Digital Health Acceptability Questionnaire (DHAQ)

Abstract

The Digital Health Acceptability Questionnaire (DHAQ), developed by Haydon et al. in 2023, is an original psychometric instrument designed to measure consumers’ acceptance of remote healthcare services. Specifically, the DHAQ targets two prevalent modalities of telehealth delivery: telephone consultations and videoconference appointments. The development of the scale was guided by a rigorous deductive approach, rooted conceptually in the Theoretical Framework of Acceptability (TFA; Sekhon, Cartwright, & Francis, 2017).

The scale began with an initial pool of 19 items, which were ultimately refined into two parallel, yet distinct, 5-item scales: the DHAQ-Telephone Appointments and the DHAQ-Videoconference Appointments. Validation data was collected from a nationally representative sample of Australian consumers who had recently utilized telehealth services. Exploratory factor analyses confirmed a robust two-factor structure for both versions. The study established strong internal consistency and provided initial evidence for the construct validity of the DHAQ. Future applications may involve testing its convergent and divergent validity against models such as the Technology Acceptance Model (TAM-21).

Keywords

Attitude toward the Service, Consumer Attitudes, Digital Health Acceptability, Individual Capacity and Effort to Use Telehealth, Telehealth, Telephone Consultation, Theoretical Framework of Acceptability, Videoconference Consultation.

Authors

Helen M. Haydon, Taylor Major, Jaimon T. Kelly, Soraia de C. Catapan, Liam J. Caffery, Anthony C. Smith, Victor Gallegos-Rejas, Emma E. Thomas, Annie Banbury, Centaine L. Snoswell.

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Purpose

The core purpose of the DHAQ is to quantitatively assess the level of acceptability that consumers demonstrate toward receiving healthcare services accessed via digital means, specifically focusing on the experience of telephone consultations and videoconference appointments.

By separating the two primary modalities (phone and video), the DHAQ allows researchers and clinicians to identify specific barriers and facilitators influencing consumer behavior and satisfaction with different forms of remote care delivery.

Construct

The DHAQ measures the psychological construct of **Digital Health Acceptability**, which encompasses the user’s affective attitude toward the service, perceived effort required, and alignment with personal healthcare goals. The scale is theoretically grounded in the Theoretical Framework of Acceptability (TFA), which posits that acceptability is a multi-faceted construct influenced by cognitive and emotional factors.

The scale operationalizes components such as perceived burden, efficacy, and enjoyment related to using digital platforms for health consultations. The identified two-factor structure in the validation study further suggests that acceptability is composed of dimensions related to practical ease and overall attitude toward the service.

Validity

Construct Validity: Initial evidence for construct validity was established through exploratory factor analyses (EFAs). The results confirmed that the items converged into two meaningful factors for both the telephone and videoconference versions, providing empirical support for the theoretical structure derived from the TFA.

The authors recommend further validation studies, particularly focusing on **convergent and divergent validity**, by comparing DHAQ scores with established measures of technology adoption, such as the Technology Acceptance Model (TAM-21). This step would solidify the DHAQ’s standing as a measure distinct from, yet related to, general technology acceptance.

Reliability

Internal Consistency: The DHAQ demonstrated high internal consistency across both versions of the scale. The calculated Cronbach’s alpha coefficient for the full 10-item Telephone Acceptability Questionnaire was 0.91, indicating excellent internal reliability.

Similarly, the Cronbach’s alpha coefficient for the Videoconference Questionnaire was 0.92, also suggesting strong internal consistency. These high alpha values confirm that the items within each specific scale reliably measure the same underlying construct of acceptability for that modality.

Factor Analysis

Exploratory Factor Analysis (EFA): Exploratory Factor Analyses were conducted using Oblimin rotation to determine the underlying structure of the 10-item questionnaire. Separate analyses were run for the DHAQ-Telehealth and DHAQ-Videoconference versions.

Both analyses yielded a definitive two-factor solution. For the telephone version, these factors collectively explained 70.355% of the total variance. For the videoconference version, the two-factor solution accounted for 67.312% of the total variance, confirming the efficiency and robustness of the derived factor structures in explaining consumer acceptability.

Instrument

Test Type: Original Inventory/Questionnaire

Format: Items are rated on a 5-point Likert scale, with response options including “strongly disagree,” “somewhat disagree,” “neither agree nor disagree,” “somewhat agree,” and “strongly agree.”

Language Available: English

Population Group: Human (Male, Female)

Age Group: Adulthood (18 years and older)

Population Details: The validation study utilized a nationally representative sample of Australians who had accessed telehealth services within the past year. Data collection was conducted exclusively in Australia.

Test Methodology: The scale was developed and validated using a comprehensive psychometric methodology including Test Validity, Construct Validity, Test Reliability, Internal Consistency, Factor Analysis, and Exploratory Factor Analysis.

Keywords

Attitude toward the Service, Consumer Attitudes, Digital Health Acceptability, Individual Capacity and Effort to Use Telehealth, Telehealth, Telephone Consultation, Theoretical Framework of Acceptability, Videoconference Consultation.

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Authors

Author ORCID Identifier:

• Taylor Major: http://orcid.org/0000-0002-2531-8221

• Jaimon T. Kelly: http://orcid.org/0000-0003-0232-5848

• Liam J. Caffery: http://orcid.org/0000-0003-1899-7534

• Anthony C. Smith: http://orcid.org/0000-0002-7756-5136

• Victor Gallegos-Rejas: http://orcid.org/0000-0001-9856-4848

• Annie Banbury: http://orcid.org/0000-0001-8841-1215

• Centaine L. Snoswell: http://orcid.org/0000-0002-4298-9369

Affiliation: All authors are affiliated with the University of Queensland, Centre for Online Health.

Affiliation Email addresses:

• Helen M. Haydon: [email protected]

Correspondence Address: Helen M. Haydon: Princess Alexandra Hospital, University of Queensland, Centre for Online Health, Ground Floor, Building 33, Woolloongabba, Queensland, Australia, 4102. Email: [email protected]

Permissions & Fee and Test Year

Permissions: May be used for Research/Teaching purposes.
Commercial Use: No
Fee: No
Test Year: 2023

Reference’s

Haydon, H. M., Major, T., Kelly, J. T., Catapan, S. d. C., Caffery, L. J., Smith, A. C., Gallegos-Rejas, V., Thomas, E. E., Banbury, A., & Snoswell, C. L. (2023). Development and validation of the Digital Health Acceptability Questionnaire. Journal of Telemedicine and Telecare, 29(10, Suppl), 8S–15S. https://doi.org/10.1177/1357633X231202279

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Items of the Digital Health Acceptability Questionnaire (DHAQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Thinking about all of the telehealth [phone/video] appointments that you have ever had, please choose the response [Strongly disagree through to Strongly agree] below that best fits your opinion.

1. Telehealth fits with my idea of what good healthcare should be.

2. Having [phone/video] appointments is in line with my healthcare goals.

3. It took very little effort to have appointments via [phone/video].

4. Having healthcare appointments via [phone/video] was not a burden.

5. I believe [phone/video] appointments meet my healthcare needs.

6. Having [phone/video] appointments saved me time.

7. Telehealth [phone/video] was easy for me to use.

8. I have no doubt in my ability to set up and have my healthcare appointments via [phone/video].

9. I really enjoy having my healthcare appointments via [phone/video].

10. I liked having my healthcare appointments via [phone/video].