This study used the theory of planned behavior (TPB), which was extended to include relevant constructs such as computer self-efficacy, anxiety and habit, to investigate registered nurses' (RNs') adoption of healthcare information systems (HIS) in Nova Scotia, Canada. An analysis of data collected from 197 RNs in a cross-sectional survey showed that their attitudes towards HIS were positively impacted by computer self-efficacy and computer anxiety (lack thereof). RNs' attitudes toward HIS and facilitating organizational conditions significantly influenced intentions to use HIS at work. Contrary to prediction, subjective norm did not influence RNs' intentions to use HIS in the research setting. Computer habit mattered for RNs' acceptance of HIS. Information from the study benefits the management of RNs' HIS use in Nova Scotia, in particular, and comparable parts of Canada and the world.
TopIntroduction
Healthcare information systems (HIS), such as clinical decision support systems (CDSS), enterprise or electronic medical record (EMR) systems and electronic health record (EHR) have become valuable assets to clinicians across the world (Silva & Ball, 2002; Kuhn et al., 2006; Combs, 2006; Ludwick & Doucette, 2009; Buntin et al., 2011; Lee et al., 2013). It is accepted that healthcare computing systems provide tangible benefits to healthcare delivery, yet studies have reported that clinicians, including nurses, have not readily accepted HIS and related technologies in work environments (Timmons, 2003; Paré et al., 2011; Montague et al., 2013). In particular, nurses’ underutilization of, and resistance to healthcare technologies are well-documented (Timmons, 2003; Paré et al., 2011; Montague et al., 2013; Griebel et al., 2013).
Underutilization of technologies in healthcare settings is unfavorable given vast amount of money spent to procure such tools (Kuhn et al., 2006; Buntin et al., 2011). Moreover, the gains of HIS will not be fully realized if the people expected to use such applications resist them. Healthcare facilities that do not use HIS efficiently will lose the trust of their patients and be deemed not fit for purpose (Kuhn et al., 2006; Buntin et al., 2011; Lee et al., 2013). Studies designed to investigate factors that positively influence healthcare professionals’ use of HIS and related technologies in healthcare settings merit commendation (Timmons, 2003; Ludwick & Doucette, 2009; Paré et al., 2011; Montague et al., 2013; Lee et al., 2013). To enrich theory development, it is important for perspectives from different parts of the world be entertained.
Theoretical frameworks including the Technology Acceptance Model (TAM) (Davis, 1989), Theory of Planned Behavior (TPB) (Ajzen, 1991), and the Unified Theory of Acceptance and Use of Technology (UTAUT) (Venkatesh et al., 2003) have been used to investigate clinicians’ information systems (IS) adoption or acceptance (Ammenwerth et al., 2003; Dillon et al., 2005; Aggelidis & Chatzoglou, 2009; Asua et al., 2012; Maillet et al., 2015). In a comprehensive review of healthcare studies that used TAM, Holden and Karsh (2010) concluded that this particular framework is limited in composition and may benefit from the addition of relevant constructs or factors. Contrastingly, TPB and UTAUT offer more comprehensive perspectives and have started to gain popularity among healthcare researchers (Chau & Hu, 2002; Dillon et al., 2005; Aggelidis & Chatzoglou, 2009; Schaper & Pervan, 2007; Asua et al., 2012).