The Interplay of Trust and Subjective Norms in Telemedicine Adoption by a Minority Community at Einstein Medical Center Philadelphia

Telemedicine is not released into a social vacuum. In some communities - such as the underserved, low income, mostly minority community served by Einstein Medical Center Philadelphia (EMCP) - the social context presents the medical center with unique challenges centered on a strong community sense of historical discrimination. That context is manifested in people being less inclined to trust symbols of external authority and in their strong reliance on subjective norms. Analyzing 540 survey responses by EMCP emergency department (ED) patients shows that trust in the EMCP portal was the strongest predictor of its acceptance. Being an African American had no effect on portal acceptance compared to others in the community. Importantly, there was a negative interaction effect of subjective norms and trust on portal acceptance - meaning that increasing this trust can reduce the importance of subjective norms or, alternatively, that lower subjective norms may increase the importance of trust in determining acceptance. This moderation may have very practical implications for EMCP because, while it might be challenging for EMCP to change long established subjective norms, it is within their power to increase trust in the portal. Theoretical and practical implications are discussed.