors in Hospital
Settings: A Systematic Review and Meta-Analysis. Syst. Rev. 2014, 3, 56. [CrossRef] [PubMed]
45. Sligo, J.; Gauld, R.; Roberts, V.; Villa, L. A Literature Review for Large-Scale Health Information System Project Planning,
Implementation and Evaluation. Int. J. Med. Inform. 2017, 97, 86–97. [CrossRef]
46. Amato, M.G.; Salazar, A.; Hickman, T.-T.T.; Quist, A.J.; Volk, L.A.; Wright, A.; McEvoy, D.; Galanter, W.L.; Koppel, R.; Loudin, B.
Computerized Prescriber Order Entry–Related Patient Safety Reports: Analysis of 2522 Medication Errors. J. Am. Med. Inform.
Assoc. 2017, 24, 316–322. [CrossRef]
47. Khajouei, R.; Jaspers, M.W.M. The Impact of CPOE Medication Systems’ Design Aspects on Usability, Workflow and Medication
Orders: A Systematic Review. Methods Inf. Med. 2010, 49, 3–19. [CrossRef]
48. Korb-Savoldelli, V.; Boussadi, A.; Durieux, P.; Sabatier, B. Prevalence of Computerized Physician Order Entry Systems–Related
Medication Prescription Errors: A Systematic Review. Int. J. Med. Inform. 2018, 111, 112–122. [CrossRef]
49. Nanji, K.C.; Rothschild, J.M.; Salzberg, C.; Keohane, C.A.; Zigmont, K.; Devita, J.; Gandhi, T.K.; Dalal, A.K.; Bates, D.W.; Poon, E.G.
Errors Associated with Outpatient Computerized Prescribing Systems. J. Am. Med. Inform. Assoc. 2011, 18, 767–773. [CrossRef]
50. Zhan, C.; Hicks, R.W.; Blanchette, C.M.; Keyes, M.A.; Cousins, D.D. Potential Benefits and Problems with Computerized
Prescriber Order Entry: Analysis of a Voluntary Medication Error-Reporting Database. Am. J. Health-Syst. Pharm. 2006, 63,
353–358. [CrossRef] [PubMed]
51. Kadmon, G.; Bron-Harlev, E.; Nahum, E.; Schiller, O.; Haski, G.; Shonfeld, T. Computerized Order Entry with Limited Decision
Support to Prevent Prescription Errors in a PICU. Pediatrics 2009, 124, 935–940. [CrossRef] [PubMed]
52. Kadmon, G.; Pinchover, M.; Weissbach, A.; Hazan, S.K.; Nahum, E. Case Not Closed: Prescription Errors 12 Years after
Computerized Physician Order Entry Implementation. J. Pediatr. 2017, 190, 236–240. [CrossRef] [PubMed]
53. Blijleven, V.; Koelemeijer, K.; Wetzels, M.; Jaspers, M. Workarounds Emerging from Electronic Health Record System Usage:
Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care. JMIR Hum. Factors 2017, 4, e7978. [CrossRef]
54. Boonstra, A.; Jonker, T.L.; Van Offenbeek, M.A.G.; Vos, J.F.J. Persisting Workarounds in Electronic Health Record System Use:
Types, Risks and Benefits. BMC Med. Inform. Decis. Mak. 2021, 21, 183. [CrossRef]
55. Flanagan, M.E.; Saleem, J.J.; Millitello, L.G.; Russ, A.L.; Doebbeling, B.N. And Computer-Based Workarounds to Electronic Health
Record Use at Three Benchmark Institutions. J. Am. Med. Inform. Assoc. 2013, 20, e59–e66. [CrossRef]
56. Friedman, A.; Crosson, J.C.; Howard, J.; Clark, E.C.; Pellerano, M.; Karsh, B.-T.; Crabtree, B.; Jaén, C.R.; Cohen, D.J. A Typology of
Electronic Health Record Workarounds in Small-to-Medium Size Primary Care Practices. J. Am. Med. Inform. Assoc. 2014, 21,
e78–e83. [CrossRef]
57. Baumann, L.A.; Baker, J.; Elshaug, A.G. The Impact of Electronic Health Record Systems on Clinical Documentation Times:
A Systematic Review. Health Policy 2018, 122, 827–836. [CrossRef]
58. Joukes, E.; Abu-Hanna, A.; Cornet, R.; De Keizer, N. Time Spent on Dedicated Patient Care and Documentation Tasks Before and
After the Introduction of a Structured and Standardized Electronic Health Record. Appl. Clin. Inform. 2018, 9, 46–53. [CrossRef]
59. Poissant, L.; Pereira, J.; Tamblyn, R.; Kawasumi, Y. The Impact of Electronic Health Records on Time Efficiency of Physicians and
Nurses: A Systematic Review. J. Am. Med. Inform. Assoc. 2005, 12, 505–516. [CrossRef]
60. Melnick, E.R.; Dyrbye, L.N.; Sinsky, C.A.; Trockel, M.; West, C.P.; Nedelec, L.; Tutty, M.A.; Shanafelt, T. The Association between
Perceived Electronic Health Record Usability and Professional Burnout among US Physicians. In Proceedings of the Mayo Clinic
Proceedings; Elsevier: Amsterdam, The Netherlands, 2020; Volume 95, pp. 476–487.
