Educational Disparities in Virtual Healthcare App Acceptance: A Multi-Group TAM Analysis Among Existing Users in West Bengal, India

Background: Education may play a role in digital health adoption. Yet, how exactly it influences the Technology Acceptance Model (TAM) among existing users of virtual healthcare consultation apps is not clear in India. This paper explores whether different levels of education change the effects of main TAM variables on the acceptance of virtual healthcare apps by the people of West Bengal, India. The study focuses on existing users of virtual healthcare consultation apps. Methods: This quantitative cross-sectional study collected data from 341 individuals from three education groups through online-only recruitment. The study used a 19-item questionnaire adapted from validated TAM, technology acceptance and telehealth studies on virtual healthcare app usage and purposive stratified sampling was used to ensure group representation. After assessing reliability, validity and measurement invariance, multi-group structural equation modelling in IBM AMOS 20.0 was used to test five moderation hypotheses. Results: The measurement model across the three education groups produced the results of reliability and validity within acceptable limits. Configural and metric invariance were both supported. However, the structural weights model demonstrated a significant chi-square difference which pointed to path coefficients varied across the groups. Education significantly moderated the influence of attitude on behavioural intention (Δχ² = 18.063, df = 2, p<0.001) and the influence of behavioural intention on actual use (Δχ² = 15.789, df = 2, p<0.001). The effects of trust on attitude, perceived usefulness on attitude and perceived ease of use on attitude were not significantly moderated by education. Conclusion: Education level significantly moderated two of the five TAM pathways examined: The relationship between attitude and behavioural intention and the relationship between behavioural intention and actual use. The relationships from trust, perceived usefulness and perceived ease of use to attitude were not significantly moderated by education. Therefore, in digital health research, education factor evaluation when considering TAM pathways across user groups should not be overlooked.