Applying UTAUT in Clinical Informatics Research.

Author:Abayomi, Owolabi Kehinde

Introduction and background of the study

The importance of theoretical framework in clinical informatics was reinstated by Ocholla and LeRaox (2011) who claim that theoretical framework enhances clinical informatics research clarity, promotes appropriateness of research and ensures effectiveness in research work. Also, Grix (2010:174) highlight the relevance of theoretical framework in clinical informatics by arguing that theoretical framework provides a guideline to research design, result interpretation and data analysis. It is important to note that the application of theoretical framework in research activities has played a great role in research development (Brink et al., 2013:27).

Despite this, many researchers are not aware of the importance of theoretical framework in social informatics studies particularly in sub-Saharan Africa. A search database revealed that there is paucity of literature on the use UTAUT in clinical informatics studies. SCOPUS database which is the largest abstract and citation database of peer review of literature (Sirisathikul and Sirisathinkul, 2015), the data based was used to access the number of articles/papers that have employed UTAUT to underpin their studies between the years 2005 and 2015

Based on the analysis of Scopus data base, it was revealed that about 1,582 articles, journals, books and conference papers used UTAUT in their various studies. With USA have a total publication of 311, Malaysia, 166, China141, UK 136, Taiwan, 126. Coming back to Africa, South Africa takes the lead with 46 publications that used UTAUT from the year 2005-2015 has stated in the methodology, followed by Nigeria with 06, Sudan,03 and Ghana 02. Surprisingly, amongst all these publications only few were tailored toward clinical informatics research. Only four studies used UTAUT to inform their clinical informatics research in South Africa while other countries in the continent failed to record a single study that employed UTAUT to inform their clinical informatics research. Compared with what we have in advanced countries where majority of their studies employed UTAUT to inform their clinical informatics studies.

Studies have found that clinical informatics resources are underutilised among medical doctors in many healthcare facilities which they claimed are causing medical errors and damages to medical operations. In providing solution to this, many technology acceptance theories have been develop to examine information technology acceptance of medical doctors, one of the theories is UTAUT. UTAUT has proven to be a very powerful theoretical tool in the analysis of acceptance, rejection of ICT. Despite this, there is very poor usage of the theory among social informatics scholars. Thomas, Singh and Gaffar (2013) attributed poor use of UTAUT theory to many inconsistencies in research results. Meanwhile, the use of the theory is a very important area of study that examines the relationship between information technology and various professionals such as medical doctors. Yet, many scholars in the field of clinical informatics have not been able to tap the full potential of UTAUT in their studies. This indicates knowledge gap in the application of UTAUT in clinical informatics research.

Based on the foregoing, the study will be examined the relevant of UTAUT in clinical informatics research in order to create awareness about the need to apply the theory in clinical informatics and social informatics studies. The paper started with the introduction and background of the study, methodology, application of the theory, appraisal critiques and application of the theory to clinical informatics.

Methodology for the literature review

One of the crucial stages in a research is the literature review. Ridely (2012:3) defines a literature review as the selection of available documents from published and unpublished sources which contain information ideas, data and evidence written from a particular standpoint to fulfil certain aims or express certain views on the nature of the research or topic and ways in which it will be investigated and the effective evaluation of these documents in relation to research being processed. Literature review is very important for any scientific research. The effective literature review create a solid foundation for academic research, for knowledge advancing and it facilities theory development in academic study.

For the purpose of this research a literature review that synthesizes published work on application of UTAUT in clinical informatics was conducted. There is general review of the relevant publications on the topic and it was not limited to specific years or specific journals.

In order to identify relevant publications addressing the subject matter of the research a structured approach suggested by Webster and Watson (2000) was applied which suggested the following: (1) using keyword to search in relevant journal databases (2) selection of relevant publications with matching criteria (3) intensive reading of identify publications. The literature search for the study was undertaken in a four month period May to September, 2015 as part of my doctorate thesis.

For the purposes of the review, the SCOPUS, EBSCO Host and Goole Scholar were used. Various search strings were used to get relevant information from the data bases which include UTAUT and clinical informatics, ICT in healthcare and e-health. Searches were limited to publications in English.

User acceptance theory

The use of clinical informatics is growing rapidly in healthcare delivery, medical doctors' acceptance of it has not always been impressive (Yarbroughm, 2007). As a result many studies have tried to investigate the behavioural factors that affect the use of clinical informatics among medical doctors (Mourad, 2012; Abubakare et al, 2013 and Olasina et al 2014). Esmanellzadeh et al (2011:18) observe that user acceptance to technology in healthcare environment has not always been successful. Contributing to this, Pyno et al (2013:15) note that adoption of clinical informatics by medical doctors has lagged behind in developing countries. Pare and Trudel (2007:23) note that there is an urgent need to promote the use of clinical informatics by medical doctors in healthcare environment particularly effective in health facilities .They identified various supporting factors that need to be put in place for effective use of clinical informatics which include the provision of technical supports and adequate trainings for medical doctors on its use. On the other hand, Lin and Cheng (2015), point out what factor that determines user acceptance and use of technology such as clinical informatics is actually the user's intention. Based on this there is need to examine the meaning of user acceptance theory

There are many theories relevant to a study of user acceptance of ICT and many of these theories focus on people's intention to engage in a particular behaviour (i.e. adoption and use of ICT) as a relevant conceptual framework. Olasina (2014) notes that research on access and use of information and communication has been informed by a number of theories which include the following are among the accepted models :UTAUT by Venkatesh et al. (2003), Theory of Reasoned Action (TRA) (Fishbein and Ajzen 1975), The Theory of Planned Behaviour (TPB) (Ajzen 1991),The Technology Acceptance Model (TAM) (Davis 1989), the Combined-TAMTPB (Taylor and Todd 1995),Model of PC Utilization (MPCU) (Thompson et al. 1991), Motivational Model (MM) (Davis et al., 1992), Social Cognitive Theory (SCT) (Bandura 1986), Innovation Diffusion Theory (IDT) (Rogers 1995), IS Successful Model (DeLone and Mc Lean, 2003) and Technology Fit Model (Goodhue and Thompson, 1995).

All these models are being widely used in information related research and their use has been received and adopted within clinical informatics studies as well. For the purpose of this study, UTAUT will be employed and the justification for it will be fully discussed in the later part of the research work. The medical profession is information-driven because medical personnel need information for diagnosing, treating and for making decisions on patients' treatment. Ingweren and Javelin (2005:386) describe information seeking for medical practice as a way by which a medical doctor seeks information through the examination of various information sources with the intention to diagnose and treat their patients and also use information for decision making on issues relating to solving medical problems. Marchionini (1995) states ways by which medical doctors can seek for information. This includes the internet, books, journals, professional colleagues, conferences and training.

Information and communication technology is a very important medium of information for the healthcare sector, particularly medical doctors because it has the potentials to improve the quality of services that healthcare users receive, enhances health safety, reduces healthcare costs, reduces medical errors, improves standards and promotes efficiency. Contributing to this,

Lapointe and Rivard (2005) maintain that medical doctors should be encouraged to always use technologies in performing their duties. More-over, the growing rate of the use of information and communication technology in various healthcare facilities around the globe has led to the recognition of technology acceptance as an important issue in the implementation of technology in healthcare facilities (Hu et al, 1999:94; Sun et al 2013:187).

However, Kaplan and Kimberly (2009:291) note that over 40% of adoption of ICT in various hospital environments in the USA has witnessed failure and abandonment. They identify various reasons that could be responsible for this to include lack of adequate knowledge and technical skills on how individuals and firms can adopt information communication and technology for effective job performance. Lewis et al...

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