Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China.
Front Public Health. 2022 Mar 14;10:778253. doi: 10.3389/fpubh.2022.778253. eCollection 2022.
Promoting technology diffusion and utilization is a key measure to address the great disparity in technical capacity within integrated health systems. However, even the effectiveness and appropriateness regarding technology has been widely recognized, its diffusion and utilization are still stagnant. The mechanisms that influence the technology from being recognized to being widely applied in practice remain largely unknown.
Taking hepatic contrast-enhanced ultrasound (CEUS) as an example, this study aimed to investigate the comprehensive influencing mechanism of organizational atmosphere and organizational practice on the knowledge, attitude, and practice toward diffusion and utilization of hepatic CEUS in the medical alliance.
Based on the integration of organizational ready for change (ORC) and knowledge-attitude-practice (KAP), a structured questionnaire was developed. A multistage random sampling method was applied to investigate physicians who directly use CEUS working at the liver disease-related departments of sampled health institutions. Structural equation modeling (SEM) was used to verify the proposed hypotheses, and determine the relationship between the factors.
In total, 292 physicians were included. SEM results demonstrated that knowledge influenced both attitude and practice, while attitude positively predicted practice. Organizational practice and organizational atmosphere associated positively with each other. Organizational atmosphere positively affected the physicians' attitude toward CEUS diffusion and utilization (β = 0.425, < 0.001), while organizational practice positively affected corresponding knowledge (β = 0.423, < 0.001) and practice (β = 0.275, < 0.001). Additionally, there was a partial mediating effect between organizational practice and physicians' CEUS diffusion and utilization behavior.
By verifying the influencing mechanism of organizational atmosphere and organizational practice on the physicians' KAP of hepatic CEUS diffusion and utilization, this study benefit tailoring strategies for promoting technology diffusion and utilization within medical alliance. It is recommended to develop an organizational atmosphere of advocating technology innovation, establish organizational support mechanism (SM) with multiple concrete supporting countermeasures, and so on.
促进技术扩散和应用是解决综合卫生系统技术能力差距的关键措施。然而，即使技术的有效性和适宜性已得到广泛认可，其扩散和应用仍停滞不前。影响技术从被认可到在实践中广泛应用的机制在很大程度上仍不为人知。
以肝脏超声造影（CEUS）为例，本研究旨在探讨组织氛围和组织实践对医疗联盟中肝脏 CEUS 扩散和应用的知识、态度和实践的综合影响机制。
基于组织变革准备度（ORC）和知识-态度-实践（KAP）的整合，设计了一份结构化问卷。采用多阶段随机抽样方法，调查了在抽样医疗机构的肝病相关科室直接使用 CEUS 的医生。结构方程模型（SEM）用于验证假设，并确定因素之间的关系。
共纳入 292 名医生。SEM 结果表明，知识既影响态度又影响实践，而态度又积极预测实践。组织实践和组织氛围彼此正相关。组织氛围积极影响医生对 CEUS 扩散和应用的态度（β=0.425，<0.001），而组织实践积极影响相应的知识（β=0.423，<0.001）和实践（β=0.275，<0.001）。此外，组织实践与医生 CEUS 扩散和应用行为之间存在部分中介效应。
通过验证组织氛围和组织实践对医生肝脏 CEUS 扩散和应用的 KAP 的影响机制，本研究有助于制定促进医疗联盟内技术扩散和应用的策略。建议营造倡导技术创新的组织氛围，建立具有多种具体支持措施的组织支持机制（SM）等。
