Phansalkar Shobha, Weir Charlene R, Morris Alan H, Warner Homer R
Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84112-5750, USA.
Int J Med Inform. 2008 Mar;77(3):184-93. doi: 10.1016/j.ijmedinf.2007.02.002. Epub 2007 Apr 3.
Implementation of evidence-based techniques, such as explicit computerized protocols, has achieved limited success among clinicians. In this study, we describe the development and validation of an instrument for assessing clinicians' perceptions about use of explicit computerized protocols.
Qualitative assessment of semi-structured interviews with clinicians gave rise to a cognitive model evaluating the factors that motivate clinicians to use explicit computerized protocols. Using these constructs we developed a 35-item instrument which was administered to 240 clinicians (132 nurses, 53 physicians and 55 respiratory therapists), in three health-care institutions.
Factor analysis identified nine factors that accounted for 66% of the total variance cumulatively. Factors identified were: Beliefs regarding Self-Efficacy, Environmental Support, Role Relevance, Work Importance, Beliefs regarding Control, Attitude towards Information Quality, Social Pressure, Culture, and Behavioral Intention. The strongest predictor was Beliefs regarding Self-Efficacy, which accounted for 26% of the total variance of intention to use explicit computerized protocols. Results supported the reliability and construct validity of the instrument.
Clinicians' perceptions play a critical role in determining their intention to use explicit computerized protocols in routine clinical practice. Behavioral theories will help us understand factors predicting clinicians' intention to use explicit computerized protocols and recognize the implications of these factors in the design and implementation of these protocols.
实施循证技术，如明确的计算机化协议，在临床医生中取得的成功有限。在本研究中，我们描述了一种用于评估临床医生对使用明确计算机化协议看法的工具的开发和验证。
对临床医生进行半结构化访谈的定性评估产生了一个认知模型，用于评估促使临床医生使用明确计算机化协议的因素。利用这些结构，我们开发了一个包含35个条目的工具，并在三个医疗机构中对240名临床医生（132名护士、53名医生和55名呼吸治疗师）进行了施测。
因子分析确定了九个因素，这些因素累计占总方差的66%。确定的因素包括：自我效能信念、环境支持、角色相关性、工作重要性、控制信念、对信息质量的态度、社会压力、文化和行为意图。最强的预测因素是自我效能信念，它占使用明确计算机化协议意图总方差的26%。结果支持了该工具的可靠性和结构效度。
临床医生的看法在决定他们在常规临床实践中使用明确计算机化协议的意图方面起着关键作用。行为理论将帮助我们理解预测临床医生使用明确计算机化协议意图的因素，并认识到这些因素在这些协议设计和实施中的影响。
