IT adoption in social care: A study of the factors that mediate technology adoption

• Author: Xiaojun Wang,Abid Mohammed,Gareth R. T. White,Hing Kai Chan
• DOI: http://doi.org/10.1002/jsc.2200
• Published date: 01 May 2018
• Date: 01 May 2018

RESEARCH ARTICLE

DOI: 10.1002/jsc.2200

Strategic Change. 2018;27(3):267–279. wileyonlinelibrary.com/journal/jsc © 2018 John Wiley & Sons, Ltd. 267

Abstract

Organizaons within the social care sector are faced with demanding changes driven by the gov‐

ernment’s agenda to modernize and an ageing populaon, requiring high quality and personalized

services that are eciency and cost‐eecve, facilitated by complex organizaonal technology.

Eorts to improve the eciency and eecveness of social care provision need to be mindful

of the peculiaries of the sector, in parcular, the poor level of informaon technology (IT) skills

and abilies. Job specicaons will require revision as technology is increasingly integrated with

care workers’ current roles and responsibilies. Social care organizaons that are able to de‐

velop and implement eecve IT strategies may well be able to leverage a signicant compeve

advantage.

1 

|

 INTRODUCTION

There has been an increasing call for research into informaon tech‐

nologies (IT) to facilitate “real change” in the organizaons and societ‐

ies in which they are implemented. Public services in parcular are in

need of development in order to improve their contribuon to society

(Berry & Bendapudi, 2007; Desouza et al., 2007; Wastell & White,

2010). They require targeted research, in collaboraon with expert

praconers (Ward, 2012), to explore the idiosyncrasies of a sector

that diers markedly from the private sector in terms of its purpose,

stang, governance and funding structures (Teo & Ranganathan,

2003). No longer can IT adopon be seen as simply a technology‐

driven organizaonal change, rather it must be viewed as a complex,

iterave process of societal change (Robey & Boudreau, 1999; Walsh,

Ke, & Baskerville, 2010).

Social care concerns the provision of healthcare to individuals

within their own homes (NHS, 2015). As life expectancy increases

and individuals exercise their rights to choose their mode and pro‐

vider of healthcare, social care services play an increasingly important

role in maintaining naonal health (ONS, 2014). Thirty years ago, it

was socially acceptable for people that needed care to be catered

for in long‐stay hospitals, and eecvely to be excluded from society

(Pung People First, 2007). Consequently, social care today forms

a much greater proporon of healthcare provision in the UK with

around 1.6 million people now working in the sector (Eborall, Fenton,

& Woodrow, 2010). An esmated 21,900 organizaons in England,

including the Naonal Health Service, large charies, councils with

social services and small care homes, deliver adult social care (Fenton,

2011).

The “privazaon” of service delivery contracts has led the 150

local authories with social service responsibilies to outsource over

80% of social care services to independent organizaons creang a

highly compeve and fragmented small and medium enterprise

structure (Eborall, 2003). The role of social services departments has

therefore changed to act as a care broker and care manger (Asthana,

2011; Thane, 2009) rather than a provider of direct support.

For these reasons social care organizaons are looking to maxi‐

mize the opportunies aorded to them in order to deliver against

the challenges that lie ahead (Gershon, 2003). Technology is expected

to facilitate the cost‐eecve provision of social care services both

in administrave and managerial processes and in care pracce

(DoH, 2005). Despite the millions spent on researching healthcare

IT, the research community has yet to agree whether informaon

systems (IS) will make healthcare more seamless, ecient, paent‐

centered and safe, or more fragmented, me‐consuming, technol‐

ogy‐centered, and risky (Baines, Wilson, & Walsh, 2010; Dey, Sinha,

IT adopon in social care: A study of the factors that

mediate technology adopon*

Abid Mohammed1 | Gareth R. T. White2 | Xiaojun Wang3 | Hing Kai Chan4

1Arooj Consulng, ClarkstonGlasgow, United

Kingdom

2Faculty of Business and Society, University

of South Wales, United Kingdom

3School of Economics Finance and

Management, University of Bristol, United

Kingdom

4Nongham University Business School

China, United Kingdom

Correspondence

Gareth R. T. White, Faculty of Business

and Society, University of South Wales,

Pontypridd CF37 1DL, UK.

Email: gareth.white@southwales.ac.uk

* JEL classicaon codes: I18, M15.

MOHAMMED et al.

268

& Thirumalai, 2013; Greenhalgh & Stones, 2010; Petrakaki, Barber, &

Waring, 2012).

Studies of technology acceptance, discussed in the following sec‐

ons, have found a range of factors that mediate users’ intenons to

engage with new IS. Few studies, however, have been undertaken that

specically explore the use of technology in a social care seng and

none have yet examined the factors that moderate IT adopon. This

study makes a contribuon to knowledge by examining the moderat‐

ing eects of IT adopon in a Social Care seng in the South

West of England ulizing an adapted Unied Theory of Acceptance

and Use of Technology (UTAUT) framework. Reecng the character‐

iscs of the sector, the moderang eects of Gender, Age and IT Skills

upon behavioral intenon are examined through a survey of social

care workers.

