| Description |
Implementation of evidence-based techniques, such as computerized protocols, has achieved limited success owing to a behavioral bottleneck"" among clinicians. We describe the development and validation of an instrument, for assessing critical care clinicians' perceptions about use of computerized protocols. We developed a 35-item instrument based on the constructs of a cognitive model we previously proposed. Following minor revisions to ensure content and semantic validity the instrument was administered to 240 clinicians (132 nurses, 53 physicians and 55 respiratory therapists), in three health-care institutions. Principal components analysis was used for extraction of factors. We report the clinicians' perceived likelihoods of 15 outcomes related to use of computerized protocols. Principal components analysis identified nine factors, explaining 66% of the total variance. Beliefs regarding Self-Efficacy' ((3 = 0.185, p<0.001) was the most important predictor of the outcome (Behavioral Intention) and explained 26% of the total variance. Other factors contributing to this outcome were Environmental Support, Role Relevance, Work Identity, Beliefs regarding Control, Information Quality, Social Pressure and Culture. Results supported the reliability and construct validity of each of the above scales. Clinicians' identified 'Improvement of data collection' (Mean±SD) (73.45±22.44), 'Uniformity of care' (71.83±20.64), 'Dependence on computers' (71.49±26.40), ability to 'Track logic of protocol' (68.56±22.44) and 'Improve patients' quality of care' (68.49±22.75) as the most important factors. Clinicians' perceptions are critical predictors of computerized protocol adoption in routine practice. Development of instruments for measurement of clinician attributes that predict computerized protocol use should help us to design and implement computerized protocols that meet the needs of critical care medicine."" |
