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The purpose of this study is to propose a hybrid model integrating the expectation-confirmation model with the views of cognitive absorption (CA) theory and updated DeLone and McLean information system success model to examine whether quality factors as antecedents to medical professionals’ beliefs can affect their continuance intention of the cloud-based e-learning system.

This study’s sampling frame was taken from among medical professionals working in hospitals with over 300 beds in Taiwan which had implemented the cloud-based learning management system (LMS) with a blend of asynchronous and synchronous technologies. Sample data for this study were collected from medical professionals at six hospitals in Taiwan. The data for this study were gathered by means of a paper-and-pencil survey, and each sample hospital that participated in this study was asked to identify a contact person who could distribute the survey questionnaires to medical professionals who had experience in using the cloud-based LMS in their learning. A total of 600 questionnaires were distributed, and 378 (63.0%) usable questionnaires were analyzed using structural equation modeling in this study.

This study proved that medical professionals’ perceived learner–content interaction quality, learner–system interaction quality, service quality, cloud storage service quality and learner–human interaction quality all positively caused their perceived usefulness, confirmation and CA elicited by the cloud-based e-learning system, which jointly explained their satisfaction with the system, and resulted in their continuance intention of the system.

Several limitations and suggestions may open avenues for future research. First, the limitation of self-reported measures should be considered; future research may combine with qualitative data (e.g. semi-structured, narrative, in-depth interviews, focus group interviews and open-ended questions) to get more complete interpretations of medical professionals’ cloud-based e-learning continuance intention. Next, this study’s data were collected from hospitals in Taiwan only; given this study’s limited scope, future research may generalize this study’s sample to the respondents of other national cultural backgrounds and make cross-country comparisons to enhance the completeness of this study. Finally, this study’ results were based on cross-sectional data; future research may use a longitudinal analysis by taking into account the evolution of medical professionals’ cloud-based e-learning continuance intention over time.

This study fully evaluates interaction-related and cloud-related quality determinants through an understanding of medical professionals’ state of CA in explaining their cloud-based e-learning system continuance intention that is difficult to expound with only their utilitarian perception of the system. Hence, the results contribute to deep insights into an all-round quality evaluation in the field of medical professionals’ cloud-based e-learning continuance intention, and extrinsic and intrinsic motivators are both taken into consideration in this study’s theoretical development of medical professionals’ cloud-based e-learning continuance intention to acquire a more comprehensive and robust analysis.

The purpose of this study is to propose the research model integrating the expectation-confirmation model with the views of learning engagement (LE) and extending DeLone and McLean information systems (IS) success model to examine whether quality determinants as antecedents to students' beliefs can influence students' continuance intention of massive open online courses (MOOCs).

Sample data for this study were collected from students enrolled in a comprehensive university in Taiwan. A total of 600 questionnaires were distributed, and 363 (60.5%) useable questionnaires were analyzed using structural equation modeling in this study.

This study proved that students' perceived knowledge quality, system quality, interface design quality, learner–instructor interaction quality, and collaboration quality all positively caused students' perceived usefulness, confirmation and LE in MOOCs, which jointly explained students' satisfaction with MOOCs and subsequently resulted in students' continuance intention of MOOCs.

This study fully evaluates IS-related and interaction-related quality determinants via an understanding of students' state of LE in explaining students' continuance intention of MOOCs that is difficult to expound with only their utilitarian perception of MOOCs. Hence, this study contributes to deep insights into an all-round quality evaluation in the field of MOOCs continuance intention and takes extrinsic and intrinsic motivators into account in the theoretical development of MOOCs continuance intention to acquire a more comprehensive and robust analysis.

The purpose of this study is to propose a research model based on the stimulus-organism-response (S-O-R) model to examine whether media richness (MR), human-system interaction (HSI) and human-human interaction (HHI) as technological feature antecedents to medical professionals’ learning engagement (LE) can affect their learning persistence (LP) in massive open online courses (MOOCs).

Sample data for this study were collected from medical professionals at six university-/medical university-affiliated hospitals in Taiwan. A total of 600 questionnaires were distributed, and 309 (51.5%) usable questionnaires were analyzed using structural equation modeling in this study.

This study certified that medical professionals’ perceived MR, HSI and HHI in MOOCs positively affected their emotional LE, cognitive LE and social LE elicited by MOOCs, which together explained their LP in MOOCs. The results support all proposed hypotheses and the research model accounts for 84.1% of the variance in medical professionals’ LP in MOOCs.

This study uses the S-O-R model as a theoretical base to construct medical professionals’ LP in MOOCs as a series of the psychological process, which is affected by MR and interaction (i.e. HSI and HHI). Noteworthily, three psychological constructs, emotional LE, cognitive LE and social LE, are adopted to represent medical professionals’ organisms of MOOCs adoption. To date, hedonic/utilitarian concepts are more commonly adopted as organisms in prior studies using the S-O-R model and psychological constructs have received lesser attention. Hence, this study enriches the S-O-R model into an invaluable context, and this study’s contribution on the application of capturing psychological constructs for completely explaining three types of technological features as external stimuli to medical professionals’ LP in MOOCs is well-documented.

The purpose of this study is to propose a research model based on the stimulus-organism-response (S-O-R) model to explore whether media richness and social interaction as environmental feature antecedents to nurses’ learning engagement (LE) can affect their continuance intention of massive open online courses (MOOCs) and task performance.