61. Peccoralo, L.A.; Kaplan, C.A.; Pietrzak, R.H.; Charney, D.S.; Ripp, J.A. The Impact of Time Spent on the Electronic Health Record
after Work and of Clerical Work on Burnout among Clinical Faculty. J. Am. Med. Inform. Assoc. 2021, 28, 938–947. [CrossRef]
[PubMed]
Big Data Cogn. Comput. 2024, 8, 180 34 of 38

62. Shanafelt, T.D.; Dyrbye, L.N.; Sinsky, C.; Hasan, O.; Satele, D.; Sloan, J.; West, C.P. Relationship between Clerical Burden and
Characteristics of the Electronic Environment with Physician Burnout and Professional Satisfaction. In Proceedings of the Mayo
Clinic Proceedings; Elsevier: Amsterdam, The Netherlands, 2016; Volume 91, pp. 836–848.
63. Thomas Craig, K.J.; Willis, V.C.; Gruen, D.; Rhee, K.; Jackson, G.P. The Burden of the Digital Environment: A Systematic Review
on Organization-Directed Workplace Interventions to Mitigate Physician Burnout. J. Am. Med. Inform. Assoc. 2021, 28, 985–997.
[CrossRef] [PubMed]
64. Berg, M.; Toussaint, P. The Mantra of Modeling and the Forgotten Powers of Paper: A Sociotechnical View on the Development of
Process-Oriented ICT in Health Care. Int. J. Med. Inform. 2003, 69, 223–234. [CrossRef] [PubMed]
65. Morquin, D. Résistance légitime sans technophobie: Analyse des impacts de l’informatisation du dossier du patient sur le cœur
du métier médical. Rev. Méd. Interne 2020, 41, 617–621. [CrossRef]
66. Davis, F.D. Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology. MIS Q. 1989, 13, 319.
[CrossRef]
67. Delone, W.H.; McLean, E.R. The DeLone and McLean Model of Information Systems Success: A Ten-Year Update. J. Manag. Inf.
Syst. 2003, 19, 9–30.
68. Chen, S.-C.; Liu, S.-C.; Li, S.-H.; Yen, D.C. Understanding the Mediating Effects of Relationship Quality on Technology Acceptance:
An Empirical Study of E-Appointment System. J. Med. Syst. 2013, 37, 9981. [CrossRef]
69. Holden, R.J.; Karsh, B.-T. The Technology Acceptance Model: Its Past and Its Future in Health Care. J. Biomed. Inform. 2010, 43,
159–172. [CrossRef]
70. Xie, H.; Prybutok, G.; Peng, X.; Prybutok, V. Determinants of Trust in Health Information Technology: An Empirical Investigation
in the Context of an Online Clinic Appointment System. Int. J. Hum.–Comput. Interact. 2020, 36, 1095–1109. [CrossRef]
71. Urbach, N.; Smolnik, S.; Riempp, G. An Empirical Investigation of Employee Portal Success. J. Strateg. Inf. Syst. 2010, 19, 184–206.
[CrossRef]
72. Lin, H.-F.; Lee, G.-G. Determinants of Success for Online Communities: An Empirical Study. Behav. Inf. Technol. 2006, 25, 479–488.
