Optimistic or Uncomfortable? Examining Privacy Perceptions of Immigrants Towards Blockchain-based Personal Health Record Adoption

Personal medical health records (PHRs) have improved patient access and control over personal health information. However, adoption rates remain low due to barriers, including accessibility and privacy concerns. These challenges are further amplified among immigrants through digital divides. Solutions such as blockchain-based PHRs have been touted to alleviate challenges while providing agency to patients. Yet, implementing blockchain elicits novel privacy challenges. As such, this study explores immigrant adoption intentions towards blockchain-based PHR systems from a privacy perspective. An extended privacy calculus model is developed to include technology perceptions, optimism, discomfort, cultural dimensions, uncertainty avoidance and collectivism. The model was tested using cross-sectional survey data, which were analyzed using partial least squares structural equation modelling (PLS-SEM). The results support the majority of the model hypotheses. Technological optimism and uncertainty avoidance enhance perceived adoption benefits while discomfort raises privacy risks. Risks and benefits are then weighed against each other to determine adoption intentions.