Sample data for this study were collected from nurses at five university-/medical university-affiliated hospitals in Taiwan. A total of 500 questionnaires were distributed, and 303 (60.6%) usable questionnaires were analyzed using structural equation modeling in this study.

This study proved that nurses’ perceived media richness and social interaction in MOOCs positively influenced their behavioral LE and psychological LE elicited by MOOCs, which jointly caused their continuance intention of MOOCs and, in turn, enhance their task performance. The results support all proposed hypotheses and the research model, respectively, explains 84.3% and 63.7% of the variance in nurses’ continuance intention of MOOCs and task performance.

This study uses the S-O-R model as a theoretical base to frame nurses’ continuance intention of MOOCs and task performance as a series of the internal process, which is affected by environmental stimuli (i.e. media richness and social interaction) and organismic states. Noteworthily, while the S-O-R model has been extensively used in prior literature, little research uses this paradigm to expound nurses’ continuance intention of MOOCs in the work settings. Besides, there is a dearth of evidence on the antecedents of nurses’ task performance in the context of MOOCs. Hence, this study’s empirical evidence contributes significantly to the existing literature on bridging the gap of limited evaluation for the research on the impact of nurses’ MOOCs learning on their task performance in the work settings, which is very scarce in the S-O-R view.

The purpose of this study is to propose a research model based on the stimulus-organism-response (S-O-R) model to test whether network externality, gamification and media richness as environmental feature antecedents to learners' learning engagement (LE) can affect their continuance intention of massive open online courses (MOOCs).

Sample data for this study were collected from learners who had experience in taking the gamified MOOCs provided by the MOOC platform launched by a well-known university in Taiwan, and 315 usable questionnaires were analyzed using structural equation modeling in this study.

This study verified that learners' perceived network externality, gamification and media richness in MOOCs positively influenced their behavioral LE, emotional LE and social LE elicited by MOOCs, which collectively caused their continuance intention of MOOCs. The results support all proposed hypotheses, and the research model accounts for 75.6% of the variance in learners' continuance intention of MOOCs.

This study uses the S-O-R model as a theoretical groundwork to construct learners' continuance intention of MOOCs as a series of the internal process, which is influenced by network externality, gamification and media richness. Noteworthily, three psychological constructs, behavioral LE, emotional LE and social LE, are employed to represent learners' organisms of MOOCs usage. To date, the concepts of network externality, gamification and media richness are rarely together adopted as environmental stimuli, and psychological constructs as organisms have received lesser attention in prior MOOCs studies using the S-O-R model. Hence, this study's contribution on the application of capturing psychological constructs for completely expounding three types of environmental features as antecedents to learners' continuance intention of MOOCs is well documented.

This study's purpose is to propose a research model based on the stimulus-organism-response (S-O-R) model to examine whether gamification and social interaction as environmental stimulus antecedents to learners' perceptions of presence can affect their continuance intention of massive open online courses (MOOCs).

Sample data for this study were collected from learners who had experience in taking gamified MOOCs provided by the MOOC platform launched by a well-known university in Taiwan, and 353 usable questionnaires were analyzed using structural equation modeling (SEM).

This study demonstrated that learners' perceived gamification, learner–instructor interaction and learner–learner interaction in MOOCs positively affected their cognitive presence, teaching presence and social presence elicited by MOOCs, which jointly expounded their continuance intention of MOOCs. The results support all proposed hypotheses, and the research model accounts for 72.6% of the variance in learners' MOOCs continuance intention.

This study employs the S-O-R model as a theoretical umbrella to frame learners' MOOCs continuance intention as a series of the internal process, which is influenced by gamification and social interaction. Noteworthily, three psychological constructs of the community of inquiry model (i.e. cognitive presence, teaching presence and social presence) are adopted to represent learners' internal experiences of MOOCs usage. To date, hedonic/utilitarian concepts are more commonly adopted as organisms in prior studies based on the S-O-R model, whereas psychological constructs have received lesser attention. Hence, this study enriches the S-O-R model into an invaluable context.

The purpose of this study is to propose a research model based on the stimulus-organism-response (S-O-R) model to explore whether gamification and personalization as environmental stimuli to learners’ learning engagement (LE) can affect their learning persistence (LP) in massive open online courses (MOOCs) and, in turn, their learning outcomes in MOOCs.

Sample data for this study were collected from learners who had experience in taking gamified MOOCs provided by the MOOCs platform launched by a well-known university in Taiwan, and 331 usable questionnaires were analyzed using structural equation modeling.

This study demonstrated that learners’ perceived gamification and personalization in MOOCs positively influenced their cognitive LE and emotional LE elicited by MOOCs, which jointly explained their LP in MOOCs and, in turn, enhanced their learning outcomes. The results support all proposed hypotheses and the research model, respectively, explaining 82.3% and 65.1% of the variance in learners’ LP in MOOCs and learning outcomes.

This study uses the S-O-R model as a theoretical base to construct learners’ learning outcomes in MOOCs as a series of the psychological process, which is influenced by gamification and personalization. Noteworthily, while the S-O-R model has been extensively used in prior studies, there is a dearth of evidence on the antecedents of learners’ learning outcomes in the context of MOOCs, which is very scarce in the S-O-R view. Hence, this study enriches the research for MOOCs adoption and learning outcomes into an invaluable context.