[CrossRef]
73. McKinney, V.; Yoon, K.; Zahedi, F. “Mariam” The Measurement of Web-Customer Satisfaction: An Expectation and Disconfirma-
tion Approach. Inf. Syst. Res. 2002, 13, 296–315. [CrossRef]
74. Yang, Z.; Cai, S.; Zhou, Z.; Zhou, N. Development and Validation of an Instrument to Measure User Perceived Service Quality of
Information Presenting Web Portals. Inf. Manag. 2005, 42, 575–589. [CrossRef]
75. Hanjaya, S.T.M.; Kenny, S.K.; Gunawan, S.S.S.E.F. Understanding Factors Influencing Consumers Online Purchase Intention via
Mobile App: Perceived Ease of Use, Perceived Usefulness, System Quality, Information Quality, and Service Quality. Mark. Sci.
Res. Organ. 2019, 32, 175–205. [CrossRef]
76. Gefen, D.; Karahanna, E.; Straub, D.W. Trust and TAM in Online Shopping: An Integrated Model. MIS Q. 2003, 27, 51–90.
[CrossRef]
77. Bhattacherjee, A.; Perols, J.; Sanford, C. Information Technology Continuance: A Theoretic Extension and Empirical Test.
J. Comput. Inf. Syst. 2008, 49, 17–26. [CrossRef]
78. Chuttur, M. Overview of the Technology Acceptance Model: Origins, Developments and Future Directions. 2009. Available
online: https://aisel.aisnet.org/sprouts_all/290 (accessed on 28 November 2024).
79. Bernarto, I. The effect of performance expectancy, perceived need, perceived value and perceived ease of use on patient satisfaction
and continuance intention in the Halodoc telemedicine service application in Jabodetabek in 2023. JMBI UNSRAT (J. Ilm. Manaj.
Bisnis Dan Inov. Univ. Sam Ratulangi) 2024, 11, 460–471.
80. Wangpipatwong, S.; Chutimaskul, W.; Papasratorn, B. Understanding Citizen’s Continuance Intention to Use e-Government
Website: A Composite View of Technology Acceptance Model and Computer Self-Efficacy. Electron. J. e-Gov. 2008, 6, 55–64.
81. Gu, D.; Yang, X.; Li, X.; Jain, H.K.; Liang, C. Understanding the Role of Mobile Internet-Based Health Services on Patient
Satisfaction and Word-of-Mouth. Int. J. Environ. Res. Public Health 2018, 15, 1972. [CrossRef]
82. Tandon, U.; Kiran, R.; Sah, A.N. Analysing the Complexities of Website Functionality, Perceived Ease of Use and Perceived
Usefulness on Customer Satisfaction of Online Shoppers in India. Int. J. Electron. Mark. Retail. 2016, 7, 115. [CrossRef]
83. Ashghar, S.A.; Nurlatifah, H. Analisis Pengaruh Perceived Ease of Use, Perceived Usefulness, Dan Perceived Risk Terhadap
Keinginan Membeli Kembali Melalui e-Trust Dan s-Satisfaction (Studi Kasus Pengguna Gopay Pada Transaksi UMKM). J. Al
Azhar Indones. Seri Ilmu Sos. 2020, 1, 40–52. [CrossRef]
84. Büttner, O.B.; Göritz, A.S. Perceived Trustworthiness of Online Shops. J. Consum. Behav. 2008, 7, 35–50. [CrossRef]
85. Rahmiati, R.; Yuannita, I.I. The Influence of Trust, Perceived Usefulness, Perceived Ease of Use, and Attitude on Purchase
Intention. J. Kaji. Manaj. Bisnis 2019, 8, 27–34. [CrossRef]
86. Fung, R.; Lee, M. EC-Trust (Trust in Electronic Commerce): Exploring the Antecedent Factors. In Proceedings of the AMCIS 1999
Proceedings, Milwaukee, WI, USA, 13–15 August 1999.
87. Chellappa, R.K. Consumers’ Trust in Electronic Commerce Transactions: The Role of Perceived Privacy and Perceived Security.
Univ. South. Calif. Work. Pap. 2008, 13, 35–36.
88. O’cass, A.; Fenech, T. Web Retailing Adoption: Exploring the Nature of Internet Users Web Retailing Behaviour. J. Retail. Consum.
Serv. 2003, 10, 81–94. [CrossRef]
Big Data Cogn. Comput. 2024, 8, 180 35 of 38

89. Flavián, C.; Guinalíu, M.; Gurrea, R. The Role Played by Perceived Usability, Satisfaction and Consumer Trust on Website Loyalty.
Inf. Manag. 2006, 43, 1–14. [CrossRef]
90. Suh, B.; Han, I. The Impact of Customer Trust and Perception of Security Control on the Acceptance of Electronic Commerce. Int.
