The Impact Of Nurses' Reactions And Behavioural Intention On The Acceptance And Use Of Hospital Electronic Information Management Systems(HEIMS) In Ghana

Healthcare establishments are urgently enforcing electronic medical records(EMRs)systems throughout the world.EMRs are meant to guide a clinical and nursing group of workers in their day to day work via the potential of digital data processing methods.The EMRs have the possibility of enhancing high-quality medical care while minimizing the expenses of accessing healthcare.Thus,they are considered as an essential technological know-how for healthcare presently and in the years ahead.Consequently,this will probably lead to high-quality healthcare with expanded scientific-based medical and nursing services,coupled with decreased healthcare costs.Usually,the use of such systems in developed nations as well as in some growing nations has already emerged as an actuality.Nursing as a caregiving service is primarily focused on a procedure that entails evaluating,diagnosing,planning,implementing and assessing the care of the affected person,while the documentation in the health report ought to mirror this system.As part of Ghana's digitalization initiative of major organisations,the MOH of Ghana is also doing its best in implementing electronic health record systems in the various hospitals in the country,especially the ones which belong to the state.However,since nurses play a very important role in the medical sector,their technology acceptance assessment is a timely one.In this study,all forms of health technologies and electronic information management platforms are referred to as hospital electronic information management systems(HEIMS).Notably,HEIMS are widely used in Ghana,and hence its performance must be carefully assessed.Nurses as clinical health personnel are the largest cluster of hospital staff and are the pillar of healthcare delivery.The Health Information Management(HIM)unit frequently collaborates with the nursing unit in collecting,analyzing,and disseminating data,creating reports and addressing problems associated with the health records.Therefore,they cannot be ignored in the acceptance or adoption assessment of HEIMS in Ghana.The main objective of this research is to evaluate nurses' readiness in the acceptance and adoption of hospital HEIMS in selected major hospitals in Ghana via the application of the “Unified Theory of Acceptance and Use of Technology(UTAUT)model”.Specifically,the study seeks to;(1).assess the expected performance of nurses and its influence on usage behaviour of HEIMS;(2).evaluate the expected effort of nurses and its influence on usage behaviour of HEIMS;(3).determine the social influence of nurses and its influence on usage behaviour of HEIMS;(4).assess the facilitating conditions of the hospitals and behavioural intentions of nurses that have an influence on usage behaviour of HEIMS;(5).determine whether the computer literacy level of nurses have any substantial effect on their intentions to use HEIMS;and(6).evaluate whether the nurses' “attitude towards the use of information technology(IT)have any influence on their intentions of using HEIMS.A descriptive non-experimental research design was employed in this study to recruit 660 nurses(404 females and 256 Males)from three teachings and two regional hospitals in Ghana.An electronic platform(open data kit mobile application)standardised questionnaire(with the UTAUT based questions as a guide)was designed on smartphones prior to self-administration and analysis with the Smart PLS “Structural Equation Modelling”(SEM)path analysis(including mediation and moderation effects).Indeed,using nurses as the study population is of no coincidence because their duty post is at the frontline of the clinical healthcare system with direct contact to important patient clinical data in Ghanaian hospitals.In this context,issues that are of crucial significance include the authenticity,completeness,timeliness,integrity and safety of both the paper and the digital health data.Nursing services are one key field that has been substantially influenced by health technology usage.In this regard,some knowledge of technology/computing literacy is,therefore,turning into a career prerequisite in many healthcare centres.It is reported that healthcare providers like nurses are discovered to resist technology.More importantly,the successful implementation of any e Health and EHRs critically depends on user acceptance.This study,therefore,assesses Nurses' acceptance of the adoption of HEIMS via the application of the UTAUT model.It was observed that all the respondents used two main types of HEIMS(LHIMS and HAMS)in the regional and teaching hospitals in Ghana.The overall goodness of fit was assessed via some model fit measures.The results of the goodness of fit statistics were acceptable.The structural model was examined via SEM technique with the effects of nine main constructs tested.The main constructs were “performance expectancy”(PE),“effort expectancy”(EE),“social influence”(SI),“attitude towards the use of technology”(ATUT),“facilitation conditions”(FC),“computer self-efficacy”(SE),“computer anxiety”(ANX)as independent variables and “behavioural intentions”(BI)as well as “use behaviour”(UB)of HEIMS serving as the main dependent variables.The independent variables;“PE,EE,SI,ATUT,SE and ANX” all explained a total variance of 61.9%(R2 = 0.619)of BI to use HEIMS without any moderating effects of age,gender,professional experience or voluntariness.In terms of usage behaviour of HEIMS,PE,EE,SI,FC and the mediating role of BI explained 74.9%(R2 = 0.749)of the variance.The structural model was examined once again but this time with the moderating effects of age,gender,professional experience and voluntariness on PE,EE,and SI.PE(moderated by age and gender),EE(moderated by age,gender,and professional experience),SI(moderated by age,professional experience,and voluntariness),ATUT,SE,and ANX all explained a total variance of 90.6%(R2 = 0.906)of BI to use HEIMS.In terms of usage behaviour of HEIMS,PE,EE,SI,FC and the mediating role of BI also explained 74.9%(R2 = 0.749)of the variance.In all,eleven hypotheses were tested.Out of the eleven tested hypotheses,seven of them were supportive or accepted or were proven to be true.Based on these findings,hospital administrators should put measures in place to ensure a conducive working environment for the nurses to continue using HEIMS as well as encourage and support them to adopt and use the system.Hospital managers should also continue to provide the necessary IT resources needed for HEIMS usage.The results of this study provide empirical and scientific contributions to aid a better understanding of the behavioural issues regarding the readiness of nurses in the adoption of HEIMS in Ghanaian Hospitals.The outcome of this study will enrich the literature in this area and create an important awareness that will initiate further research,especially in developing countries.