'Which' in User Acceptance Studies of Healthcare Software

321 Pages·2013·3.58 MB·English

Exploring New Factors and The Question of
‘Which’ in User Acceptance Studies of
Healthcare Software
Noor Azizah KS Mohamadali, MSc.
Thesis submitted to the University of Nottingham
for the degree of Doctor of Philosophy
School of Computer Science
The University of Nottingham
United Kingdom
September 2012
Abstract
Theimportanceofuseracceptanceoftechnologyiscriticalforthesuccessoftechnology
implementationinthehealth-caresector. Spendingontheprocurementofnewtechnology
is growing in the hope of improving patient care as well as providing better services to
thepublic,thusitisimportantthatthetechnologyisusedtoachieveitsintendedpurpose.
Successorfailureoftechnologyimplementationdependsupontheacceptanceoftheuser
and this is evident through the growing number of studies on evaluation particularly on
user acceptance of the technology. While various models and frameworks have been
developed to address factors associated with technology acceptance, they provide little
understanding on the reasons for discrepancies in acceptance of the same system among
different users. In response to this issue, this thesis proposes a theoretical model which
suggests the role of ‘fit’ between user, technology and organization as an antecedent of
user acceptance factors. This model was suggested based on a review of the literature
and was empirically investigated on medical students’ intention to use medically related
software.
The proposed model in this thesis integrates three very well known existing models
namelytheUnifiedTheoryofAcceptanceandUseofTechnology(UTAUT),theDeLone
McLeanISSuccessModelandtheTask-TechnologyFitModel. Themodelisexaminedas
asinglemodel,whichinvestigates(1)theeffectofperceivedfitbetweenuser,technology
and organization on factors defined by UTAUT and the IS Success Model; (2) the effect
of perceived fit between user, technology and organization on management support and
information security expectancy construct; and (3) the effect of management support and
informationsecurityexpectancyonintentiontouse.
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In particular, this thesis seeks to investigate the role of ‘fit’ between user, technology
and organization variable asan antecedent of performance expectancy, effort expectancy,
social influence, facilitating conditions, software quality, service quality, information
quality,managementsupportandinformationsecurityexpectancy. Thisthesisalsoinves-
tigatestheroleofmanagementsupportandinformationsecurityexpectancyconstructson
intention to use which, to the best of researcher’s knowledge, have not been investigated
together with an integrated model, as proposed in this thesis. Further, it presents and
discusses empirical findings from the Internet survey and Drop-off approaches of 113 re-
spondentswhichexaminedstudents’intentiontousemedicallyrelatedsoftwareusingthe
Partial Least Square (PLS) approach to Structural Equation Modeling (SEM). WarpPLS
version 3.0 software was used to analyze the empirical data in this thesis. The findings
of this thesis support the hypothesized relationship proposed in the theoretical model.
Specifically,theresultsrevealedthatperceiveduser-technology-organizationfithasasig-
nificant effect on all the factors defined in the model except for social influence. The
resultsalsoprovidestrongevidenceoftherelationshipsbetweenthemanagementsupport
andinformationsecurityexpectancyconstructswiththeintentiontouseconstruct.
Thisthesiscontributestotheoreticalandpracticalknowledgebyproviding,forthefirst
time, evidence about the relationship between perceived user-technology-organization fit
with constructs defined by both UTAUT and the IS Success Model. Further, the rela-
tionships between perceived user-technology-organization fit with management support
and information security constructs are shown. Additionally this thesis provides empiri-
calsupportontherelationshipbetweenthemanagementsupportandinformationsecurity
expectancy constructs with the intention to use construct. The introduction and inclusion
of organization fit with user and technology fit contributes to the body of knowledge in
evaluationstudiesandprovidesamorecompletemodelwithinuseracceptancestudiesto
help to understand the reasons for different acceptance among users of the same system
ortechnology.
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Further,thisthesisinvestigatestheapplicabilityofthemulti-criteriadecisionanalysis
(MCDA) techniques to answer the question of ‘which’ in evaluation studies particularly
within user acceptance studies. Existing evaluation studies provide the means to answer
thequestionofwhat,why,who,whenandhow,butnotexplicitlythequestionof‘which’.
The question of ‘which’ needs to be explicitly addressed and specifically recognized in
user acceptance studies. Although various studies implicitly provide the answer to the
question of ‘which’, the importance of ‘which’ as the most critical factor or the most
influential factor should be addressed explicitly in user acceptance studies. This thesis
examinedthreewellusedmethodswhichareclassicalAHP,FuzzyAHPChangs’method
and Fuzzy AHP α and λ method, to assign weights between various factors and sub-
factors of user acceptance. Acceptance factors of two different types of software were
computed using each of these methods. The empirical data were collected from medical
students for medically-related software and from research students for research-related
software.
Theapproachesexamined,inthissecondpartofthesis,arenotintendedtoshowwhich
is the best method or techniques to evaluate user acceptance, but rather to illustrate the
various options which are available within MCDA approaches to derive weights among
evaluation items and subsequently provide an answer to address the question of ‘which’
explicitly within user acceptance studies. The results of assigning weights to factors and
sub-factors using three different methods provide strong justification on the applicability
of the MCDA methods as a decision support tool. The results show that these methods
produced the same ranking of the factors which influence user acceptance (with slight
variation using Fuzzy Chang’s method on medical software acceptance). The inclusion
of the ‘which’ question can enhance evaluation studies in the health informatics research
andfindingsrelatedtouseracceptanceofhealth-caretechnology.
