Department of Health Management, Room 108 in the Building for School of Public Health, Fujian Medical University, No. 1 Xuefubei Road, Minhou District, Fuzhou, 350122, China.
BMC Med Inform Decis Mak. 2021 May 31;21(1):173. doi: 10.1186/s12911-021-01540-8.
The promotion of early diagnosis is undoubtedly effective in reducing the burden of disease. Contrast-enhanced ultrasound (CEUS) is a diagnostic technology for liver cancer, but its implementation faces some challenges. Understanding the influencing factors of CEUS utilization is crucial for its successful implementation. However, such research is rare. The aims of this study were to investigate the status of CEUS utilization and its predictors in China.
Through multistage random sampling, a cross-sectional study design was conducted among physicians in charge of direct use of CEUS working at liver disease-related departments of sampled health institutions. To access the potential influencing factors of physicians' CEUS utilization, a structured questionnaire was developed based on the theoretical model, which was developed by integration of the Theory of Planned Behavior (TPB) and Technology Acceptance Model (TAM). Structural equation modeling was used to verify the proposed hypotheses, and analyze the relationship and mechanism between the factors.
A total of 309 physicians were enrolled. The mean score of utilization behavior was 2.04 (SD = 1.07), and 37.22% above the mean. The favorable fitting results demonstrated that the integration of TAM and TPB was an acceptable model. SEM results also identified physicians' intentions to use CEUS was directly associated with utilization behavior (β = 0.287, P < 0.001). Attitude (β = 0.272, P < 0.001), subjective norm (β = 0.172, P = 0.013), perceived behavioral control (β = 0.491, P < 0.001) and perceived usefulness (β = 0.108, P = 0.027) significantly influenced physicians' intentions. Besides, subjective norm (β = 0.065, P = 0.021), perceived behavioral control (β = 0.141, P = 0.003), and perceived ease of use (β = 0.022, P = 0.033) indirectly affected physicians' CEUS utilization.
The findings provide a reference for understanding the factors associated with physicians' utilization of CEUS. Additionally, the proposed measures such as building innovative and incentive environment, providing high quality and adequate training, etc., will help promote the utilization of CEUS, thereby increasing the detection rate of liver cancer, and improving the survival rate and the quality of life for liver cancer patients.
促进早期诊断无疑可以有效减轻疾病负担。超声造影（CEUS）是一种肝癌诊断技术，但在实施过程中面临一些挑战。了解 CEUS 使用的影响因素对于其成功实施至关重要。然而，此类研究很少。本研究旨在调查中国 CEUS 使用现状及其预测因素。
通过多阶段随机抽样，对来自抽样医疗机构肝病相关科室直接使用 CEUS 的医师进行横断面研究。为了评估医师 CEUS 使用的潜在影响因素，根据理论模型（整合了计划行为理论（TPB）和技术接受模型（TAM））开发了结构化问卷。结构方程模型用于验证假设，并分析因素之间的关系和机制。
共纳入 309 名医师。使用行为的平均得分为 2.04（SD=1.07），高于平均值的 37.22%。拟合良好的结果表明，TPB 和 TAM 的整合是一个可接受的模型。SEM 结果还表明，医师使用 CEUS 的意愿直接与使用行为相关（β=0.287，P<0.001）。态度（β=0.272，P<0.001）、主观规范（β=0.172，P=0.013）、感知行为控制（β=0.491，P<0.001）和感知有用性（β=0.108，P=0.027）显著影响医师的意愿。此外，主观规范（β=0.065，P=0.021）、感知行为控制（β=0.141，P=0.003）和感知易用性（β=0.022，P=0.033）间接影响医师对 CEUS 的使用。
研究结果为了解与医师 CEUS 使用相关的因素提供了参考。此外，还提出了一些措施，如建立创新和激励环境、提供高质量和充足的培训等，这将有助于促进 CEUS 的使用，从而提高肝癌的检出率，改善肝癌患者的生存率和生活质量。
