ICACSIS 2018
00 ©2018 IEEE
Analysis of Factors Affecting User’s Intention in
Using Mobile Health Application: A Case Study of
Halodoc
Clarissa Nuralifa Mangkunegara, Fatimah Azzahro, and Putu Wuri Handayani
Faculty o f Computer Science, Universitas Indonesia, Depok, Indonesia
clarissanrlf@gmail.com, putu.wuri@cs.ui.ac.id
Abstract— This study aims to evaluate essential factors that
affect user’s behavioral intention in using Halodoc, a mobile
health application. This study examines factors from several
theories and perspective such as TAM, TPB and Health Belief
Model. A total of 146 Halodoc’s users completed the online
survey. The data is processed by using SmartPLS (v. 3.2.7).
The result shows that perceived usefulness, perceived
behavioral control, trust, self-health awareness, system quality,
and attitude influence users’ behavioral intention in using
Halodoc.
Keywords— Behavioral Intention, Mobile Health
Application, Halodoc, PLS-SEM
I. In t r o d u c t io n
Indonesia ranks 113 out o f 188 countries on the Human
Development Index (HDI) reported in World Human
Development Report 2016 [1], HDI is calculated using
several dimensions such as health, education and income.
Indonesian, especially one lives in rural area, still have low
awareness on health issues such as the importance of
vaccinating children and doing medical check-up regularly.
Limited access to health provider and health education plays
a big part to this phenomenon. Mobile health has a
tremendous opportunity to solve these problems. As reported
by APJII, Indonesia has a high rate o f mobile phone
adoption, reaching to more than 10 million users, or 80% of
Indonesia population [2],
M-health is an application that utilizes smartphone
devices and their functions to educate users about health and
improve the performance of existing health services [3].
Despite its benefits, the use of m-health in developing
country such as Indonesia has not been maximized due to
inadequate infrastructure and low level of health awareness
[4], In addition, there are also other factors such as security
and privacy issues, lack of regulatory oversight, and limited
evidence-based literature [5].
Technology-based healthcare trends in Indonesia are
experiencing considerable growth. This happened due to the
existence of many health-related problems that can be solved
with m-health technology. For example, there is a large gap
between number of doctors and patients in Indonesia. The
imbalanced distribution between doctors and the needs of the
community, especially in rural areas [6]. Halodoc, a startup
company that develop mobile health application in
Indonesia, try to solve this problem by providing
communities with access to doctors through its application
[7]. Other health-related startups in Indonesia, such as
Alodokter and Medika, develop many applications that can
help solving health-related issue in Indonesia [8]. Halodoc
itself is considered as a new startup since Halodoc was
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launched in 2016. Based on our interview in April 18th 2018
with the Head o f Product o f Halodoc, the interaction with the
Halodoc application itself only for 50% o f users from all
over users owned by Halodoc. Therefore, Halodoc continues
to innovate and evaluate its application to improve the
services provided to meet customer expectation and lead to
increasing the numbers o f users and the interaction within the
application.
However, in order to achieve success, one should
examine what factors may affect users’ adoption of m-health.
This study explores several factors from different IT
adoption theories such as Technology Acceptance Model
(TAM), Theory of Planned Behavior (TPB), dan Unified
Theory of Acceptance and Use of Technology (UTAUT). In
addition, this study also uses factors from health theories
such as Health Belief Model (HBM) and Protection
Motivation Theory (PMT).
This paper organize as follows. First, we provide brief
overview o f the literature on mobile health in Indonesia and
IT adoption theories. Second, we draw explanation for our
hyphoteses development. Next, we present the methodology
as well as research results. Finally, we discuss our finding
along with conclusion.
II. L i t er a t ur e Re v i e w
A. HaloDoc - Mobile Health App from Indonesia
Mobile health (m-health) are medical and public health
practices supported by mobile devices such as mobile
phones, patient surveillance devices, PDAs (Personal Digital
Assistants), and other wireless devices [9], In other words,
m-health is an application that utilizes mobile devices and
their functions to educate users about health and improve the
performance o f existing health services [3]. The use of m-
health brings several advantages such as being able to
provide health services to rural areas and faster emergency
services [4]. Additionally, m-health may provide health
services at more affordable prices and faster access while
mainting the quality with evidence-based health information
[5]. However, the benefits of a m-health can only be felt if
every element of the m-health including infrastructure, health
facilities, and medical practitioners are available [10].
