Willingness to Use Personal Health Record Systems: A Mixed-Methods Study Among Multi-Ethnic Civil Servants in an Upper-Middle-Income Country

Abstract Background Electronic personal health record (PHR) systems allow individuals to access and manage their medical records seamlessly across healthcare providers to enhance service delivery and health outcomes. The success of the PHR systems depends on people’s willingness to use (WTU) them. Despite the increasing implementation of this technology in Malaysia, there is a lack of official documentation regarding its acceptance or adoption. Given its high implementation costs, it is essential to gauge the public’s WTU, assess the findings, and take appropriate measures to improve it. Methods This study aimed to determine the WTU as well as understand its predictors and insights among multi-ethnic civil servants from 15 ministries in Putrajaya, Malaysia, using a convergent mixed-methods study. The cross-sectional study was based on the Unified Theory of Acceptance and Use of Technology with linear regression analysis. Meanwhile, the generic qualitative study was based on semi-structured interviews with thematic analysis. Results The majority of respondents were willing to use the PHR system both currently and in the future. Significant predictors of performance expectancy (PE), facilitating conditions (FC), and social influence (SI) were integrated with the six themes of PE, FC, SI, effort expectancy (EE), human factors (HF), and perceived risk (PR). PE influenced WTU through health status, convenience, administrative efficiency, and incentives, while FC encompassed accessibility, self-efficacy, and assistance. SI depended on the impact of the healthcare provider, social connections, social media figure, promotion, stranger, and sense of autonomy. As for EE, informants underscored the importance of system integration, stability, and user interface. Additionally, HF extended beyond age, gender, and experience to include race, education, income, and employment. Meanwhile, PR was in regard to security, privacy, information credibility, and legal instruments. Conclusion Addressing these domains through tailored strategies can fulfil population needs, enhance system optimization, increase user acceptance, and support sustainable nationwide PHR system adoption.