2 

|

 LITERATURE REVIEW

2.1 

|

 Technology use in social care

The Wanless report (2002; p. 102) proposed that “without a major

advance in the eecve use of ICT…the health service will nd it

increasingly dicult to deliver.” There is lile informaon idenfy‐

ing whether nongovernmental healthcare organizaons have in fact

invested in IT. The few examples include the Brandon Trust reviewing

and evaluang its business IS (Stair & Reynolds, 2006). Riley and Smith

(1997) commented that the social care sector had not been a great

user of IT and its applicaon was generally less well developed than in

the rest of the health care sector. They state that social care organiza‐

ons did not start to use IT unl fairly late and that this change was

largely due to the recommendaons of the Griths (1988) report on

Community Care that opened up the provision of social care to the free

market and therefore to more technologically mature care providers.

Most of the literature on technology use in health care sengs indi‐

cates frequent failure in the ability to deliver eecve technology deploy‐

ment. Bhaacherjee and Hikmet (2007) claim that most healthcare IT

development projects focus on system consideraons such as security,

connecvity, and new funconalies, rather than user consideraons

such as the system’s impact on user’s work behaviors. Aarts (2011)

reviews the complexies of healthcare IT and concludes that the majority

of system failures occur during the period of implementaon, and simi‐

lar to Bhaacherjee and Hikmet (2007), note the eect that the imple‐

mentaon had upon users’ work processes. Implementaon failures also

adversely aect future system developments since people are less con‐

dent that implementaon will be successful (Aarts, 2011; Heath, Lu, &

Svensson, 2003; Smith & Smart, 1999; Standish Group, 1995).

Gaining and sustaining commitment to new methods of work‐

ing are problems that are oen associated with the introducon of IS

(Chaey & White, 2010; Riley & Smith, 1997). These problems are par‐

cularly evident in health and social care environments due to a lack

of enthusiasm to use computers, a percepon that investment in IT

removes resources from service users and the purpose for introducing

systems not being communicated eecvely (Riley & Smith, 1997). IT

deployment and usage are oen regarded as a burden that interferes

with their core missions and diverts precious resources from those in

need in order to sasfy bureaucrac requirements (Petrakaki et al.,

2012; Zhang & Guerrez, 2007). The factors that impact upon the

adopon and acceptance of new technologies in this disnct sector

are therefore in need of careful examinaon.

2.2 

|

 Technology acceptance

Organizaons have aempted to take advantage of the advances in

hardware and soware capabilies by invesng in costly IS. Many,

however, have failed to reap the benets of these systems due to the

problem of underulizaon (Venkatesh & Davis, 2000). The successful

use of IS depends not only on the commissioning of technology itself,

but the fact that it has to be accepted and used by employees in order

to improve performance (Marler & Liang, 2012).

Riley and Smith’s (1997) study of IS development and implemen‐

taon in social services is the rst of few studies relang to the use

of technology in the social care sector in England. Later studies exam‐

ined the impact of technology on unskilled work (Munro & Rainbird,

2002) and the relaonship between technology and medical pracce

(Heath et al., 2003) and managing mobile provision for community

healthcare support (Fitch & Adams, 2006). Further studies have been

conducted outside the U.K., comprising a wide range of methods

and contexts and indicate that it is an issue of global concern. These

include an applicaon of the decomposed theory of planned behavior

in a social services seng in the United States (Zhang & Guerrez,

2007), technology power in health and social care in Canada (Poland,

Lehoux, Holmes, & Andrews, 2005), Business Process Reengineering

in Danish social service administraon (Hagedorn‐Rasmussen & Voge‐

lius, 2003), social services contracng in the United States (Romzek

& Johnston, 2005), nursing in Taiwan (Chen, Wu, Su, & Yang, 2008),

physicians in the United States (Bhaacherjee & Hikmet, 2007; Klein,

2007), technology and nursing in Australia (Barnard & Gerber, 1999;

Barnard, 2002), occupaonal therapists’ percepon of informaon

and communicaon technology in Australia (Taylor & Lee, 2005),

Enterprise Resource Planning adopon among surgeons in Denmark

(Jensen & Aanestad, 2007), meeng paents’ needs with ISs in Hol‐

land (Riet, Berg, Hiddema, & Sol, 2001), emergency room caregivers’

use of Radio Frequency Idencaon technology (Chen et al., 2008),

and the process of technology acceptance in a Belgian university hos‐

pital (Devolder, Pynoo, Sijnave, Voaet, & Duyck, 2012).

While numerous models exist for the study of technology accep‐

tance, including technology acceptance model, theory of reasoned

acon, and theory of planned behavior, Venkatesh, Morris, Davis, and

Davis (2003) referred to several prominent models with roots in IS,

psychology, sociology, and innovaon theories when formulang the

UTAUT. Venkatesh et al. (2003) examined the eect of the models’

determinants on intenon. As a general rule it is found that when

behaviors pose no serious problems of control, they can be predicted

from intenons with considerable accuracy (Ajzen, 1988; Sheppard,

Hartwick, & Warshaw, 1988).

The UTAUT framework has been ulized in a variety of studies

to uncover those factors that determine users’ likelihood of using IT.