Yuan, Jingbo; Shah, Sayed Ki aya ; Popp, Jozse ; Ace edo-Duque, Angel
A icle
Unde s anding he o ced adop ion o an AI-based heal h
code sys em in China
Am i ea u Economic Jou nal
P o ided in Coope a ion wi h:
The Bucha es Uni e si y o Economic S udies
Sugges ed Ci a ion: Yuan, Jingbo; Shah, Sayed Ki aya ; Popp, Jozse ; Ace edo-Duque, Angel (2024) :
Unde s anding he o ced adop ion o an AI-based heal h code sys em in China, Am i ea u
Economic Jou nal, ISSN 2247-9104, The Bucha es Uni e si y o Economic S udies, Bucha es , Vol.
26, Iss. 66, pp. 550-567,
h ps://doi.o g/10.24818/EA/2024/66/550
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AE
Unde s anding he Fo ced Adop ion
o an AI-Based Heal h Code Sys em in China
550 Am i ea u Economic
UNDERSTANDING THE FORCED ADOPTION
OF AN AI-BASED HEALTH CODE SYSTEM IN CHINA
Jingbo Yuan1 , Sayed Ki aya Shah2, Jozse Popp3
and Angel Ace edo-Duque4
1)2) Shenzhen Uni e si y, Shenzhen, China
3)WSB Uni e si y, Poland
4)Public Policy Obse a o y, Uni e sidad Au onoma de Chile, San iago, Chile
Please ci e his a icle as:
Yuan, J., Shah, S.K., Popp, J. and Ace edo-Duque, A.,
2024. Unde s anding he Fo ced Adop ion o an AI-
Based Heal h Code Sys em in China. Am i ea u
Economic, 26(66), pp. 550-567.
DOI: h ps://doi.o g/10.24818/EA/2024/66/550
A icle His o y
Recei ed: 16 No embe 2023
Re ised: 7 Feb ua y 2024
Accep ed: 10 Ma ch 2024
Abs ac
Wi h he g ow h o echnology and he exigency o con inuously imp o e hei
socioeconomic posi ion, use s mus g adually adop new AI-based solu ions. Howe e , use s
may expe ience dissa is ac ion and us a ion when aced wi h he eplacemen o p e ious
sys ems. To b idge his gap, his s udy p oposes a heo e ical model ha elies on he o ced
accep ance and usage o AI-based se ices du ing COVID-19 in China. This esea ch
examined he implemen a ion o a no el heal h code sys em in which use s we e o ced o
exclusi ely adop his sys em o es ic ace- o- ace in e ac ions. The s udy hypo heses we e
e alua ed by employing s uc u al equa ion modelling (SEM) on he da a ob ained om a
su ey o 262 Chinese use s. The esul s show ha he o ced accep abili y o use is impac ed
by echnological and pe sonal ac o s. This s udy demons a es he o ced implemen a ion
and daily u ilisa ion o he heal h code sys em o mee he social needs o he ulne able
popula ion and o e s a comp ehensi e analysis o he p ocess by which policies a e
o mula ed. This amewo k will incen i ise socioeconomic p og ess in ins i u ions and
socie y, as well as assis o he academicians in o ganising hei hough s and p omo ing he
de elopmen o heo y.
Keywo ds: o ced accep ance, PLS-SEM model, COVID-19, heal h-code sys em, China
JEL Classi ica ion: O1, O3, I1, M3
Co esponding au ho s, Sayed Ki aya Shah and Jozse Popp – e-mail: [email p o ec ed].cn and
[email p o ec ed]
This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons
A ibu ion License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in
any medium, p o ided he o iginal wo k is p ope ly ci ed. © 2024 The Au ho (s).
Economic In e e ences
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Vol. 26 • No. 66 • May 2024 551
In oduc ion
The cu ing-edge ea u es o echnology ha e changed use beha iou du ing he e y
ca as ophic COVID-19 ou b eak ha decima ed he whole wo ld (Li e al., 2021). Wi h he
choice o emain indoo s, he ho el, leisu e, and ou ism sec o s ha e seen signi ican nega i e
e ec s, since indi iduals we e unable o isi o engage in hese kinds o businesses and
ac i i ies. The use o inno a i e echnology is a signi ican ad an age in he mode n pe iod
in add essing he di icul ies posed by epidemics (Shah e al., 2022). Companies ha e
de eloped and implemen ed AI-powe ed con ac moni o ing ools expedi iously o no i y
use s and public heal h p o essionals i anyone has been exposed o he disease and o
de e mine whe he a ho spo should be decla ed. Acco ding o he MIT lis o such
applica ions, some a e ansi o y, op ional, and po able, while o he s, such as China's heal h
code sys em, a e manda o y, ubiqui ous, and in usi e. P e iously, mobile icke ing, mobile
paymen , and o he online se ices ha e all been used by he high-speed ain, ai line, public
anspo a ion businesses, e c. (Khajeheian and Eb ahimi, 2020). Howe e , he quick c ea ion
o an online AI-based “heal h code sys em” is one a ea o ac ual success ha p o ides use s’
whe eabou s, con ac in o ma ion, and physiological in o ma ion h ough hei sma phone.
In addi ion, Chinese pha macis s and companies ha we e in he o e on o he pandemic
quickly in oduced o he cu ing-edge AI-based me hods in esponse o his pandemic. The
eopening o indus ies and he wo ld economy has been made possible using big da a and
AI echnologies o quick and eal- ime decision-making and social seg ega ion (Li e al.,
2021). Today, esea che s belie e ha using AI-based p oduc s has ad an ages o bo h
se ice p o ide s and use s, con ibu ing o u u e socio-economic de elopmen (Meu e e
al., 2003). Howe e , use s end o p io i ise e iciency and cos -e ec i eness. Consequen ly,
hey end o a ibu e quali y imp o emen s o he a ailabili y o sel -se ice op ions and
bene i om he no ions o au onomy and empowe men (Collie and Kimes, 2013; Reinde s
e al., 2015). Fo his pu pose, many i ms ha e aised he acui y o he wo h o hei se ices,
educed expendi u es, and expanded hei dis ibu ion ne wo ks simul aneously by educing
cos s o ob ain economic bene i s (Bea son e al., 2007; Olah e al., 2021). Howe e , he mos
adical app oach o businesses o o ce consume s o adop such new p oduc s o se ices is
o elimina e he o iginal choice (Cse di and Kenesei, 2021).
