The Nature and Role of Perceived Threats in User Resistance to Healthcare Information Technology: A Psychological Reactance Theory Perspective

The Nature and Role of Perceived Threats in User Resistance to Healthcare Information Technology: A Psychological Reactance Theory Perspective

Madison N. Ngafeeson, Joseph A. Manga
DOI: 10.4018/IJHISI.20210701.oa2
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The efforts of the United States government in the past 15 years have included harnessing the power of health information technology (HIT) to improve legibility, lessen medical errors, keep costs low, and elevate the quality of healthcare. However, user resistance is still a barrier to overcome in order to achieve desired outcomes. Understanding the nature of resistance is key to successfully increasing the adoption of HIT systems. Previous research has showed that perceived threats are a significant antecedent of user resistance; however, its nature and role have remained vastly unexplored. This study uses the psychological reactance theory to explain both the nature and role of perceived threats in HIT-user resistance. The study shows that perceived helplessness over process and perceived dissatisfaction over outcomes are two unique instances of perceived threats. Additionally, the results reveal that resistance to healthcare information systems can manifest as reactance, distrust, scrutiny, or inertia. The theoretical and practical implications of the findings are discussed.
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1. Introduction

By the end of 2015, the United States healthcare sector was expected to have completely transitioned from a paper health record system to an electronic health record (EHR) system. It is believed that successful transition will benefit the nation in improving legibility, lessening medical errors, keeping costs low, and boosting the overall quality of care (Blumenthal & Tavener, 2010). But as some researchers have noted, the effective use of, and beneficial outcomes from information systems are not automatically guaranteed (Haddara & Moen, 2017; Lee, Ghapanchi, Talaei-Khoei, & Ray, 2015). As early reports demonstrate, this information technology (IT)-enabled change is meeting with resistance, not altogether uncommon. Physicians, nurses and other practitioners are resisting this change (Buntin, Burke, Hoaglin & Blumenthal, 2011). As other studies have indicated, physicians’ intention to adopt health record systems such as clinical decision support systems (CDSS) is significantly impacted by perceived threats to their professional autonomy and their involvement in making decisions about CDSS (Esmaeilzadeh et al., 2015). Nevertheless, success depends on the effective and efficient use of these systems in getting work done.

Kim and Kankanhalli (2009) have stated that the failure in new systems can be attributed to user resistance. Lapointe and Rivard (2005) developed a framework to conceptualize user resistance to information technology. In their model Lapointe and Rivard (2005) posited that user resistance to an information system results from perceived threats, which in turn evolve from certain initial conditions—an interplay of political and interpersonal factors resulting from people’s interaction with an information system (IS).

Though user resistance to IT and its critical antecedent, perceived threats, have been clearly acknowledged in literature (Lapointe & Rivard, 2012), only few studies have attempted empirical testing of these two constructs. With the exception of Bhattacherjee and Hikmet (2007), and Kim and Kankanhalli (2009); there is almost a dearth of empirically investigated frameworks. Considering the benefits of electronic health record systems and the relative failure in the implementation of these systems, an understanding of the nature and role of a key antecedent of resistance as perceived threats is clearly necessary. The use of diverse theories that afford us different perspectives are also very important.

Health information systems like EHRs play a pivotal role in the collection, storage, and transmission of healthcare data. It is the data generated from these systems that are then analyzed through healthcare analytics to generate the information needed to drive healthcare outcomes. Informaticians and healthcare professionals depend on this information for both tactical and strategic purposes, including: health outcomes improvement, evidence-based medical practice, and e-health research.

This study explores the nature of both user resistance to health IT and perceived threats—defined as a negative assessment that the users make of an IT implementation. We examine the concept through the lens of the psychological reactance theory in the context of electronic health record system. Specifically, this study seeks to answer two questions: (1.) What is the nature of user resistance to health IT? And, (2.) What are the characteristics and role of perceived threats to user resistance to health IT? To address these research questions, the theory of psychological reactance and key insights from justice literature are explored. The proposed model is then empirically tested within a health care setting, using partial least squares (PLS) structural equation modeling.

In the following section, key literature relating to the conceptual background on user resistance to IT is reviewed. Next, the theory and model development is set forth. Third, the research method and analysis are presented. Fourth, the results, discussion are made. Lastly, the conclusions and implications of the research are presented.

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