J. Electron. Commer. 2003, 7, 135–161.
91. Bai, Y.; Varadharajan, V. A Language for Specifying Sequences of Authorization Transformations and Its Applications. In
Information and Communications Security; Han, Y., Okamoto, T., Qing, S., Eds.; Lecture Notes in Computer Science; Springer:
Berlin/Heidelberg, Germany, 1997; Volume 1334, pp. 39–49, ISBN 978-3-540-63696-0.
92. Bernstein, T.; Bhimani, A.B.; Schultz, E.; Siegel, C.A. Internet Security for Business; John Wiley & Sons, Inc.: Hoboken, NJ, USA,
1996.
93. Keen, P.; Ballance, G.; Chan, S.; Schrump, S. Electronic Commerce Relationships: Trust by Design; Prentice Hall PTR: Hoboken, NJ,
USA, 1999.
94. Ott, R. Building Trust Online. Comput. Fraud. Secur. 2000, 2000, 10–12. [CrossRef]
95. Gefen, D. E-Commerce: The Role of Familiarity and Trust. Omega 2000, 28, 725–737. [CrossRef]
96. Lin, Y.-K.; Lin, C.-J. Factors Predicting Patients’ Perception of Privacy and Satisfaction for Emergency Care. Emerg. Med. J. 2011,
28, 604–608. [CrossRef]
97. Deshefy-Longhi, T.; Dixon, J.K.; Olsen, D.; Grey, M. Privacy and Confidentiality Issues in Primary Care: Views of Advanced
Practice Nurses and Their Patients. Nurs. Ethics 2004, 11, 378–393. [CrossRef] [PubMed]
98. Beldad, A.D. Trust and Information Privacy Concerns in Electronic Government. Ph.D. Thesis, University of Twente, Enschede,
The Netherlands, 2011.
99. Hong, W.; Hong Kong University of Science and Technology; Thong, J.Y.L. Internet Privacy Concerns: An Integrated Conceptual-
ization and Four Empirical Studies. MIS Q. 2013, 37, 275–298. [CrossRef]
100. Chan, F.K.Y.; Thong, J.Y.L.; Brown, S.A.; Venkatesh, V. Service Design and Citizen Satisfaction with E-Government Services:
A Multidimensional Perspective. Public Adm. Rev. 2021, 81, 874–894. [CrossRef]
101. Nayeri, N.D.; Aghajani, M. Patients’ Privacy and Satisfaction in the Emergency Department: A Descriptive Analytical Study.
Nurs. Ethics 2010, 17, 167–177. [CrossRef] [PubMed]
102. Hoffman, D.L.; Novak, T.P. Marketing in Hypermedia Computer-Mediated Environments: Conceptual Foundations. J. Mark.
1996, 60, 50–68. [CrossRef]
103. Culnan, M.J.; Bies, R.J. Consumer Privacy: Balancing Economic and Justice Considerations. J. Soc. Issues 2003, 59, 323–342.
[CrossRef]
104. Friedman, B.; Khan, P.H.; Howe, D.C. Trust Online. Commun. ACM 2000, 43, 34–40. [CrossRef]
105. Moorman, C.; Deshpandé, R.; Zaltman, G. Factors Affecting Trust in Market Research Relationships. J. Mark. 1993, 57, 81–101.
[CrossRef]
106. Kim, D.J.; Ferrin, D.L.; Rao, H.R. A Trust-Based Consumer Decision-Making Model in Electronic Commerce: The Role of Trust,
Perceived Risk, and Their Antecedents. Decis. Support Syst. 2008, 44, 544–564. [CrossRef]
107. Metzger, M.J. Effects of Site, Vendor, and Consumer Characteristics on Web Site Trust and Disclosure. Commun. Res. 2006, 33,
155–179. [CrossRef]
108. Belanger, F.; Hiller, J.S.; Smith, W.J. Trustworthiness in Electronic Commerce: The Role of Privacy, Security, and Site Attributes.
J. Strateg. Inf. Syst. 2002, 11, 245–270. [CrossRef]
109. Bart, Y.; Shankar, V.; Sultan, F.; Urban, G.L. Are the Drivers and Role of Online Trust the Same for All Web Sites and Consumers?
A Large-Scale Exploratory Empirical Study. J. Mark. 2005, 69, 133–152. [CrossRef]
110. Chellappa, R.K.; Sin, R.G. Personalization versus Privacy: An Empirical Examination of the Online Consumer’s Dilemma.
