DISCUSSION
The results suggest that COVID-19 anxiety has a positive effect on willingness to try telediagnostics, intention to use it and satisfaction with currently available e-health services, confirming hypotheses H1, H2 and H3. However, it should be noted that the negative effect of mistrust in e-health and technology is also demonstrated (hypotheses H4 and H6), and the coefficient is higher in both cases, i.e. fear of coronavirus alone is not sufficient to overcome techno-phobia.
Hypothesis H5 must be rejected, as distrust of technology and e-health does not affect intention to use. This is presumably because the intention to use implies a complete switch to telediagnostics, whereas the intention to try is essentially a one-off, requiring a completely different level of commitment. In the former case, face-to-face contact with doctors would be virtually absent, which could make the process impersonal, and the patient-doctor bond and trust would be lost. Several studies [8, 20, 31] have highlighted the importance of the latter: appropriate doctor-patient communication, friendliness, emotional support or even explaining test results in a simple, understandable way have greatly improved patient satisfaction.
This is probably why mistrust of e-health and technology was not significant and why technological readiness had a negative impact on intention to use. This question does not focus on the technological shortcomings of the services, but on whether the individual would forego the traditional but intimate doctor-patient relationship, which has a major impact on satisfaction. In fact, for those who were more technology-savvy and had more experience with Hungarian e-health services - the logistic regression model clearly showed that they were more likely to have tried services such as EESZT - technological proficiency was associated with a negative sign, i.e. they were even less willing to give up the personal doctor-patient relationship. Hypotheses H7 and H8 must therefore be rejected, as technological literacy has no positive effect on either intention to use or willingness to try.
As expected and in line with the literature, positive attitudes had a significant positive effect on intention to use and willingness to try telediagnostics, as well as satisfaction with the services tried, so that hypotheses H11, H12 and H13 can be accepted. The positive effect of individual benefits on intention to try and willingness to use (H9) also confirmed expectations, while the expected social benefits were not significant in any of the models (H10 is therefore rejected). This is not surprising, as perceived social benefits have not been reported as a relevant factor in the literature, in contrast to e.g. social pressure [11, 26, 54] - it will be useful to include the phenomenon of perceived social pressure in future research on e-health.
It is clear that the uncertainty and fear caused by the pandemic has had a positive impact on perceptions of e-health and may increase the willingness to try new technologies. However, it is unlikely to be enough on its own to achieve widespread acceptance of e-health. Mistrust of the technology seems to be a more relevant factor in the results, and positive attitudes and perceived individual benefits seem to have a greater positive impact. Therefore, it would be useful to launch awareness campaigns that point out the personal benefits of e-health in an easily understandable and clear way, and dispel the general mistrust of the technology.
It should also be noted that the sample is not representative of the society of the Central European country analysed, so there are obvious limitations. The survey used random sampling, which meant that our sample consisted mainly of young people with an average/above-average standard of living. This is probably the reason why several demographic variables (education, income, place of residence) did not reach significance, and it would be desirable to repeat the data collection in the future with a representative sample by gender, age and region. Alternatively, it would be more useful to look at the effects of perceived social pressure rather than social benefits, and it may be interesting to see how e-health and perceptions of available services have changed in almost a year since our sample was taken and the pandemic restrictions were lifted.