Halodoc is an m-health application that features a
doctor's consultation, laboratory checks, and inter-pharmacy.
Halodoc worked with 19,000 doctors spread across Indonesia
and has more than 100 thousand users by early 2017 [11].
Halodoc provide scheduled online consultation with doctors
via app by utilizing voice and video call. Patients may
benefit from Halodoc since they do not have to go to
hospitals to consult a doctor. Moreover, patients can also
choose doctor based on their budget. In Indonesia, doctors
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can have difference consultation fees. Additionally, Halodoc
also provide ApotikAntar, a feature that allows patients to
buy medicines without having to leave the house.
B. Behavioral Intention towards m-health apps
Behavioral intention is a factor that explains a person's
intentions in using or adopting a behavior, in this case,
adopting a m-health application [12]. Behavioral intention
can be influenced by technological aspects, organization, and
characteristics of an individual. Ajzen [13] states that the
greater a person's intention in adopting a behavior, the more
likely he is to do it. This is confirmed by Davis [14] and
Venkatesh et al. [15] which states that behavioral intention is
a strong predictor in determining the adoption o f the actual
use of technology [3].
Research on m-health adoption are mainly using
information technology adoption such as TAM, TPB, and
UTAUT. These theories have their own strength and
weakness, so many researchers try to combine several
theories to provide a more thorough perspective. This study
also combines several IT adoption theories. However, this
study also uses health-related theories such as Health Belief
Model (HBM) and Protection Motivation Theory (PMT) [16]
to predict what factors affecting users’ intention to use
Halodoc.
III. H y p o t h eses De v e l o pm e n t
Perceived ease of use, a factor from Technology
Acceptance Model, describes a person's level of trust in
easiness of using a technology [16]. Perceived ease of use
can be assessed based on several characteristics such as the
clarity and easiness to understand the technology, easy to be
learned, flexible, and does not require much effort to use it.
Davis [14] states that an application that is easy to use can be
easier to be accepted by users. This argument also supported
by the research of Dwivedi et al. [17] which states that the
ease of use of a technology is an important factor in
determining a person's attitude and intention towards new
technology. Additionally, a study from Day et al. [18] found
that although an m-health application was very useful for
patients, if it was difficult to use, the patients will have
negative perception towards the app and reduce their
intention to use it [19]. Based on this, these following
hyphotheses are developed:
Hla: Perceived ease o f use positively influence users’
attitude to adopt Halodoc.
Hlb: Perceived ease of use positively influence users’
behavioral intention to adopt Halodoc.
In TAM, perceived usefulness can be defined as a
person's level of trust that using a system will improve their
performance [14], Perceived usefulness can be measured
from several aspects, namely faster task completion,
improvement on services quality, improvement on the
efficiency and accuracy o f patient services [19], Davis [14]
states that generally a person will have the desire to use an
application if he believes that the application will help him
doing his work better. This was confirmed by Lim et al. [20]
through their research. Lim et al. [20] ask group of women in
Singapore to read health-related information from mobile
website. The women found that the information is useful to
improve their health and confidence, so they want to access
978-1-7281-0135-4/18/S31.00 ©2018 IEEE
the website again. Therefore, these following hypotheses are
proposed:
H2a: Perceived usefulness positively influence users’
attitude to adopt Halodoc.
H2b: Perceived usefulness positively influence users’
behavioral intention to adopt Halodoc.
Perceived severity can be defined as a factor that
describes how serious the impact can be caused by a threat
[21]. Perceived severity, one o f the factors in protection
motivation theory (PMT), is important to be considered in
the context of m-health adoption. This is because perceived
severity is a factor that describes how a perceived threat can
increase awareness that will affect the attitudes and
behaviors that will be adopted, in this case using the m-
health application to avoid possible threats [22]. Thus, these
following hyphotheses are developed:
H3a: Perceived severity positively influence users’
attitude to adopt Halodoc.
