Adoption of telemedicine services among older adults in a low-income developing country: an fsQCA, ANN and PLS-SEM approach

Purpose This study explores the determinants influencing the adoption of telemedicine services by older adults in a low-income developing country, utilizing a combined methodological approach of partial least squares structural equation modeling (PLS-SEM), fuzzy-set qualitative comparative analysis (fsQCA) and artificial neural network (ANN) analysis. Design/methodology/approach Employing a purposive sampling technique, data from 348 respondents were analysed to identify significant predictors of telemedicine adoption intention. Findings The findings indicate that perceived usefulness, perceived ease of use, perceived knowledge and perceived severity positively influence attitudes toward telemedicine. Conversely, perceived vulnerability, response efficacy and self-efficacy did not show a significant impact on attitude. Additionally, while perceived risk was found to negatively moderate the relationship between attitude and adoption intention, resistance to change did not exhibit any moderating effect on this relationship. On the other hand, sensitivity analysis using ANN identified perceived usefulness as the most influential factor on attitude (100%), followed by perceived ease of use (32.9%), perceived knowledge (29.0%) and perceived severity (28.8%) (Model A). Similarly, Model B highlights the fact that attitude toward telemedicine is the most influential factor in generating adoption intention among older adults (100%). Meanwhile, the findings from fsQCA uncovered seven distinct combinations that are equally effective in generating a positive attitude toward telemedicine adoption. Furthermore, fsQCA revealed that self-efficacy and response efficacy are the most significant antecedents influencing attitudes toward telemedicine services. Practical implications The results offer nuanced insights into the facilitators and barriers to telemedicine adoption among older populations in contexts like Bangladesh. These findings have critical implications for service providers, healthcare professionals and policymakers aiming to enhance telemedicine usage among older adults in developing regions. Originality/value The study’s originality lies in the integration of the Technology Acceptance Model and Protection Motivation Theory within a comprehensive structural model, alongside the application of both symmetric and asymmetric analytical techniques. By merging diverse theoretical frameworks and robust methodologies, this research contributes substantially to the literature on digital health services adoption and lays the groundwork for future interventions.