Inf. Technol. Manag. 2005, 6, 181–202. [CrossRef]
111. Ganguly, B.; Dash, S.; Cyr, D. The Influence of Website Characteristics on Trust in Online Travel Portals in India: The Moderating
Role of Demographic and Psychographic Variables. Tour. Recreat. Res. 2011, 36, 57–68.
112. Roman, S. The Ethics of Online Retailing: A Scale Development and Validation from the Consumers’ Perspective. J. Bus. Ethics
2007, 72, 131–148. [CrossRef]
113. Ali, F.; Dey, B.L.; Filieri, R. An Assessment of Service Quality and Resulting Customer Satisfaction in Pakistan International
Airlines: Findings from Foreigners and Overseas Pakistani Customers. Int. J. Qual. Reliab. Manag. 2015, 32, 486–502. [CrossRef]
114. Ramli, N.B.; Fun, C.S.; Idris, F. Kajian Kepuasan Pelanggan Terhadap Perkhidmatan Perpustakaan Universiti Awam Di Malaysia.
J. Pengur. 2009, 28, 23–43.
115. Nie, L.; Oldenburg, B.; Cao, Y.; Ren, W. Continuous Usage Intention of Mobile Health Services: Model Construction and
Validation. BMC Health Serv. Res. 2023, 23, 442. [CrossRef]
116. Nitecki, D.A.; Hernon, P. Measuring Service Quality at Yale University’s Libraries. J. Acad. Librariansh. 2000, 26, 259–273.
[CrossRef]
117. AL-Mhasnah, A.M.; Salleh, F.; Afthanorhan, A.; Ghazali, P.L. The Relationship between Services Quality and Customer Satisfaction
among Jordanian Healthcare Sector. Manag. Sci. Lett. 2018, 8, 1413–1420. [CrossRef]
118. Andreea, M.; Ruxandra, L. The Degree of Satisfaction Perceived by Healthcare Services Consumers in State Hospitals-Case Study
Emergency County Hospital from Alba Iulia. Ann. Univ. Apulensis Ser. Oeconomica 2016, 18, 43.
119. Tsoukatos, E.; Mastrojianni, E. Key Determinants of Service Quality in Retail Banking. EuroMed J. Bus. 2010, 5, 85–100. [CrossRef]
Big Data Cogn. Comput. 2024, 8, 180 36 of 38

120. Ahmed, I.; Nawaz, M.M.; Usman, A.; Shaukat, M.Z.; Ahmed, N. A Mediation of Customer Satisfaction Relationship between
Service Quality and Repurchase Intentions for the Telecom Sector in Pakistan: A Case Study of University Students. Afr. J. Bus.
Manag. 2010, 4, 3457.
121. Teo, T.S.; Srivastava, S.C.; Jiang, L.I. Trust and Electronic Government Success: An Empirical Study. J. Manag. Inf. Syst. 2008, 25,
99–132. [CrossRef]
122. Azzopardi-Muscat, N.; Sørensen, K. Towards an Equitable Digital Public Health Era: Promoting Equity through a Health Literacy
Perspective. Eur. J. Public Health 2019, 29, 13–17. [CrossRef]
123. Srinivasan, D. The Impact of Trust in E-Government on Electronic Health Literacy. World Med. Health Policy 2014, 6, 22–38.
[CrossRef]
124. Sørensen, K. Fostering Digital Health Literacy to Enhance Trust and Improve Health Outcomes. Comput. Methods Programs
Biomed. Update 2024, 5, 100140. [CrossRef]
125. McKnight, D.H.; Chervany, N.L. What Trust Means in E-Commerce Customer Relationships: An Interdisciplinary Conceptual
Typology. Int. J. Electron. Commer. 2001, 6, 35–59. [CrossRef]
126. Alawneh, A.; Al-Refai, H.; Batiha, K. Measuring User Satisfaction from E-Government Services: Lessons from Jordan. Gov. Inf. Q.
2013, 30, 277–288. [CrossRef]
127. Welch, E.W.; Hinnant, C.C.; Moon, M.J. Linking Citizen Satisfaction with E-Government and Trust in Government. J. Public Adm.
Res. Theory 2005, 15, 371–391. [CrossRef]
128. Orren, G. Fall from Grace: The Public’s Loss of Faith in Government. In Why People Don’t Trust Government; Harvard University
Press: Cambridge, MA, USA, 1997; pp. 77–107.