H3b: Perceived severity positively influence users’
behavioral intention to adopt Halodoc.
Subjective norm defined as the influence or pressure that
comes from the social environment to someone to do or not
to do a certain behavior [13]. Many researchers referred
subjective norms as determining factor in ones’ intention to
adopt a technology. A study conducted by Verissimo found
that doctors tend to want to use medical mobile applications
after discussions between doctors that give positive
responses towards the application [23]. In the context of
HaloDoc, the desire to use the application can arise due to
the influence of people around the user. Thus, these
following hyphotheses are developed:
H4: Subjective norm positively influence users’
behavioral intention to adopt Halodoc.
Perceived behavioral control is one of the factors in TPB
which describes a person's assessment of his ability to use
technology [12]. Ajzen [13] states that perceived behavioral
control is an important factor in determining a person's
behavioral intention. This is because, one's self-confidence is
very influential on actions that he will do in the future. Ajzen
[13] gives an example if there are two people who have the
same desire to practice skiing, and they have tried it,
someone who has better confidence in his ability has a
greater likelihood o f being able to master skiing than people
who doubt his ability. Therefore, this study wants to see the
effect o f perceived behavioral control in the context of m-
health adoption. Thus, this following hypothesis is
developed:
H5: Perceived behavioral control positively influence
users’ behavioral intention to adopt Halodoc.
Trust is a factor that explains a person's level of
confidence that using m-health applications is safe and there
is privacy threat [16]. In the context of m-health application,
the level of trust can be measured by various aspects o f the
such as the honesty of the service provider, the credibility of
the service provider, and the reputation o f the m-health
service provider. If a m-health application has good
credibility and is trusted by its users, then the user's desire to
use the application will increase. Thus, this following
hypothesis is proposed:
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H6: Trust positively influence users' behavioral intention
to adopt Halodoc.
Perceived risk can be defined as a subjective expectation
o f a user against the loss that will be felt when using mobile
health application [24]. M-health applications such as
Halodoc have similar potential risks with online transactions
in general. There are possibilities o f transaction failures that
may harm users. Additionally, there are possibilities of fraud
that may lead to a decrease in the user's desire to adopt m-
health application. The greater the risk a person feels about
the m-health application, the person tends to discourage of
using m-health applications [16]. Therefore, this study
concludes the following hypothesis:
H7: Perceived risk negatively influence users’ behavioral
intention to adopt Halodoc.
Self-health awareness is a factor that explains a person's
awareness of his/her health condition and has the confidence
to manage it by adopting healthy behaviour [25]. The use of
m-health applications such as Halodoc can be categorized as
healthy living behavior because through the use of
applications, users can search information that can improve
their health conditions. Aalto and Uutela (1997) in the study
o f Deng and Liu [26] found that the more a person's
confidence in his ability to manage self-health, the more
likely it is for someone to adopt healthy behavior. Therefore,
this hypothesis is given:
H8a: Self-health awareness positively influence users’
attitude to adopt Halodoc.
H8b: Self-health awareness positively influence users’
behavioral intention to adopt Halodoc.
According to Mohamadali & Aziz, system quality is a
factor that explains the characteristics expected from an
information system such as ease o f use, system flexibility,
system reliability, feature usage, and response time [27]. The
results o f research conducted by Barakovic & Skorin-Kapov
state that system quality aspects such as loading time,
interface design, usability, and information quality have an
influence on the user's perception o f the use o f mobile web
browsing [28]. Furthermore, good system quality will also
Fig. 1. Research Model
978-l-7281-0135-4/18/$31.00 ©2018 IEEE
influence users’ intention to adoption an application, in this
case, the m-health application. Therefore, this study proposes
that:
H9a: System quality positively influence users’ attitude
to adopt Halodoc.
H9b: System quality positively influence users’
behavioral intention to adopt Halodoc.
Attitude is a factor that explains the level of a person's
assessment of things that are beneficial or not profitable from
the behavior in question [29]. Cocosila and Archer (2010) in
the study o f Hussein et al. states that attitude is one of the
factors that play an important role in the adoption of a
technology [3]. In the context of this research, if a user has a
positive attitude towards the m-health application, then the
more likely the user is to adopt it [12]. Based on this
explanation, it can be concluded that:
H10: Attitude positively influence users’ behavioral
intention to adopt Halodoc.
