Understanding Women's Willingness to Use e-Health for HIV-Related Services: A Novel Application of the Technology Readiness and Acceptance Model to a Highly Stigmatized Medical Condition

Background: E-health may expand access to effective behavioral interventions for women living with HIV (WLH), and others living with a highly stigmatized medical condition. Introduction: Theory may help us to understand e-health program uptake. This mixed methods study examined theoretical applications of the Technology Readiness and Acceptance Model (TRAM) to predict willingness to take part in an e-health videoconferencing group program (i.e., participants interacting with each other in real time via videoconferencing) among a group of WLH. Materials and Methods: Women were recruited from HIV/AIDS clinics in an urban area of the southeastern United States. Each participant completed a structured interview. Data were analyzed using a parallel convergent mixed methods design. Results: Participants (N = 91) had a mean age of 43 years and were primarily African American (66%). Despite limited experience with videoconferencing (14.3%), many (71%) reported willingness to attend an intervention via video group for WLH. Qualitative analysis revealed that the constructs of the TRAM (Innovativeness, Optimism, Discomfort, Insecurity, Perceived Usefulness, or Perceived Ease-of-Use) were evident; however, additional mediating factors specific to WLH emerged, including group readiness and HIV-related privacy concerns. Discussion: Group readiness and privacy concerns may be important considerations when applying the TRAM to technology-based group programs for highly stigmatized populations, including WLH. Conclusions: Existing theoretical frameworks may be useful in understanding the willingness of people to take part in group-based e-health interventions, but may need to be modified to account for the role of stigma in e-health program uptake.