The in oduc ion o inno a i e echnological solu ions o deli e supe io se ice and
imp o e cos e iciency is an essen ial ea u e o hese de elopmen s o bo h o ganisa ions
and inal use s (De eci e al., 2019; Chuenyindee e al., 2022). Howe e , in oducing new
echnology, p oduc , o se ice modes may inc ease use esis ance and lead o a decline in
in en ion and sa is ac ion (Cao e al., 2021). The e o e, he seamless in eg a ion o
echnological ad ancemen s is impe a i e (Chen e al., 2022; Ullah e al., 2023), which is no
uncommon in he heal h indus y. This sec o and ela ed use s a e equen ly compelled o
main ain only he mos e ec i e me hod, as cos -e ec i eness is an absolu e necessi y. The
in oduc ion o no el sys ems leads o he end o he old sys em, which o en includes he
closu e o indi idual and human in e ac ion me hods (Reinde s e al., 2015; Ma e al., 2019;
Cse di and Kenesei, 2021). As passi e ecipien s o hese shi s, ela ed use s may belie e
ha deploying he new amewo k is no in hei bes in e es s. The e o e, hey a e eluc an
o accep hese changes, al hough inno a i e echnology-based modes would ha e been a
mo e socially com o able and economically bene icial. In hese ci cums ances, i is i al o
iden i y he aspec s ha may aid use and o ganisa ion adop ion o no el sys ems and se ices.
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The objec i e o his a icle is o asce ain he ac o s ha in luence he p opensi y o use s o
adop a newly manda ed sys em, he decisions made by i ms, and he po en ial socioeconomic
consequences o such sys ems. An indica ion o pe sonal social and economic de elopmen
can be obse ed in he o m o ele a ed socioeconomic s a us, measu ed by a ibu es such as
pe sonal weal h and income. O he majo aspec s a e s anda d o li ing, quali y o li e, and
o e all heal h. A he o ganisa ional le el, socioeconomic g ow h can be seen in inc eases in
global compe i i eness, e enue, consume needs, company asse s, gene al business po en ial,
and wo k o ce quali y. This s udy emphasises he conside a ions and pe spec i es o use s
ega ding he implemen a ion o new se ice p ocedu es h ough manda o y usage. Since he
COVID-19 pandemic, he e has been limi ed schola ly ocus on his speci ic subjec . This
s udy has a dis inc i e design, as i p esen s a p ac ical example o using heal h code sys ems
o de elop a no el me hod o check-up in he COVID-19 en i onmen . This a icle seeks o
examine o he ac o s ha migh imp o e he accep ance o new echnologies o widesp ead
use, going beyond he undamen al design and ocal s uc u es. As his opic has ha dly e e
been in es iga ed, ou indings ha e implica ions o businesses in he heal h indus y a bo h
heo e ical and p ac ical le els. Theo e ically, his s udy’s indings con ibu e o he li e a u e
by de eloping an idea o he en o ceabili y o AI echnology use and he socio-economic
p emises o o ced adop ion. On a p ac ical le el, i ocuses on inno a i e heal h se ices in
China and o he heal h o ganisa ions ha wan o use echnological inno a ions. All businesses
ha in end o swi ch o a no el AI-based sys em wi hou p ese ing he old one should be
conscious o he ac o s ha migh aid in he acquisi ion p ocess.
The s uc u e o his a icle is as ollows. Following he in oduc ion, an ex ensi e li e a u e
e iew examines he backg ound o inno a i e echnology. The s udy ou comes o he o ced
accep ance o new se ice sys ems a e also co e ed in dep h in he li e a u e e iew. Then,
based on he li e a u e s udy, a heo e ical model o o ced accep ance is p esen ed and
assessed employing he s uc u al equa ion modelling echnique. The esea ch’s se ing is
ou lined in he me hodology sec ion, ollowed by an o e iew o he empi ical indings.
Finally, he esul s a e e alua ed in he discussion and implica ions sec ion.
1. Li e a u e e iew
1.1. Heal h code sys em
The COVID-19 ou b eak s a ed in Decembe 2019 in China and had sp ead o 210 coun ies
wo ldwide by May 19, 2020, wi h 4,731,458 cases epo ed (Mi anda e al., 2022). On
Janua y 30, 2020, he Wo ld Heal h O ganisa ion (WHO) decla ed he COVID-19 pandemic
a wo ldwide public heal h eme gency and e med his in ec ion a “pandemic” on Ma ch 12,
2020 ( Yi e al., 2020; Mi anda e al., 2022). The p o ision o pha macy and heal h se ices
du ing his pandemic was a challenge ha inc eased he impo ance o online AI-based
se ices. The quick c ea ion o an online heal h code sys em is one a ea o success in using
AI and big da a knowledge. This cu ing-edge app enabled i ms o keep ack o a pe son’s
a els, use s’ con ac eco ds, and biome ic in o ma ion. A s ong i al y be ween Alibaba
and Tencen se ed as uel o he c ea ion and implemen a ion o such a p oduc using AI
and big da a. On Feb ua y 9, 2020. The wo la ges co po a ions in China simul aneously
launched and de eloped hei s uc u es in hei ele an capi al ci ies. The quick expansion
o he heal h code sys em h oughou he whole coun y was made possible by compe i ion
be ween he wo digi al i ans and widesp ead backing om local go e nmen s h oughou
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Vol. 26 • No. 66 • May 2024 553
China. A he end o Feb ua y, he coun ywide heal h code sys em was embedded in o
Wecha o he i s ime. Wi hin a mon h, his se ice was used mo e han 6 billion imes
among he 900 million WeCha use s alone (Tan, 2020). Following he heal h code sys em
implemen ed by Tencen and Alipay, which was subsequen ly app o ed by he S a e Council
o China, all use s o his applica ion a e equi ed o p o ide hei pe sonal in o ma ion,
including a el his o y, con ac his o y, and medical de ails. By inpu ing hei da a, he wo-
dimensional codes wi h colou s ca ego ise hei heal h isk le els. The pa icula c i e ia and
s anda d a ied among p o inces; howe e , he elemen a y colou scheme adhe ed o
uni o m egula ions na ionally. The g een QR code pe mi ed indi iduals o a el wi hin he
ci y; yellow indica ed he po en ial isk o needing o isola e a home o 7-14 days; Code
Red s ipula ed 14 days o isola ion a home o in a cen alised place. A e mee ing he
isola ion equi emen s, he code was au oma ically e u ned o g een and local a el was
allowed again. The de elopmen o heal h in o ma ion sys ems made i possible o o he
i ms o make and adop his ype o inno a ions using AI, big da a, and machine lea ning
echniques (Song e al., 2021).
