Modeling factors explaining the acceptance, actual use and satisfaction of nurses using an Electronic Patient Record in acute care settings: an extension of the UTAUT

Background and purpose: End-user acceptance and satisfaction are considered critical factors for successful implementation of an Electronic Patient Record (EPR). The aim of this study was to explain the acceptance and actual use of an EPR and nurses' satisfaction by testing a theoretical model adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT).

Methods: A multicenter cross-sectional study was conducted in the medical-surgical wards of four hospitals ranked at different EPR adoption stages. A randomized stratified sampling approach was used to recruit 616 nurses. Structural equation modeling techniques were applied.

Results: Support was found for 13 of the model's 20 research hypotheses. The strongest effects are those between performance expectancy and actual use of the EPR (r=0.55, p=0.006), facilitating conditions and effort expectancy (r=0.45, p=0.009), compatibility and performance expectancy (r=0.39, p=0.002). The variables explained 33.6% of the variance of actual use, 54.9% of nurses' satisfaction, 50.2% of performance expectancy and 52.9% of effort expectancy.

Conclusions: Many results of this study support the conclusions of prior research, but some take exception, such as the non-significant relationship between the effort expectancy construct and actual use of the EPR. The results highlight the importance of the mediating effects of the effort expectancy and performance expectancy constructs. Compatibility of the EPR with preferred work style, existing work practices and the values of nurses were the most important factors explaining nurses' satisfaction. The results reveal the complexity of this change and suggest several avenues for future research and for the implementation of IT in healthcare.