Figure 1 illustrate the study’s research model that was
developed in prior paragraph. There are 15 hypotheses
proposed in this study.
IV. Re s e a r ch Me t hodol ogy
A. Instrument Development
Questionnaire is utilized to collect data by measuring 11
variables that examined in this research, namely, perceived
usefulness, perceived ease of use, perceived risk, perceived
behavioural control, system quality, self-health awareness,
trust, perceived severity, subjective norm, attitude, and
behavioural intention. The indicators o f each variable are
developed based on previous research and then translated to
Bahasa Indonesia. Five-point Likert scales are employed to
indicate the respondent’s levels o f agreement or
disagreement with each statement. Table I shows the
example of indicators for perceived usefulness’ construct To
maintain the meaning o f original instruments, readability test
was conducted before starting the data collecting process.
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C ode Interview Q uotation C lassification
V. Re sea r c h M et h o d o l o g y Jabodetabek, Bandung, Batam,
Denpasar, Jambi, Kuta, Malang,
A. Instrument Development Padang, Palembang, Jogja, Semarang,
Solo, Sidoaijo, Samarinda, and
Questionnaire is utilized to collect data by measuring 11 Surabaya”
variables that examined in this research, namely, perceived
usefulness, perceived ease o f use, perceived risk, perceived VI. Re sea r c h Re s u l t s
behavioural control, system quality, self-health awareness,
trust, perceived severity, subjective norm, attitude, and A. Construct Validation
behavioural intention. The indicators o f each variable are The proposed research model consists o f formative and
developed based on previous research and then translated to reflective indicators. For formative indicators, we assess its
Bahasa Indonesia. Five-point Likert scales are employed to validity by measuring the VIF and T-value as can be seen in
indicate the respondent’s levels of agreement or Table IV. Additionally, we assess the reliability o f reflective
disagreement with each statement. Table I shows the indicators by measuring its Composite Reliability,
example of indicators for perceived usefulness’ construct. To Cronbach’s Alpha and loading factors. Meanwhile, the
maintain the meaning of original instruments, readability test validity o f reflective indicators is measured using AVE. The
was conducted before starting the data collecting process. results o f reliability and validity testing is depicted at Table
IV.
TABLE I. In d ic a t o r s for Pe r c e iv e d u sef u l n ess c o n st r u c t

C ode Indicators Source TABLE IV. Th e Re s u l t s o f Re l ia b il it y a nd Co n v e r g e n t

PU1 HaloDoc App can speed up searching Davis (1989) Va l id it y Te s t in g
process for finding suitable doctor’s schedule
L oading
PU2 HaloDoc App can improve my productivity W u e ta l. (2011) V ariable Indicator CA CR AVE
F actor
PU3 HaloDoc App is effective to use Davis (1989)
ATTl 0,852
PU4 HaloDoc App is efficient to use Davis (1989)
A ttitude ATT2 0,88 0,825 0,896 0,741
PU5 Overall, HaloDoc App is useful to me W u e ta l. (2011)
ATT3 0,851
B. Data Collection BI1 0,841
Behavioral
BI2 0,864 0,728 0,846 0,649
The sample o f this study was HaloDoc users in Intention
BD 0,702
Indonesia that utilize the app for searching health related HA1 0,705
information, reserving doctor appointment, and ordering Self-H ealth HA2 0,825
0,808 0,874 0,635
medicine. The data were collected via an official online Awareness HA3 0,823
survey questionnaire by using Survey UI domain. HA4 0,829
Participants were recruited via popular social networking PBC1 0,862
Perceived
PBC2 0,721
sites for Tokopedia users such as Facebook, Line Square, behavioral 0,805 0,873 0,634
PBC3 0,739
Whatsapp, Twitter, Instagram, dan Linkedln. Limited gifts control
PBC4 0,853
were offered to encourage participation. After deleting PEOU1 0,851
duplicates and incomplete responses, 146 valid surveys Perceived PEOU2 0,82
0,901 0,927 0,717
remained. Besides using a questionnaire, this study also ease o f use PEOU3 0,852
using a qualitative data by doing interview with the PEOU4 0,838
organization (Halodoc). The interview result will be used to PR1 0,918
P erceived
support the quantitative data to provide a more in-depth PR3 0,841 0,791 0,873 0,698
risk
PR4 0,739
analysis. Table II summarizes the demographics of the
PS1 0,899
respondents and Table HI shows some part of interview Perceived
PS2 0,82 0,877 0,918 0,789
result. Severity
PS3 0,941
PU2 0,758
TABLE II. De m o g r a ph y o f r e s po n d e n t s P erceived PU3 0,832
0,815 0,878 0,644
usefulness PU4 0,81
D em ographic C ategory Frequency %
PU5 0,808
Gender Male 42 29%
Female 104 71%
Age <21 26 18%
21-30 105 72% TABLE V. Th e Re s u l t s o f Re l ia b il it y a n d Co n v e r g e n t
31-40 7 5% Va l id it y Te s t in g (c o n t .)