1.2. Fo ced use o no el echnology
Se ice-o ien ed o ganisa ions empowe use s o pe o m pa icula asks by implemen ing
cu ing-edge echnologies wi h cos sa ings and addi ional bene i s. Howe e , his ideal win-
win scena io can only ma e ialise i use s e ec i ely deploy and u ilise he echnology. Wi h
ei he nega i e o posi i e ewa ds, se ice businesses mos equen ly in luence consume s
o use inno a i e echnology (Liljande e al., 2006). Posi i e inducemen s include discoun s
and one-o deals, while nega i e mo i a ions include he use o penal ies and ees ha make
he ini ial op ion less appealing. Fo ced accep ance and usage ep esen he u mos ex eme
si ua ion, in which he oppo uni y o selec a ypical p oduc o se ice is elimina ed
(Reinde s e al., 2015). Punishmen ac ics, which elici esis ance simila o compulsion, a e
much less e ec i e han ewa d sys ems (T ampe e al., 2014). The e o e, i is appa en ha
he p ocess o choosing a deploymen s a egy is in ica e and equi es signi ican a en ion
o de ail. A business essen ially de e mines o implemen compelled use o accele a e he
implemen a ion o speci ic echnologies and begin ealising e iciency bene i s. Howe e ,
compulsion can al e and hinde use endo semen o a ce ain echnological sys em. The
e osion o in ellec ual con ol and he subsequen esis ance o consuming he no el se ice
mode is cen al o explaining his nega i e e ec . The s udy o Feng e al. (2019) suppo ed
he heo y o psychological eac ance by demons a ing ha when ai line consume s a e
equi ed o use sel -se ice check-in ending machines, hey will po ay his as a isk o hei
eedom ha will cause psychological eac ance. This esponse will esul in a pessimis ic
ou look and he ejec ion o he new echnology p oduc o se ice (Reinde s e al., 2015).
Despi e use s being awa e o he ad an ages associa ed wi h echnology usage, being o ced
in o adop ing an al e na i e may immedia ely p o oke hos ili y o nega i e emo ions
(Johnson e al., 2008; Cse di and Kenesei, 2021). Hence, he use o o ce ul me hods
diminishes use sa is ac ion wi h echnology, since i heigh ens buye app ehension and
anxie y while assessing o using new echnological se ices (Liu, 2012). Fu he mo e, such
inno a i e echnology manda es can lowe use s’ pe cep ions o he i m’s o e all se ice
quali y (Lin and Hsieh, 2007). Reinde s e al. (2015) showed in a s udy o he o ced
deploymen o new echnology sys ems in he Ne he lands ha e en echnology p o essionals
ha e issues ha lead o unhappiness and un a ou able wo d-o -mou h. The e o e, op imal
e en ion o con en ional al e na i es is equi ed in conjunc ion wi h inno a i e echnologies
o inc ease use and company bene i s (Oh e al., 2013). Fu he mo e, businesses can mo e
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554 Am i ea u Economic
beyond he ea ly opposi ion and ge use s used o p ac ising inno a i e echnology sys ems
exclusi ely o some se ice aspec s. In ha case, hey will equen ly comp ehend he
ad an ages o such echnologies (Cse di and Kenesei, 2021).
1.3. P e ious s udies
Mos esea ch on echnology ocuses on he ideas o inno a ion di usion (DOI) and he
echnology adop ion model – TAM (Fishbein and Ajzen, 1981). TAM became an essen ial
pa adigm applied o adop ing a new echnology p oduc o se ice (Schepe s and We zels,
2007; Belanche e al., 2020). Acco ding o TAM, he wo p ima y ac o s o no el echnology
acquiescence a e he pe cei ed use ulness (PUS), which is he ex en o which he consume
conside s ha employing he sys em will imp o e he pe o mance o he assigned ac i i y
and he pe cei ed ease o use (PEU), he ex en o which he consume conside s he sys em’s
use will no in ol e ex a ime and ene gy. Accep ance is in luenced bo h di ec ly and
indi ec ly by pe cei ed use ulness and ease o use. Acco ding o he DOI heo y (Roge s e
al., 2005), which ocuses on he p ocess a he han he ou come, consume ai s dis inguish
ea ly adop e s om la e adop e s and he elemen s ha acili a e adop ion. Based on
addi ional explo a ion, hese use ai s can be ca ego ised as echnology willingness, desi e
o engage, pe cei ed isk, o sel -e icacy (Cse di and Kenesei, 2021). This li e a u e e iew
has looked a he consume accep ance o se ice echnologies on hei own o in combina ion
wi h o he se ice echnologies. Fo example, Lee e al. (2012) e alua ed he sui abili y o
he se ice p ocedu e and he in luence o enabling ac o s on he adop ion o such se ices.
