Disease Characteristics Influence the Privacy Calculus to adopt Electronic Health Records: A randomized controlled trial in Germany

Background: The electronic health record (EHR) is integral to improving healthcare efficiency and quality. Its successful implementation hinges on patient willingness to use it, particularly in Germany where concerns about data security and privacy significantly influence usage intention. Little is known, however, about how specific characteristics of medical data influence patients' intention to use the EHR. Objective: This study aims to validate the Privacy Calculus Model (PCM) in the EHR context and to assess how personal and disease characteristics, namely disease-related stigma and disease time course, affect PCM predictions. Methods: An online survey was conducted to empirically validate the PCM for EHR, incorporating a case vignette varying in disease-related stigma (high/low) and time course (acute/chronic), with 241 German participants. The data were analyzed using SEM-PLS. Results: The model explains R2=71.8% of the variance in intention to use. The intention to use is influenced by perceived benefits, data privacy concerns, trust in the provider, and social norms. However, only the disease's time course, not stigma, affects this intention. For acute diseases, perceived benefits and social norms are influential, whereas for chronic diseases, perceived benefits, privacy concerns, and trust in the provider influence intention. Conclusions: The PCM validation for EHRs reveals that personal and disease characteristics shape usage intention in Germany. This suggests the need for tailored EHR adoption strategies that address specific needs and concerns of patients with different disease types. Such strategies could lead to a more successful and widespread implementation of EHRs, especially in privacy-conscious contexts. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors received no financial support for the research and/or authorship of this article. We also thank the evangelisches Studienwerk Villigst and the German Federal Ministry of Education and Research, who provided the doctoral scholarship (NvK) without which this research would not have been possible. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This Ethics Committee of the Department of Psychology and Ergonomics (Institut fuer Psychologie und Arbeitswissenschaft [IPA]) at Technische Universitaet Berlin approved this study (tracking number: AWB\_KAL\_1_230311). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.