129. Howard, G.S.; Smith, R.D. Computer Anxiety in Management: Myth or Reality? Commun. ACM 1986, 29, 611–615. [CrossRef]
130. Saadé, R.G.; Kira, D. Computer Anxiety in E-Learning: The Effect of Computer Self-Efficacy. J. Inf. Technol. Educ. Res. 2009, 8,
177–191.
131. Kay, R.H. Exploring the Relationship between Emotions and the Acquisition of Computer Knowledge. Comput. Educ. 2008, 50,
1269–1283. [CrossRef]
132. Barbeite, F.G.; Weiss, E.M. Computer Self-Efficacy and Anxiety Scales for an Internet Sample: Testing Measurement Equivalence
of Existing Measures and Development of New Scales. Comput. Hum. Behav. 2004, 20, 1–15. [CrossRef]
133. Bolliger, D.U.; Halupa, C. Student Perceptions of Satisfaction and Anxiety in an Online Doctoral Program. Distance Educ. 2012, 33,
81–98. [CrossRef]
134. Ouajdouni, A.; Chafik, K.; Boubker, O. Measuring E-Learning Systems Success: Data from Students of Higher Education
Institutions in Morocco. Data Brief 2021, 35, 106807. [CrossRef]
135. Hermawan, I.; Sartono, S.; Hidayat, F.; Suharmanto, S. Model of Consumer Trust, Technology Anxiety, Sales Service Support, and
Other in Features e-Marketplace System to Built Customer Satisfaction. In Proceedings of the International Conference of Ethics on
Business, Economics, and Social Science (ICEBESS 2018); Atlantis Press: Dordrecht, The Netherlands, 2019; pp. 73–79.
136. Agarwal, R.; Karahanna, E. Time Flies When You’re Having Fun: Cognitive Absorption and Beliefs about Information Technology
Usage. MIS Q. 2000, 665–694. [CrossRef]
137. Venkatesh, V.; Davis, F.D. A Theoretical Extension of the Technology Acceptance Model: Four Longitudinal Field Studies. Manag.
Sci. 2000, 46, 186–204. [CrossRef]
138. Boubker, O.; Lakhal, M.; Ait Yassine, Y.; Lotfi, H. Towards Sustainable Transport in the Moroccan Context: The Key Determinants
of Electric Cars Adoption Intention. World Electr. Veh. J. 2024, 15, 136. [CrossRef]
139. Flavián, C.; Guinalíu, M. Consumer Trust, Perceived Security and Privacy Policy: Three Basic Elements of Loyalty to a Web Site.
Ind. Manag. Data Syst. 2006, 106, 601–620. [CrossRef]
140. Yoo, B.; Donthu, N. Developing a Scale to Measure the Perceived Quality of an Internet Shopping Site (SITEQUAL). Q. J. Electron.
Commer. 2001, 2, 31–45.
141. Bozan, K.; Bozan, G. Technology-Enabled Type-1 Diabetes Self-Management–Protection Motivation Theory Perspective. In
Proceedings of the 57th Hawaii International Conference on System Sciences, Honolulu, HI, USA, 3–6 January 2024.
142. Ly, A.; Zemek, R.; Wright, B.; Zwicker, J.; Schneider, K.; Mikrogianakis, A.; Conradi, A.; Johnson, D.; Clark, B.; Barlow, K.;
et al. “What Is the Actual Goal of the Pathway?”: Examining Emergency Department Physician and Nurse Perspectives on the
Implementation of a Pediatric Concussion Pathway Using the Theoretical Domains Framework. BMC Health Serv. Res. 2021, 21,
119. [CrossRef] [PubMed]
143. Shen, H.; Van Der Kleij, R.; Van Der Boog, P.J.M.; Wang, W.; Song, X.; Li, Z.; Brakema, E.; Lou, X.; Chavannes, N. Digital
Tools/eHealth to Support CKD Self-Management: A Qualitative Study of Perceptions, Attitudes and Needs of Patients and
Health Care Professionals in China. Int. J. Med. Inform. 2022, 165, 104811. [CrossRef] [PubMed]
144. Zainal Badri, S.K.; Wan Mohd Yunus, W.M.A.; Ramos, H.M.; Mahmud, N. Remote Learning and Its Implications toward
Study-Life Conflicts and the Mental Health of University Students: Does Studying at Home or Campus Matter? High. Educ. Res.
