Citizens Rate Priorities for Public Personal Health Records in Taiwan

Before people adopt a public personal health record (PHR) platform, they form opinions about which of its components matter most. A cross-sectional study conducted in Taiwan has now quantified those pre-adoption value perceptions and tested a new analytical tool for setting implementation priorities. The work, published in Archives of Public Health, applied Importance–Performance Analysis (IPA) together with the Chuchiming Index (ChI) to survey data from internet-using citizens who were asked to evaluate an AI-powered extended PHR platform concept.

The study addressed a recognized gap: value perceptions of individual PHR components at the pre-adoption stage remain underexplored, even though they play a critical role in promoting adoption of public PHRs. IPA itself has limitations, because skewed distributions of evaluations can make it hard to identify which issues deserve priority. The researchers therefore complemented the standard quadrant analysis with the Chuchiming Index, which quantifies improvement priorities numerically.

In the study, participants first watched a video introducing the AI-powered extended PHR platform concept. They then rated the importance and acceptance of platform functions and of system design and security components. Participants were grouped according to whether they had experience using an existing public PHR platform. Because age and income were identified as factors associated with use of the existing platform, the team also carried out stratified IPA analyses by these two characteristics.

The analysis included 177 participants. Across the board, all components showed high importance and acceptance regardless of whether respondents were users or nonusers of the existing public PHR platform—a ceiling effect that is common in public service evaluations and precisely the situation in which plain IPA quadrant placement can obscure priorities. The ChI was used to sharpen the picture within and beyond the quadrants.

Among nonusers, three components—medical record display, wearable data integration, and platform integration—fell into Quadrant II of the IPA grid, the zone typically interpreted as high importance with lower current performance, and all three carried positive ChI values. Among users, no items fell into Quadrant II, yet platform integration still showed a high ChI value, indicating that it remained a priority even for people already familiar with a public PHR platform.

For system design and security, privacy and security assurance recorded the highest ChI values in both groups, users and nonusers alike. This suggests that, whatever a respondent’s hands-on experience, assurance that personal health data are private and secure stood out as the component most in need of strengthening in the move toward a public PHR offering.

The stratified analyses added a sociodemographic dimension. They showed marked differences in value perceptions by usage experience among older adults and among middle-income groups, the two strata examined because of their association with existing platform use. In other words, the same component can be perceived very differently depending on whether an experienced or inexperienced respondent within these groups is evaluating it.

The authors conclude that value perceptions of individual public PHR platform components differ by usage experience and by sociodemographic characteristics. Promoting adoption, they argue, requires optimization strategies that span platform design, system implementation, and user uptake, tailored to the needs of different population groups rather than applied uniformly.

On the methods side, the study positions the Chuchiming Index as a complement to IPA that enhances the identification and interpretation of priorities even under the ceiling effects typical of public service evaluations. The findings are intended to contribute to decision-making on the design and implementation strategies of public PHR platforms. As with any cross-sectional survey, the results capture perceptions at one point in time among internet-using citizens who viewed a concept video, so they reflect stated pre-adoption valuations rather than measured post-adoption behavior; the article is currently shared as an accepted manuscript subject to further edits before the final Version of Record.

Subject of Research: Citizens' value perceptions and implementation priorities for public personal health record platforms in Taiwan, assessed with importance–performance analysis and the Chuchiming Index.

Article Title: Value perceptions and implementation priorities for public PHR adoption in Taiwan: an importance–performance analysis with the Chuchiming Index

Article References: Ono, Y., Chen, C.-C., Chiu, C.-H., Li, Y.-K., Chen, Y.-L., Hsiao, P.-J., Lin, K.-Y., Chen, M., Lin, M.-C., & Chu, C.-M. (2026). Value perceptions and implementation priorities for public PHR adoption in Taiwan: an importance–performance analysis with the Chuchiming Index. Archives of Public Health. https://doi.org/10.1186/s13690-026-02105-9

Image Credits: AI Generated

DOI: 10.1186/s13690-026-02105-9

Keywords: personal health records, Taiwan, importance-performance analysis, Chuchiming Index, digital health, health information systems, cross-sectional study, privacy and security, platform integration, health technology adoption, Value, perceptions