The ex a elemen s ha subs an ially impac ed he link be ween in en ion o use and ac ual
usage we e added o he TAM as he model’s ounda ion. The echnology accep ance model
equen ly augmen ed by nume ous elemen s was also employed as a heo e ical amewo k
in mos esea ch on new echnology p oduc s and se ices. Acco ding o Whi e e al. (2012),
he in luence o si ua ional elemen s on echnology adop ion is equen ly mo e signi ican
han sen imen s abou hese echnologies. Based on his, we also ex ended he TAM wi h
o he ac o s in he con ex o an inno a i e heal h code sys em se ice in China.
2. P oposed heo e ical model and hypo heses
Analysis o p io heo e ical and empi ical s udies in he ield o AI echnology and equi ed
u ilisa ion demons a es ha es ic ing use access o p e e ed p oduc s o se ices ypically
elici s nega i e use esponses. Fo cing one se ice al e na i e may cause educed adop ion
(Feng e al., 2019), un a ou able assessmen (Reinde s e al., 2015), nega i e e alua ion o
he new echnology (Liu, 2012), o e en mig a ion o a di e en se ice (Whi e e al., 2012).
In addi ion, ad e se emo ional, cogni i e, and beha iou al e ec s a e possible. When use s
a e o ced o use a speci ic se ice wi hou al e na i es, i migh cause anxie y, educed us ,
discom o , hesi a ion, o pe cei ed coe cions o hei independence (Feng e al., 2019).
To b idge his gap, we p esen a amewo k ha ocuses on he adop ion o no el AI-based
se ices h ough o ce and a emp s o iden i y he ac o s ha con ibu e o his adop ion o
a e sion. Ou main concep is he accep abili y o businesses’ o ce ul beha iou o o ce
employees o u ilise new al e na i e se ices. The e o e, ou measu emen s ocus mo e on
he accep abili y o o ced accep ance a he han jus i s consequences. In his ega d, we
aim no only o in es iga e esponses o coe ci e ac ion, bu also he ac o s ha may acili a e
i s accep ance. Based on he adop ion esea ch and p oli e a ion o new echnologies, we
Economic In e e ences
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Vol. 26 • No. 66 • May 2024 555
p opose ha o ced accep ance is in luenced by use pe sonali y and echnological ac o s.
The p oposed model (Figu e no.1) and he hypo heses a e discussed below.
Figu e no. 1. P oposed heo e ical model
2.1. Pe cei ed ease o use (PEU)
PEU measu es how e o less a use conside s i o use a ce ain piece o echnology (Fishbein
and Ajzen, 1981). The ex en o which use s a e awa e o he in icacy linked o a ce ain
echnology will in luence i s adop ion. As a esul , he same link is assumed when hinking
abou o ced accep ance; use s who hink ha using an AI heal h code sys em is simple would
be mo e inclined o accep i . The e o e, we sugges he ollowing hypo hesis:
H1: Pe cei ed ease o use is posi i ely co ela ed wi h o ced accep ance usage.
2.2. Pe cei ed use ulness (PUS)
PUS e e s o “ he le el o which a use in ui i ely eels ha using a pa icula echnology
will bene i and boos his/he pe o mance” (Da is, 1989). In he con ex o his s udy, PUS
happens when a use o an AI heal h code sys em hinks ha i will imp o e hei abili y o
accomplish hei needs. Based on his, we s i e o s udy he ela ionship be ween PUS and
use s’ in en ions and pu o wa d he ollowing ele an assump ion:
H2: Pe cei ed use ulness is posi i ely co ela ed wi h o ced accep ance usage.
2.3. Pe cei ed us (PTR)
PTR is ela ed o “ he p oduc o se ice p o iding ce i ica es and labelling as e idence o
i s sa e y and eliabili y” (Maye e al., 1995; Sil a e al., 2017). G une e al. (2014) con end
ha i us in a p oduc inc eases, he e mus be an upsu ge in he belie ha he p oduc
sa is ies he equi ed condi ions. To c ea e us , some ea u es a e impo an , such as he
exis ence o he ce i ie ’s, label, and p oduce ’s s a us, and p es ige o he p oduc
(Anisimo a, 2016). The same connec ion is hus conside ed when conside ing o ced
accep ance and usage; use who belie es u ilising a heal h code sys em is eliable is mo e
likely o accep i .
H3: Pe cei ed us is posi i ely co ela ed wi h o ce accep ance usage.
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2.4. Social anxie y (SOA)
Fenigs ein e al. (1975) desc ibe social anxie y as a eeling o discom o caused by being
awa e o o he s’ opinions o onesel as a social objec . In he li e a u e on inno a i e
echnology, social anxie y is ypically a loca ion egula o iden i ied h ough c owding
pe cep ion, alle ia ing he impo an link be ween a i ude and in en ion o p ac ice such
echnology (Gelb ich and Sa le , 2014). We con end ha social anxie y may unc ion as an
a ibu e in addi ion o being conside ed jus simply as a si ua ional aspec when using such
echnologies. People’s ac ions o assessmen s can a y depending on hei ole ance o he
s ess ha comes om ha ing o he s see hem use he heal h code se ice; his is especially
ue when o ced in oduc ion is included. The e o e, we p opose he ollowing:
H4: Social anxie y is posi i ely co ela ed wi h o ced accep ance usage.
