Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
I&E Meaningful Research, Bogotá, Colombia.
J Med Internet Res. 2020 Aug 6;22(8):e18388. doi: 10.2196/18388.
The implementation of clinical decision support systems (CDSSs) as an intervention to foster clinical practice change is affected by many factors. Key factors include those associated with behavioral change and those associated with technology acceptance. However, the literature regarding these subjects is fragmented and originates from two traditionally separate disciplines: implementation science and technology acceptance.
Our objective is to propose an integrated framework that bridges the gap between the behavioral change and technology acceptance aspects of the implementation of CDSSs.
We employed an iterative process to map constructs from four contributing frameworks-the Theoretical Domains Framework (TDF); the Consolidated Framework for Implementation Research (CFIR); the Human, Organization, and Technology-fit framework (HOT-fit); and the Unified Theory of Acceptance and Use of Technology (UTAUT)-and the findings of 10 literature reviews, identified through a systematic review of reviews approach.
The resulting framework comprises 22 domains: agreement with the decision algorithm; attitudes; behavioral regulation; beliefs about capabilities; beliefs about consequences; contingencies; demographic characteristics; effort expectancy; emotions; environmental context and resources; goals; intentions; intervention characteristics; knowledge; memory, attention, and decision processes; patient-health professional relationship; patient's preferences; performance expectancy; role and identity; skills, ability, and competence; social influences; and system quality. We demonstrate the use of the framework providing examples from two research projects.
We proposed BEAR (BEhavior and Acceptance fRamework), an integrated framework that bridges the gap between behavioral change and technology acceptance, thereby widening the view established by current models.
临床决策支持系统（CDSS）的实施作为促进临床实践变革的干预措施受到许多因素的影响。关键因素包括与行为改变相关的因素和与技术接受相关的因素。然而，关于这些主题的文献是分散的，并且来源于两个传统上相互独立的学科：实施科学和技术接受。
我们的目的是提出一个综合框架，弥合 CDSS 实施中行为改变和技术接受方面的差距。
我们采用迭代过程，将来自四个贡献框架的结构映射出来——理论领域框架（TDF）；实施研究综合框架（CFIR）；人、组织和技术适配框架（HOT-fit）；以及统一技术接受和使用理论（UTAUT）——以及通过系统综述方法确定的 10 篇文献综述的发现。
由此产生的框架包括 22 个领域：与决策算法的一致性；态度；行为调节；对能力的信念；对后果的信念；意外情况；人口统计学特征；努力期望；情绪；环境背景和资源；目标；意图；干预特征；知识；记忆、注意力和决策过程；医患关系；患者的偏好；绩效期望；角色和身份；技能、能力和能力；社会影响；以及系统质量。我们展示了该框架的使用，提供了来自两个研究项目的示例。
我们提出了 BEAR（行为和接受框架），这是一个综合框架，弥合了行为改变和技术接受之间的差距，从而拓宽了当前模型所确立的观点。
