Article Text

Original research
Determinants of physicians’ online medical services uptake: a cross-sectional study applying social ecosystem theory
  1. Xueqing Peng1,
  2. Zhiguang Li2,3,
  3. Chi Zhang4,
  4. Rui Liu5,
  5. Yongzhi Jiang5,
  6. Jiayu Chen3,
  7. Zixin Qi5,
  8. Jinjin Ge1,
  9. Shiqi Zhao1,
  10. Meng Zhou4,
  11. Hua You1,4
  1. 1School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
  2. 2Center for Health Policy and Management Studies, Nanjing University, Nanjing, Jiangsu, China
  3. 3The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
  4. 4School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
  5. 5School of Health Policy & Management, Nanjing Medical University, Nanjing, Jiangsu, China
  1. Correspondence to Dr Hua You; youhua98{at}


Objective To investigate the determinants of willingness and practice of physicians’ online medical services (OMS) uptake based on social ecosystem theory, so as to formulate OMS development strategies.

Design Cross-sectional survey.

Setting Research was conducted in two comprehensive hospitals and two community hospitals in Jiangsu, China, and the data were gathered from 1 June to 31 June 2020.

Participants With multistage sampling, 707 physicians were enrolled in this study.

Outcome measure Descriptive statistics were reported for the basic characteristics. χ2 test, Mann-Whitney U test and Spearman’s correlation analysis were used to perform univariate analysis. Linear regression and logistic regression were employed to examine the determinants of physicians’ OMS uptake willingness and actual uptake, respectively.

Results The mean score of the physicians’ OMS uptake willingness was 17.33 (range 5–25), with an SD of 4.39, and 53.3% of them reported having conducted OMS. In the micro system, factors positively associated with willingness included holding administrative positions (b=1.03, p<0.05), OMS-related awareness (b=1.32, p<0.001) and OMS-related skills (b=4.88, p<0.001); the determinants of actual uptake included holding administrative positions (OR=2.89, 95% CI 1.59 to 5.28, p<0.01), OMS-related awareness (OR=1.90, 95% CI 1.22 to 2.96, p<0.01), OMS-related skills (OR=2.25, 95% CI 1.35 to 3.74, p<0.01) and working years (OR=2.44, 95% CI 1.66 to 3.59, p<0.001). In the meso system, the hospital’s incentive mechanisms (b=0.78, p<0.05) were correlated with willingness; hospital advocated for OMS (OR=2.34, 95% CI 1.21 to 4.52, p<0.05), colleagues’ experiences (OR=3.81, 95% CI 2.25 to 6.45, p<0.001) and patients’ consultations (OR=2.93, 95% CI 2.02 to 4.25, p<0.001) were determinants of actual uptake. In the macro system, laws and policies were correlated with willingness (b=0.73, p<0.05) and actual uptake (OR=1.98, 95% CI 1.31 to 2.99, p<0.01); media orientation was also associated with willingness (b=0.74, p<0.05).

Conclusion Multiple determinants influence physicians’ OMS application. Comprehensive OMS promotion strategies should be put forward from multidimensional perspectives including the micro, meso and macro levels.

  • telemedicine
  • health policy
  • organisation of health services
  • public health
  • social medicine

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author. E-mail:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author. E-mail:

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  • XP, ZL and CZ contributed equally.

  • Contributors HY designed the study and critically reviewed, commented and revised the manuscript. XP, ZL and CZ participated in the data analysis, performed the final statistical analyses and prepared the first version of manuscript. YJ, RL, JC, and ZQ collected the data. MZ, SZ and JG collected literature materials.

  • Funding National Natural Science Foundation of China (No. 72074122), Jiangsu college students’ innovation and entrepreneurship training programme (No. 202010312066Z).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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