2.5. Sel -e icacy (SEY)
Bandu a (1977) de ines SEY as an indi idual’s opinion o hei capabili y o ca y ou a speci ic
beha iou . I s heo e ical unde pinnings a e es ablished in social cogni ion heo y, which
main ains ha SEY iews a e a majo cogni i e ac o ha in luences beha iou . Highe SEY
boos s echnological adop ion, as he use o inno a i e echnologies equi es con idence in one’s
abili ies (Limayem e al., 2007; Cse di and Kenesei, 2021). A heal h code sys em adop ion is
mo e likely o be a success ul p ocedu e, e en when used o cibly, he mo e com o able and
con iden , when a pe son is u ilising i . The e o e, we p opose he ollowing:
H5: Sel -e icacy is posi i ely co ela ed wi h o ced accep ance usage.
2.6. Con inuance in en ions (CIN)
Fo cing use s o abandon an accep able mode o a heal h check sys em may ha e a
de imen al impac on hei pe cep ions o he o ganisa ion h ough un a ou able wo d-o -
mou h (Reinde s e al., 2015; Cse di and Kenesei, 2021). Use s do no conside i equi able
o a co po a ion o push hem o pe o m a ask hey would no o dina ily do. Fu he mo e,
Bi ne e al. (2002) disco e ed ha use s may be deeply a ached o he ini ial me hod o
p o ision manne wi h which hey a e amilia . The mos haza dous esul o compelled
p ac ice is he c ea ion o nega i e pe cep ions abou he p oduc o he i m, which can lead
o a educed le el o use e en ion. Because new echnology o en enhances se ice quali y,
i a co po a ion can pe suade clien s o assen and welcome he o ced use o newe
echnologies, i can lead o g ea e use happiness and con inuance in en ions (Cse di and
Kenesei, 2021; Zhongjun e al., 2022). As a esul , we hypo hesise as ollows:
H6: Fo ced accep ance is posi i ely co ela ed wi h con inuance in en ions.
3. Me hodology
This s udy ocused on a e olu iona y se ice sys em ha was implemen ed in China du ing
he COVID-19 pandemic, using AI and big da a. To unde s and he use ’s in en owa ds his
se ice, an online su ey was conduc ed using con enience sampling me hods. A
ques ionnai e was s uc u ed based on p e ious li e a u e ela ed o he new echnology
se ices. Based on (Gelb ich and Sa le , 2014; Cse di and Kenesei, 2021), h ee ques ions
ela ed o he SOA es we e selec ed o he use o new echnology, while he h ee i ems
ela ing o SEY we e cen ed on (Webs e and Ma occhio, 1992). Rega ding he
Economic In e e ences
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Vol. 26 • No. 66 • May 2024 557
cha ac e is ics o echnology, he h ee ques ions used o assess PUS and PEU we e used
om he Cse di and Kenesei (2021) wo k, while he h ee i ems used o de e mine PTR and
CIN we e based on (Chong e al., 2012; Pa k e al., 2019) esea ch. Finally, we c ea ed a i e-
poin scale o assess he accep abili y o o ce accep ance and use as he main s udy concep .
This scale co e ed use s' cogni i e, emo ional, and beha iou al endencies owa d heal h
code se ice esul ing om o ced u ilisa ion (Da is, 1989).
Nex , we used a cau ious app oach o desc ibe hese elemen s in a way ha would allow us o
unde s and he key ac o s o o ced accep ance and consump ion. We adop ed p e-exis ing
scales om he esea ch o gua an ee he eliabili y o he scales. We employed back- ansla ion
B islin (1970) i e a i ely and collabo a i ely o ensu e he accu acy o he ansla ions (Shah and
Zhongjun, 2021; Mus a a e al., 2022). Two expe s ansla ed indi idually he scales’
componen s om English o Chinese. A e a aining unanimi y, he i ems we e back- ansla ed
by a hi d knowledgeable schola , and a e some epe i ions, he g oup once mo e came o a
consensus. Twen y- i e people answe ed he ques ionnai e as a pilo es . A ew small ph asing
changes we e made o ensu e comple e cla i y based on he pilo es esul s.
The e we e wo sec ions o he ques ionnai e. The in oduc ion o he esea ch’s goal was
made in he i s pa , which was hen ollowed by ques ions on he esponden s’
demog aphics. A e he sec ion on he esponden s’ a i udes owa ds new se ices, o ced
mig a ion, and con inuous in en ion, gene al a i ude ques ions abou echnology use and
pe sonal conside a ions eme ged. A e ha , all he pa icipan s we e ins uc ed o dis ibu e
su eys using he “snowball” app oach o iends and we e in o med ha hei eplies would
be kep anonymous and used only o academic pu poses o sa egua d hei iden i y. The
e hics council a Shenzhen Uni e si y ga e he ques ionnai e i s seal o app o al. This
allowed all pa icipan s o p o ide hei consen o ill ou he ques ionnai e. We used non-
p obabilis ic samples in his a icle because we we e mo e conce ned wi h basic
psychological p ocesses han gene alising he popula ion. S uc u al equa ion modelling
(SEM) me hodology pe mi s using non-p obabilis ic ab idged samples. The s udy aimed o
in es iga e he o ced accep ance phenomena a he han he desc ip i e a angemen o he
popula ion (Hai e al., 2016; Shah e al., 2021). A o al o 262 esponden s we e included in
he inal sample a e elimina ing incomple e eplies (Hai e al., 2017). Table no. 1 p o ides
a ho ough desc ip ion o he sample. The s udy ou comes exhibi ed ha men (54.9%) and
women (45.03%) we e in ol ed almos equally, wi h mo e han 85% o pa icipan s aged 20
o 50 and ha ing a highe educa ion le el.
Table no. 1. Demog aphic in o ma ion
Measu e
Ca ego ies
F equency
Pe cen age
Loca ion
Beijing
157
59.93
Shanghai
9
3.43
Wuhan
82
31.30
O he
14
5.34
Gende
Male
144
54.96
Female
118
45.04
Age
20-35
121
46.19
35-50
104
39.69
51-65
37
14.12
Educa ion
O he
23
8.78
P ima y
45
17.18
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o an AI-Based Heal h Code Sys em in China
564 Am i ea u Economic
Bi ne , M.J., Os om, A.L. and Meu e , M.L., 2002. Implemen ing success ul sel -se ice
echnologies. Academy o Managemen Pe spec i es, [e-jou nal] 16(4), pp. 96-108.
h ps://doi.o g/10.5465/ame.2002.8951333.