Declaration
The work in this thesis is based on research carried out at the Intelligent Modelling and
Analysis (originally, the Automated Scheduling, Optimisation and Planning) Research
Group,theSchoolofComputerScience,theUniversityofNottingham,England. Nopart
ofthisthesishasbeensubmittedelsewhereforanyotherdegreeorqualificationanditall
myownworkunlessreferencedtothecontraryinthetext.
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Dedication
To the memory of my beloved, respected and greatly missed father, Allahyarham Haji
MohamadalibinSyedAbdulKadir.
Withloveandpride...
Tomymother,AminahMohdShariff
Tomyhusband,SheikAbdullahMohamedShahabudden
Tomyparents-in-law,MohamedShahabudeenandShahjahanBeevi
Tomydaughters,NoorAfreenaandNoorAsifa.
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Acknowledgements
Alhamdullilah hi Robbil Allamin to Allah, the Al-Mighty, the Most Beneficient and the
Most Merciful who made this journey possible by granting me the patient, the courage
andthestrength. WithoutHisblessingthisjourneywouldnotbepossible,alhamdullilah.
I would like to offer my sincerest gratitude to my supervisor, Professor Jon Garibaldi
for providing continuous support, guidance and knowledge throughout this research pro-
gramme.
I also would like to thank Professor Ramayah Thurasamy from University of Science
Malaysia(USM)forhisvaluablehelpandadviceespeciallyinthestatisticalaspectofthe
dataanalyses.
I would like to thank many of my colleagues and friends from the Intelligent Mod-
elling and Analysis (IMA) and Automated, Scheduling and Planning (ASAP) research
groups at the University of Nottingham. In particular I would like to thank Dr. Daniele
Soriaforhisadvicesandhelpwithmythesis.
IamalsothankfulforthehelpgiventomebystudentsfromLeicesterUniversitywho
helpedtodistributeandparticipatedinmysurvey.
Special thanks to Erni Yentti Amir for her countless help in taking care of my kids
andalwaysbeingaroundwheneverIneedhelp,cannotthankyouenough.
Aboveall,Iwouldliketothankmyhusband,SheikAbdullahMohamedShahabuden,
for his personal support and great patience to me and my daughters. Huge thanks to both
of my daughter, Noor Afreena and Noor Asifa for their love, especially their patient and
understandingwheneverIam‘down’withmywork.
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Thankstomymother,tomysistersandbrotherandalltheirfamilies,andtomyparent
in-lawfortheirsupportandencouragementthroughoutmyPhDstudy.
Tomydad,KSMohamadaliwhopassedawayon18thFebruary2011,allmysuccess
willnotbepossiblewithoutyoursupportandencouragement,tocreateapersonwhoIam
now, to always be there whenever I need, to cherish me with all your love, who I wished
tobewithmetowitnessmysuccessandIbelieveyoualwaysbethereforme.
Finally, I would like extend my gratitude to my employer, International Islamic Uni-
versity Malaysia (IIUM) and to the government of Malaysia for funding me during the
courseofmydoctoralstudies.
Glossory
TRA TheoryofReasonedAction
TRB TheoryofPlannedBehavior
TAM technologyAcceptanceModel
UTAUT UnifiedTheoryofAcceptanceandUseofTechnology
FITT FitbetweenIndividual,TaskandTechnology
P-OFit Person-OrganizationFit
TTF Task-technologyFit
PUTOF Perceiveduser-technikigy-organizationfit
PE PerformanceExpectany
EE EffortExpectancy
FC FacilitatingCondition
SWQ SoftwareQuality
SERQ ServiceQuality
MS ManagementSupport
ISE InformationSecurityExpectancy
CFA ConfirmatoryFactorAnalysis
SEM StructuralEquationModelling
PLS PartialLeastSquares
MCDA Multi-criteriaDecisionAnalysis
AHP AnalyticHierarchyProcess
AVE AverageVarianceExtract
CR ConsistencyRatio
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Contents
Abstract ii
Declaration v
Dedication vi
Acknowledgements vii
Glossory ix
1 Introduction 1
1.1 BackgroundandMotivation . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 AimsandObjectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3 ResearchQuestions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.4 OverviewofResearchandStudyMethodology . . . . . . . . . . . . . . 7
1.5 OrganisationoftheThesis . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.6 ContributiontoKnowledge . . . . . . . . . . . . . . . . . . . . . . . . . 12
2 LiteratureReviewonUserAcceptanceStudies 14
2.1 SearchStrategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.2 AnOverviewofHealth/MedicalInformatics . . . . . . . . . . . . . . . 16
2.3 EvaluationResearchinHealthInformatics . . . . . . . . . . . . . . . . . 18
2.4 UserAcceptanceStudies . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.5 UnderlyingTheoriesinTechnologyAdoption . . . . . . . . . . . . . . . 23
2.5.1 TheoryofReasonedAction(TRA) . . . . . . . . . . . . . . . . . 23
2.5.2 TheoryofPlannedBehavior(TPB) . . . . . . . . . . . . . . . . 23
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