>40 7 5%
P eriod o f using HaloDoc < 1 year 124 85% L oading
V ariable Indicator CA CR AVE
App 1-2 year 22 15% F actor
Frequency o f using < 5 times 120 82% SN1 0,932
Subjective
HaloDoc app in last month 5-10 times 32 22% SN2 0,888 0,9 0,936 0,83
Norm
> 10 times 4 3% SN3 0,912
T1 0,786
TABLE m . In t e r v ie w Su m m a r y T2 0,729
Trust T3 0,83 0,849 0,893 0,625
C ode Interview Q uotation C lassification T4 0,808
Ql “Halodoc was launched in April T5 0,795
21*2016”
Organization
02 “Halodoc is a data-driven company”
Profile
Q3 “Halodoc services have spread in
several big cities in Indonesia, such as

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TABLE VI. Th e Re s u l t s o f Re l ia b il it y a nd Co n v e r g e n t attach great importance to the use of m-health, especially to
Va l id it y Te s t in g
increase the activities that they carry out on a daily basis
V ariable Indicators T-value V IF [31].
SQ1 1,821 1,193
SQ2 2,667 1,39 The result shows that perceived severity does not have a
System Quality SQ3 7,19 1,385 positive influence on both users’ attitude and behavioral
SQ4 3,214 1,684 intention in using Halodoc application. This contrasts with
SQ5 2,975 1,398 the research of Zhao, Ni and Zhou which states that
perceived severity has a significant relationship to attitude
B. Hypothesis Testing
[16]. However, this finding aligns with Zhao, Ni and Zhou
We tested the hypotheses through Partial Least Squares that found that perceived severity does not have a strong
regression analyses using Smart PLS (v. 3.2.7). The influence compared to perceived vulnerability. Zhao, Ni and
explanatory power of the structural model is evaluated by the Zhou [16] stated that this was caused by the habits of users
R2 value, (see Table VI). In order to examine if each who only wanted to use mobile health if they had contracted
hypothesis is supported, this study assessed the path the disease not to prevent existing risks.
coefficients as can be seen at Table VII. This study utilizes
one-tailed test to examine the proposed hyphotheses. A In this study, subjective norm and perceived risk do not
hyphothesis would be accepted if have p-value less than 0.05 have a positive influence on users' behavioral intention to
with confidence level of 95% [30]. Among 15 hypotheses, 7 adopt Halodoc application. This contrasts with research
are accepted and the rest are rejected. conducted by Zhao, Ni and Zhou [16]. However, Chau and
Hu [32] argue that subjective norms do not have a significant
t a bl e vn. h y po t h e s e s t e s t in g relationship to doctors' behavioral intention to use
telemedicine technology due their concern that the new
V ariable R2
A ttitude 0,753
technology will not fit their daily routines and disrupt their
B ehavioral Intention 0,740 performance. Morover, from patients’ perspective that lives
in developing countries such as Indonesia, health awareness
TABLE V O . Hy po t h e s e s Te s t in g is seldom become their priority. Thus, influence from others
will rarely bring significant impacts on their intention to
H ypo­ adopt m-health application. Meanwhile, this study found that
P ath P -values Results
theses
H la PEOU -> ATT 0,065 Rejected
perceived risk does not have a negative influence on users'
H lb PEOU -> BI 0,275 Rejected behavioral intention in using Halodoc application. This
H2a PU -> ATT 0,0001 Accepted contrasts with research conducted by Zhao, Ni, and Zhou
H2b PU -> BI 0,003 Accepted [16], Based on authors’ observation, Halodoc users may not
H3a PS -> ATT 0,097 Rejected fully aware of the risks that might occur when using the
H3b PS -> BI 0,184 Rejected application. Furthermore, users’ may feel that the benefit
H4 SN -> BI 0,225 Rejected they get exceed its risks [24]. Halodoc provides free health
H5 PBC -> BI 0,016 Accepted
article services to educate users about healthly lifestyle. In
H6 T -> BI 0,034 Accepted
H7 PR -> BI 0,182 Rejected
order to access this useful article, one may be willing to be
H8a HA -> ATT 0,008 Accepted exposed to some risks.
