Understanding Telehealth Adoption: Psychological Needs as a Mediator of Environmental Influences

This study integrates the Push–Pull–Mooring (PPM) framework with Self-Determination Theory (SDT) to explain telehealth adoption through psychological needs. The model links external switching conditions to autonomy, competence, and relatedness, and then links these needs to intention and adoption behavior. In this study, we used a two-phase mixed-methods design with interviews and a survey of U.S. telehealth users. The results show that pull factors, especially information quality and expectation confirmation, strengthen all three psychological needs. These needs increase intention, and intention strongly predicts adoption behavior. However, collectivism weakens the intention–behavior link, because collectivist users may seek social approval before acting, even when they report strong intentions. In addition, fsQCA identifies multiple configurations that lead to adoption, which supports the existence of more than one effective pathway. Overall, telehealth adoption depends on how pull conditions satisfy psychological needs, while collectivism limits how strongly intention turns into actual use.