Dev. 2022, 41, 2523–2537. [CrossRef]
145. Stratton, S.J. Population Research: Convenience Sampling Strategies. Prehospital Disaster Med. 2021, 36, 373–374. [CrossRef]
146. Al-Emran, M.; Mezhuyev, V.; Kamaludin, A. Technology Acceptance Model in M-Learning Context: A Systematic Review. Comput.
Educ. 2018, 125, 389–412. [CrossRef]
Big Data Cogn. Comput. 2024, 8, 180 37 of 38

147. Emerson, R.W. Convenience Sampling, Random Sampling, and Snowball Sampling: How Does Sampling Affect the Validity of
Research? J. Vis. Impair. Blind. 2015, 109, 164–168. [CrossRef]
148. Hair, J.F.; Black, W.C.; Babin, B.J.; Anderson, R.E.; Tatham, R. (Eds.) Multivariate Data Analysis, 7th ed.; Pearson Prentice Hall:
Upper Saddle River, NJ, USA, 2010; ISBN 978-0-13-813263-7.
149. Schonlau, M.; Couper, M.P. Options for Conducting Web Surveys. Statist. Sci. 2017, 32, 279–292. [CrossRef]
150. Boubker, O.; Arroud, M.; Ouajdouni, A. Entrepreneurship Education versus Management Students’ Entrepreneurial Intentions.
A PLS-SEM Approach. Int. J. Manag. Educ. 2021, 19, 100450. [CrossRef]
151. Henseler, J.; Hubona, G.; Ray, P.A. Using PLS Path Modeling in New Technology Research: Updated Guidelines. Ind. Manag.
Data Syst. 2016, 116, 2–20. [CrossRef]
152. Rharzouz, J.; Bouarir, H.; El Moutaqi, B.; Rizqi, N.; Boubker, O. Factors Influencing Women’s Entrepreneurial Success in a
Patriarchal Society: Empirical Evidence from Morocco. Societies 2024, 14, 151. [CrossRef]
153. Hair, J.F.; Ringle, C.M.; Sarstedt, M. PLS-SEM: Indeed a Silver Bullet. J. Mark. Theory Pract. 2011, 19, 139–152. [CrossRef]
154. Davari, A.; Rezazadeh, A. Structural Equation Modeling with PLS. Tehran Jahad Univ. 2013, 215, 224.
155. Conway, J.M.; Lance, C.E. What Reviewers Should Expect from Authors Regarding Common Method Bias in Organizational
Research. J. Bus. Psychol. 2010, 25, 325–334. [CrossRef]
156. Bodner, T.E. Designs, Participants, and Measurement Methods in Psychological Research. Can. Psychol./Psychol. Can. 2006, 47,
263–272. [CrossRef]
157. Woszczynski, A.B.; Whitman, M.E. The Handbook of Information Systems Research; Igi Global: Pennsylvania, PA, USA, 2004.
158. Harman, H.H. Modern Factor Analysis; University of Chicago Press: Chicago, IL, USA, 1976.
159. Podsakoff, P.M.; MacKenzie, S.B.; Lee, J.-Y.; Podsakoff, N.P. Common Method Biases in Behavioral Research: A Critical Review of
the Literature and Recommended Remedies. J. Appl. Psychol. 2003, 88, 879. [CrossRef]
160. Aiken, L.S. Multiple Regression: Testing and Interpreting Interactions; Sage: London, UK, 1991.
161. Henseler, J.; Ringle, C.M.; Sarstedt, M. A New Criterion for Assessing Discriminant Validity in Variance-Based Structural Equation
Modeling. J. Acad. Mark. Sci. 2015, 43, 115–135. [CrossRef]
162. Chin, W.W. The Partial Least Squares Approach to Structural Equation Modeling. Mod. Methods Bus. Res. 1998, 295, 295–336.
163. Hair, J.F.; Hult, G.T.M.; Ringle, C.M.; Sarstedt, M. A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM); Sage:
London, UK, 2016; ISBN 1-4833-7744-X.
164. Cho, G.; Hwang, H.; Sarstedt, M.; Ringle, C.M. Cutoff Criteria for Overall Model Fit Indexes in Generalized Structured Component
Analysis. J. Mark. Anal. 2020, 8, 189–202. [CrossRef]
165. Ali, B.M.; Younes, B. The Impact of Information Systems on User Performance: An Exploratory Study. J. Knowl. Manag. Econ. Inf.
Technol. 2013, 3, 128–154.