Blu , M., Wang, C. and Schoe e , K., 2016. Fac o s In luencing he Accep ance o Sel -
Se ice Technologies: A Me a-Analysis. Jou nal o Se ice Resea ch, [e-jou nal] 19(4),
pp. 396-416. h ps://doi.o g/10.1177/1094670516662352.
B islin, R.W., 1970. Back-T ansla ion o C oss-Cul u al Resea ch. Jou nal o C oss-
Cul u al Psychology, [e-jou nal] 1(3), pp. 185-216. h ps://doi.o g/10.1177/
135910457000100301.
Cao, Z., Xiao, Q., Zhuang, W. and Wang, L., 2022. An empi ical analysis o sel -se ice
echnologies: media ing ole o cus ome powe lessness. Jou nal o Se ices Ma ke ing,
[e-jou nal] 36(2), pp. 129-142. h ps://doi.o g/10.1108/JSM-07-2020-0271.
Chen, X., Ma, Z., Ye, G. and Li, Z., 2022. Usage beha io and sa is ac ion analysis o ee-
loa ing bicycle sha ing sys em se ice: E idence om a Chinese uni e si y campus.
Resea ch in T anspo a ion Business & Managemen , [e-jou nal] 43, a icle no. 100703.
h ps://doi.o g/10.1016/j. bm.2021.100703.
Chong, A.Y.-L., Chan, F.T.S. and Ooi, K.-B., 2012. P edic ing consume decisions o adop
mobile comme ce: C oss coun y empi ical examina ion be ween China and Malaysia.
Decision Suppo Sys ems, [e-jou nal] 53(1), pp. 34-43. h ps://doi.o g/10.1016/
j.dss.2011.12.001.
Chuenyindee, T., Ong, A.K.S., Ramos, J.P., P ase yo, Y.T., Nadli a in, R., Ku a a, Y.B. and
Si iwa e hanasi i, T., 2022. Public u ili y ehicle se ice quali y and cus ome
sa is ac ion in he Philippines du ing he COVID-19 pandemic. U ili ies Policy, [e-jou nal]
75, a icle no. 101336. h ps://doi.o g/10.1016/j.jup.2022.101336.
Collie , J.E. and Kimes, S.E., 2013. Only I I Is Con enien : Unde s anding How
Con enience In luences Sel -Se ice Technology E alua ion. Jou nal o Se ice
Resea ch, [e-jou nal] 16(1), pp. 39-51. h ps://doi.o g/10.1177/1094670512458454.
Cse di, Z. and Kenesei, Z., 2021. A i udes o o ced adop ion o new echnologies in public
anspo a ion se ices. Resea ch in T anspo a ion Business & Managemen , [e-jou nal]
41, a icle no. 100611. h ps://doi.o g/10.1016/j. bm.2020.100611.
Da is, F.D., 1989. Pe cei ed Use ulness, Pe cei ed Ease o Use, and Use Accep ance o
In o ma ion Technology. MIS Qua e ly, [e-jou nal] 13(3), a icle no. 319.
h ps://doi.o g/10.2307/249008.
De eci, M., Öne , S.C., Canı ez, F. and Öne , M., 2019. E alua ion o se ice quali y in
public bus anspo a ion using in e al- alued in ui ionis ic uzzy QFD me hodology.
Resea ch in T anspo a ion Business & Managemen , [e-jou nal] 33, a icle no. 100387.
h ps://doi.o g/10.1016/j. bm.2019.100387.
Feng, W., Tu, R., Lu, T. and Zhou, Z., 2019. Unde s anding o ced adop ion o sel -se ice
echnology: he impac s o use s’ psychological eac ance. Beha iou & In o ma ion
Technology, [e-jou nal] 38(8), pp. 820-832. h ps://doi.o g/10.1080/0144929X.
2018.1557745.
Fenigs ein, A., Scheie , M.F. and Buss, A.H., 1975. Public and p i a e sel -consciousness:
Assessmen and heo y. Jou nal o Consul ing and Clinical Psychology, 43(4), pp. 522-527.
Economic In e e ences
AE
Vol. 26 • No. 66 • May 2024 565
Fishbein, M. and Ajzen, I., 1981. A i udes and o ing beha io : An applica ion o he heo y
o easoned ac ion. P og ess in applied social psychology, 1, pp. 253-313.
Fo nell, C. and La cke , D.F., 1981. E alua ing S uc u al Equa ion Models wi h
Unobse able Va iables and Measu emen E o . Jou nal o Ma ke ing Resea ch,
[e-jou nal] 18(1), a icle no. 9. h ps://doi.o g/10.2307/3151312.
Gelb ich, K. and Sa le , B., 2014. Anxie y, c owding, and ime p essu e in public sel -se ice
echnology accep ance. Jou nal o Se ices Ma ke ing, [e-jou nal] 28(1), pp. 82-94.
h ps://doi.o g/10.1108/JSM-02-2012-0051.
Hai , J.F., Sa s ed , M., Ma hews, L.M. and Ringle, C.M., 2016. Iden i ying and ea ing
unobse ed he e ogenei y wi h FIMIX-PLS: pa I – me hod. Eu opean Business Re iew,
[e-jou nal] 28(1), pp. 63-76. h ps://doi.o g/10.1108/EBR-09-2015-0094.
Hai , J.F., Sa s ed , M., Ringle, C.M. and Gude gan, S.P., 2017. Ad anced issues in pa ial
leas squa es s uc u al equa ion modeling. Los Angeles: SAGE Publica ions Inc.
