The mediating role of industry 4.0 awareness in the relationship between artificial intelligence anxiety perceptions and attitudes towards digital technology of private hospitals and intermediary organizations with decertification certificate in medical tourism: The case of Antalya province

In today's rapidly accelerating digitalization process, private hospitals and intermediary institutions operating in the field of medical tourism are undergoing a significant transformation through digital technologies and artificial intelligence–based systems. In this context, employees' attitudes toward technology and their perceptions of artificial intelligence play a critical role in the adoption of digital applications. The primary aim of this study is to examine the mediating role of Industry 4.0 awareness in the relationship between artificial intelligence anxiety levels and attitudes toward technology among employees working in private hospitals and intermediary institutions with a Health Tourism Authorization Certificate in the province of Antalya. The research model was developed within the framework of the Technology Acceptance Model, the Technophobia Approach, and the Diffusion of Innovations Theory. The study was conducted using a quantitative research method. A total of 418 responses were collected through a survey administered to the population determined by purposive sampling; after excluding invalid responses, 382 valid questionnaires were included in the analysis. Data collection tools included the Artificial Intelligence Anxiety Scale, the Attitude Toward Technology Scale, and the Conceptual Awareness of Industry 4.0 Scale. Data were analyzed using SPSS and AMOS software through exploratory and confirmatory factor analyses, correlation and regression analyses, and mediation analysis via Hayes Process Model 4. The results revealed a significant negative relationship between artificial intelligence anxiety and both attitudes toward technology and Industry 4.0 awareness. Additionally, Industry 4.0 awareness was found to have a positive effect on attitudes toward technology. However, the mediating role of Industry 4.0 awareness in the relationship between artificial intelligence anxiety and attitudes toward technology was not statistically significant. The findings emphasize the importance of managing employees' anxiety levels and increasing their awareness during digital transformation processes, offering valuable insights for sectoral strategy and policy development.