166. Stone, R.W.; Good, D.J.; Baker-Eveleth, L. The Impact of Information Technology on Individual and Firm Marketing Performance.
Behav. Inf. Technol. 2007, 26, 465–482. [CrossRef]
167. Alsabawy, A.Y.; Cater-Steel, A.; Soar, J. IT Infrastructure Services as a Requirement for E-Learning System Success. Comput. Educ.
2013, 69, 431–451. [CrossRef]
168. Wang, R.Y.; Strong, D.M. Beyond Accuracy: What Data Quality Means to Data Consumers. J. Manag. Inf. Syst. 1996, 12, 5–33.
[CrossRef]
169. Wixom, B.H.; Todd, P.A. A Theoretical Integration of User Satisfaction and Technology Acceptance. Inf. Syst. Res. 2005, 16, 85–102.
[CrossRef]
170. Amin, M.; Rezaei, S.; Abolghasemi, M. User Satisfaction with Mobile Websites: The Impact of Perceived Usefulness (PU),
Perceived Ease of Use (PEOU) and Trust. Nankai Bus. Rev. Int. 2014, 5, 258–274. [CrossRef]
171. Laukkanen, P.; Sinkkonen, S.; Laukkanen, T. Consumer Resistance to Internet Banking: Postponers, Opponents and Rejectors. Int.
J. Bank Mark. 2008, 26, 440–455. [CrossRef]
172. McKnight, D.H.; Choudhury, V.; Kacmar, C. Developing and Validating Trust Measures for E-Commerce: An Integrative Typology.
Inf. Syst. Res. 2002, 13, 334–359. [CrossRef]
173. Odom, M.D.; Kumar, A.; Saunders, L. Web Assurance Seals: How and Why They Influence Consumers’ Decisions. J. Inf. Syst.
2002, 16, 231–250. [CrossRef]
174. Ackerman, M.S.; Cranor, L.F.; Reagle, J. Privacy in E-Commerce: Examining User Scenarios and Privacy Preferences. In
Proceedings of the 1st ACM Conference on Electronic Commerce, Denver, CO, USA, 3–5 November 1999.
175. Luo, X. Trust Production and Privacy Concerns on the Internet: A Framework Based on Relationship Marketing and Social
Exchange Theory. Ind. Mark. Manag. 2002, 31, 111–118. [CrossRef]
176. Gefen, D. Customer Loyalty in E-Commerce. J. Assoc. Inf. Syst. 2002, 3, 2. [CrossRef]
177. Parasuraman, A.; Zeithaml, V.A.; Berry, L. SERVQUAL: A Multiple-Item Scale for Measuring Consumer Perceptions of Service
Quality. J. Retail. 1988, 64, 12–40.
178. Zeithaml, V.A.; Parasuraman, A.; Malhotra, A. A Conceptual Framework for Understanding e-Service Quality: Implications for Future
Research and Managerial Practice. Working Paper Report; Marketing Science Institute: Cambridge, MA, USA, 2000; No. 00-115.
179. Compeau, D.; Higgins, C.A.; Huff, S. Social Cognitive Theory and Individual Reactions to Computing Technology: A Longitudinal
Study. MIS Q. 1999, 23, 145. [CrossRef]
180. Gagné, M.; Deci, E.L. Self-determination Theory and Work Motivation. J. Organ. Behav. 2005, 26, 331–362. [CrossRef]
Big Data Cogn. Comput. 2024, 8, 180 38 of 38

181. Becker, M.H.; Maiman, L.A. Sociobehavioral Determinants of Compliance with Health and Medical Care Recommendations. Med.
Care 1975, 10–24. [CrossRef] [PubMed]
182. Bandura, A. Self-Efficacy: The Exercise of Control; Freeman: New York, NY, USA, 1997; Volume 604.
183. Sweller, J. Cognitive Load during Problem Solving: Effects on Learning. Cogn. Sci. 1988, 12, 257–285. [CrossRef]
184. Miller, W.R.; Rollnick, S. Motivational Interviewing: Helping People Change; Guilford Press: New York, NY, USA, 2012.
185. Cyr, D.; Head, M.; Larios, H. Colour Appeal in Website Design within and across Cultures: A Multi-Method Evaluation. Int. J.
Hum.-Comput. Stud. 2010, 68, 1–21. [CrossRef]
186. Suh, B.; Han, I. Effect of Trust on Customer Acceptance of Internet Banking. Electron. Commer. Res. Appl. 2002, 1, 247–263.
[CrossRef]

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