Johnson, D.S., Ba dhi, F. and Dunn, D.T., 2008. Unde s anding how echnology pa adoxes
a ec cus ome sa is ac ion wi h sel ‐se ice echnology: The ole o pe o mance
ambigui y and us in echnology. Psychology & Ma ke ing, [e-jou nal] 25(5),
pp. 416-443. h ps://doi.o g/10.1002/ma .20218.
Khajeheian, D. and Eb ahimi, P., 2021. Media b anding and alue co-c ea ion: e ec o use
pa icipa ion in social media o newsmedia on a i udinal and beha iou al loyal y.
Eu opean J. o In e na ional Managemen , [e-jou nal] 16(3), a icle no. 499.
h ps://doi.o g/10.1504/EJIM.2021.117524.
Lee, W., Cas ellanos, C. and Ch is Choi, H.S., 2012. The E ec o Technology Readiness on
Cus ome s’ A i udes owa d Sel -Se ice Technology and I s Adop ion; The Empi ical
S udy o U.S. Ai line Sel -Se ice Check-In Kiosks. Jou nal o T a el & Tou ism
Ma ke ing, [e-jou nal] 29(8), pp. 731-743. h ps://doi.o g/10.1080/
10548408.2012.730934.
Liljande , V., Gillbe g, F., Gumme us, J. and Van Riel, A., 2006. Technology eadiness and
he e alua ion and adop ion o sel -se ice echnologies. Jou nal o Re ailing and
Consume Se ices, [e-jou nal] 13(3), pp. 177-191. h ps://doi.o g/10.1016/
j.j e conse .2005.08.004.
Limayem, M., Hi , S.G. and Cheung, C.M.K., 2007. How Habi Limi s he P edic i e Powe
o In en ion: The Case o In o ma ion Sys ems Con inuance. MIS Qua e ly, [e-jou nal]
31(4), a icle no. 705. h ps://doi.o g/10.2307/25148817.
Lin, J.S.C. and Hsieh, P.L., 2007. The in luence o echnology eadiness on sa is ac ion and
beha io al in en ions owa d sel -se ice echnologies. Compu e s in Human Beha io ,
[e-jou nal] 23(3), pp. 1597-1615. h ps://doi.o g/10.1016/j.chb.2005.07.006.
Liu, S., 2012. The impac o o ced use on cus ome adop ion o sel -se ice echnologies.
Compu e s in Human Beha io , [e-jou nal] 28(4), pp. 1194-1201.
h ps://doi.o g/10.1016/j.chb.2012.02.002.
Ma, J., Chan, J., Ris anoski, G., Rajasega a , S. and Leckie, C., 2019. Bus a el ime
p edic ion wi h eal- ime a ic in o ma ion. T anspo a ion Resea ch Pa C: Eme ging
Technologies, [e-jou nal] 105, pp. 536-549. h ps://doi.o g/10.1016/j. c.2019.06.008.
AE
Unde s anding he Fo ced Adop ion
o an AI-Based Heal h Code Sys em in China
566 Am i ea u Economic
Madon, S., 2000. The In e ne and socio‐economic de elopmen : explo ing he in e ac ion.
In o ma ion Technology & People, [e-jou nal] 13(2), pp. 85-101.
h ps://doi.o g/10.1108/09593840010339835.
Maye , R.C., Da is, J.H. and Schoo man, F.D., 1995. An In eg a i e Model o
O ganiza ional T us . The Academy o Managemen Re iew, [e-jou nal] 20(3), a icle no.
709. h ps://doi.o g/10.2307/258792.
Meu e , M.L., Os om, A.L., Bi ne , M.J. and Round ee, R., 2003. The in luence o
echnology anxie y on consume use and expe iences wi h sel -se ice echnologies.
Jou nal o Business Resea ch, [e-jou nal] 56(11), pp. 899-906.
h ps://doi.o g/10.1016/S0148-2963(01)00276-4.
Mi anda, I., Sangüesa-Nebo , M.J., González, A. and Doménech, J., 2022. Impac o s ic
popula ion con inemen on ac u e incidence du ing he COVID-19 pandemic.
Expe ience om a public Heal h Ca e Depa men in Spain. Jou nal o O hopaedic
Science, [e-jou nal] 27(3), pp. 677-680. h ps://doi.o g/10.1016/j.jos.2021.03.007.
Mus a a, S., Hao, T., Qiao, Y., Shah, S.K. and Sun, R., 2022. How a Success ul
Implemen a ion and Sus ainable G ow h o e-Comme ce can be Achie ed in De eloping
Coun ies; a Pa hway Towa ds G een Economy. F on ie s in En i onmen al Science, [e-
jou nal] 10, a icle no. 940659. h ps://doi.o g/10.3389/ en s.2022.940659.
Oh, H., Jeong, M. and Baloglu, S., 2013. Tou is s’ adop ion o sel -se ice echnologies a
eso ho els. Jou nal o Business Resea ch, [e-jou nal] 66(6), pp. 692-699.
h ps://doi.o g/10.1016/j.jbus es.2011.09.005.
Olah, J., Ti on, T.A., Paskus, V. and Alpa o , G., 2021. P e e ences o Cen al Eu opean
consume s in ci cula economy. Ekonomicko-manaze ske spek um, 15(2), pp. 99-110.
Pa k, J., Amendah, E., Lee, Y. and Hyun, H., 2019. M‐paymen se ice: In e play o
pe cei ed isk, bene i , and us in se ice adop ion. Human Fac o s and E gonomics in
Manu ac u ing & Se ice Indus ies, [e-jou nal] 29(1), pp. 31-43.
h ps://doi.o g/10.1002/h m.20750.
Reinde s, M.J., F ambach, R. and Kleijnen, M., 2015. Manda o y use o echnology-based
sel -se ice: does expe ise help o hu ? Eu opean Jou nal o Ma ke ing, [e-jou nal]
49(1/2), pp. 190-211. h ps://doi.o g/10.1108/EJM-12-2012-0735.
