Knowledge, Attitude, and Factors Influencing the Intention to Adopt Clinical Decision Support Systems among Palestinian Physicians in Governmental Hospitals: A Cross-Sectional Studyرسالة ماجستير

Abstract

Introduction: One of the most popular emerging technologies in the healthcare sector is the clinical decision support system (CDSS), a feature provided by electronic health records. CDSS is any application used to aid decision making and provide knowledge regarding treatment, diagnosis, and laboratory testing. Despite the associated benefits, underutilization of CDSS is causing a global challenge. In Palestine no CDSS has been implemented yet, which necessitates exploring the acceptance and attitude level along with the possible factors influencing the intention to adopt CDSS. Objective: To assess the general knowledge and attitude level about CDSS and its distribution by demographic characteristics. Also to determine the effect of performance expectancy (PE), effort expectancy (EE), computer self-efficacy level, level of involvement in decision making, perceived threat to professional autonomy, and social influence on the intention to adopt CDSS. Methods: A validated questionnaire-based survey consisting of seven constructs with 41 items was used as a data collection tool. The constructs were derived from the modified unified theory of acceptance and use of technology (UTAUT). A total of 363 resident doctors and general practitioners (GPs) from three governmental hospitals served as a target population for this study. No eligibility criteria related to individual resident’s characteristics was required. A total of 124 questionnaires were used to conduct the study. Results: Majority of participants were males; accounting for 75% (n= 93), with mean years of experience = 2.9 years. The participants showed a moderate general knowledge level with a high intention to adopt CDSS, both of which weren’t affected by demography, except for clinical experience which positively affected CDSS knowledge. III Our results showed significant effect of performance expectancy (p=0.000, r= 0.469), effort expectancy (p=0.001, r= 0.294), computer self-efficacy level (p=0.015, r= 0.218), perceived threat to professional autonomy (p=0.001, r = - 0.302), and social influence (p=0.047, r= 0.179) on the intention to adopt CDSS. On the other hand, level of involvement in decision making regarding CDSS didn’t affect users’ acceptance (p=0.123, r= 0.140). Conclusion: This thesis provides the basis for successful implementation of CDSS in Palestinian settings. Despite the readiness of Palestinian physicians to adopt CDSS, careful and comprehensive implementation planning is needed. In this regard, several factors were identified as mediators of CDSS adoption, of which performance expectancy and perceived threat to professional autonomy have the strongest effect. Therefore, optimization of the CDSS performance and ensuring physicians’ autonomy are needed to satisfy users’ expectations and needs