H8b HA -> BI 0,140 Rejected
This study found that perceived behavioral control has a
H9a SQ -> ATT 0,0000001 Accepted
H9b SQ -> BI 0,415 Rejected
positive influence on the user's behavioral intention in using
H 10 ATT -> BI 0,014 Accepted Halodoc application. The majority of respondents in this
study belong to the productive age and live in the Greater
Jakarta area that use technology in their daily routines. Thus,
VII. D is c u s s io n they tend to be more confidence in using Halodoc.
Additionally, trust is also found as antecedent of users'
The results showed that perceived ease of use does not
behavioral intention in using Halodoc app. This is consistent
have a positive influence on users’ attitude and behavioral
with research conducted by Zhao, Ni, and Zhou [16] which
intention in using Halodoc app. This is contrary to research
find that users often rely heavily on their impression towards
conducted by Zhao, Ni and Zhou [16] which states that there
a technology which later will influence their belief in
is a significant relationship between perceived ease of use
adopting it. As new mobile health application, Halodoc
and attitude and behavioral intention. However, one may
employs doctors that registered in the Indonesian Doctors
argue that doctors, one of the subjects in this research, are
Association (IDI) and Indonesian Medical Council (KKI).
professionals who familiar with the use of technology and
This give users assurance they needed when using Halodoc
are open to new technology. Therefore, these doctors do not
service.
attach importance to the ease o f use of technology (Barker et
al., 2003). VIII. L i m i t a t io n a n d Co n c l u s io n

Additionally, this study shows that perceived usefulness
has a positive influence on users’ attitude and behavioral
intention in using Halodoc app. This finding is in line with
research conducted by Zhao, Ni and Zhou [16] which states
that perceived uselfidness has a significant relationship to
attitude and behavioral intention o f users in adopting mobile
health. Moreover, this finding is also supported by Rajkovic
et al. which states that the users o f health-related technology
This study aims to analyze the factors that influence the
user's intention to use the mobile health application in
Indonesia with the Halodoc case study. This study uses
quantitative and qualitative approaches. Based on the results
of processing and data analysis, it can be concluded that
perceived ease of use and perceived severity does not affect
the attitude and behavioral users in using the mobile health
Halodoc application. Meanwhile, subjective norms,

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perceived risk, self-health awareness, and system quality do
not affect the user's behavioral intention in using the Halodoc
mobile health application. Furthermore, perceived behavioral
control, trust, and attitude have a positive influence on users’
behavioral intention. Lastly, self-health awareness and
system quality influence users’ behavioral intention through
attitude.
All the findings of this study may be explored and
implemented by companies that developed mobile health
related application. For example, this study suggest that
every organization who developed mobile health application
should pay more attention to the usefulness o f the service
provided, since the service must resolve users’ problems.
Another example is the organization should minimize the
risk of using a mobile health application in order to gain
users’ trust toward the application. This study does, however,
pose certain limitations. First, we limited our study to
Halodoc as investigated application. Second, the
demography of respondents did not represents all users
characteristics of mobile health in Indonesia. Moreover,
future research must explore other factors that may affect
user’s attitude and intention to use mobile health application.
Further data collection needs to be conducted in order to
improve the results of this study.
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