Roge s, E.M., Medina, U.E., Ri e a, M.A. and Wiley, C.J., 2005. Complex adap i e sys ems
and he di usion o inno a ions. The Inno a ion Jou nal: The Public Sec o Inno a ion
Jou nal, 10(3), pp. 1-26.
Schepe s, J. and We zels, M., 2007. A me a-analysis o he echnology accep ance model:
In es iga ing subjec i e no m and mode a ion e ec s. In o ma ion & Managemen , [e-
jou nal] 44(1), pp. 90-103. h ps://doi.o g/10.1016/j.im.2006.10.007.
Shah, S.K. and Tang, Z., 2023. Unde s anding he Media ing E ec o Ancho ing P ice in
Ex an Ma u e 4G and Ma ke -C ea ing 5G Technology P oduc s. In e na ional Jou nal
o Inno a ion and Technology Managemen , [e-jou nal] 20(01), a icle no. 2250038.
h ps://doi.o g/10.1142/S0219877022500389.
Shah, S.K., Tang, Z., Ga u o a, B., Oláh, J. and Ace edo-Duque, Á., 2022. Modeling
consume ’s inno a i eness and pu chase in en ion ela ionship ega ding 5G echnology
in China. F on ie s in En i onmen al Science, [e-jou nal] 10, a icle no. 1017557.
h ps://doi.o g/10.3389/ en s.2022.1017557.
Economic In e e ences
AE
Vol. 26 • No. 66 • May 2024 567
Shah, S.K. and Zhongjun, T., 2021. Elabo a ing on he consume ’s in en ion–beha io gap
ega ding 5G echnology: The mode a ing ole o he p oduc ma ke -c ea ion abili y.
Technology in Socie y, [e-jou nal] 66, a icle no. 101657.
h ps://doi.o g/10.1016/j. echsoc.2021.101657.
Shah, S.K., Zhongjun, T., Sa a , A. and XinHao, Z., 2021. Consume ’s in en ion o pu chase
5G: Do en i onmen al awa eness, en i onmen al knowledge and heal h consciousness
a i ude ma e ? Technology in Socie y, [e-jou nal] 65, a icle no. 101563.
h ps://doi.o g/10.1016/j. echsoc.2021.101563.
Siebenhandl, K., Sch ede , G., Smuc, M., May , E. and Nagl, M., 2013. A Use -Cen e ed
Design App oach o Sel -Se ice Ticke Vending Machines. IEEE T ansac ions on
P o essional Communica ion, [e-jou nal] 56(2), pp. 138-159.
h ps://doi.o g/10.1109/TPC.2013.2257213.
Song, Z., Hu, Y., Zheng, S., Yang, L. and Zhao, R., 2021. Hospi al pha macis s’
pha maceu ical ca e o hospi alized pa ien s wi h COVID-19: Recommenda ions and
guidance om clinical expe ience. Resea ch in Social and Adminis a i e Pha macy, [e-
jou nal] 17(1), pp. 2027-2031. h ps://doi.o g/10.1016/j.sapha m.2020.03.027.
Tan, S. 2020. China’s No el Heal h T acke : G een on Public Heal h, Red on Da a
Su eillance. [online] A ailable a : <h ps://www.csis.o g/blogs/ us ee-china-
hand/chinas-no el-heal h- acke -g een-public-heal h- ed-da a-su eillance > [Accessed
13 Sep embe 2023]
T ampe, D., Konuş, U. and Ve hoe , P.C., 2014. Cus ome Responses o Channel Mig a ion
S a egies Towa d he E-channel. Jou nal o In e ac i e Ma ke ing, [e-jou nal] 28(4), pp.
257-270. h ps://doi.o g/10.1016/j.in ma .2014.05.001.
Ullah, M., Sohail, H.M., Khan, M.A., Zada, H., Ko aco a, M. and Oláh, J., 2023. Nexus
be ween Economic G ow h and CO2 Emission wi hin he P e iew o Ins i u ional Quali y:
Some New Insigh s om Eu ope. Am i ea u Economic, [e-jou nal] 25(64), pp. 849-866.
h ps://doi.o g/10.24818/EA/2023/64/849.
Waheed, M., Kau , K., Ain, N. and Sanni, S.A., 2015. Emo ional a achmen and
mul idimensional sel -e icacy: ex ension o inno a ion di usion heo y in he con ex o
eBook eade . Beha iou & In o ma ion Technology, [e-jou nal] 34(12), pp. 1147-1159.
h ps://doi.o g/10.1080/0144929X.2015.1004648.
Webs e , J. and Ma occhio, J.J., 1992. Mic ocompu e Play ulness: De elopmen o a
Measu e wi h Wo kplace Implica ions. MIS Qua e ly, [e-jou nal] 16(2), pp. 201-226.
h ps://doi.o g/10.2307/249576.
Whi e, A., B eazeale, M. and Collie , J.E., 2012. The E ec s o Pe cei ed Fai ness on
Cus ome Responses o Re aile SST Push Policies. Jou nal o Re ailing, [e-jou nal]
88(2), pp. 250-261. h ps://doi.o g/10.1016/j.j e ai.2012.01.005.
Yi, Z.M., Hu, Y., Wang, G.R. and Zhao, R.S., 2020. Mapping E idence o Pha macy
Se ices o COVID-19 in China. F on ie s in Pha macology, [e-jou nal] 11, a icle no.
555753. h ps://doi.o g/10.3389/ pha .2020.555753.
Tang, Z., Shah, S.K., Ahmad, M. and Mus a a, S., 2022. Modeling Consume ’s Swi ching
In en ions Rega ding 5G Technology in China. In e na ional Jou nal o Inno a ion and
Technology Managemen , [e-jou nal] 19(04), a icle no. 2250011.
h ps://doi.o g/10.1142/S0219877022500110.
