Abstract
BackgroundThe implementation of clinical decision support systems (CDSSs) as an intervention to foster clinical practice change is affected by many factors. Key factors include those associated with behavioral change and those associated with technology acceptance. However, the literature regarding these subjects is fragmented and originates from two traditionally separate disciplines: implementation science and technology acceptance.ObjectiveOur objective is to propose an integrated framework that bridges the gap between the behavioral change and technology acceptance aspects of the implementation of CDSSs.MethodsWe employed an iterative process to map constructs from four contributing frameworks—the Theoretical Domains Framework (TDF); the Consolidated Framework for Implementation Research (CFIR); the Human, Organization, and Technology-fit framework (HOT-fit); and the Unified Theory of Acceptance and Use of Technology (UTAUT)—and the findings of 10 literature reviews, identified through a systematic review of reviews approach.ResultsThe resulting framework comprises 22 domains: agreement with the decision algorithm; attitudes; behavioral regulation; beliefs about capabilities; beliefs about consequences; contingencies; demographic characteristics; effort expectancy; emotions; environmental context and resources; goals; intentions; intervention characteristics; knowledge; memory, attention, and decision processes; patient–health professional relationship; patient’s preferences; performance expectancy; role and identity; skills, ability, and competence; social influences; and system quality. We demonstrate the use of the framework providing examples from two research projects.ConclusionsWe proposed BEAR (BEhavior and Acceptance fRamework), an integrated framework that bridges the gap between behavioral change and technology acceptance, thereby widening the view established by current models.
Highlights
Every year, significant amounts of resources are invested in medical research globally, an average of 0.19% of the gross domestic product in high-income countries [1]
We propose BEhavior and Acceptance fRamework clinical decision support systems (CDSSs) (BEAR) (BEhavior and Acceptance fRamework), an integrated conceptual framework that bridges the gap between behavioral change and technology acceptance aspects of the implementation of CDSSs
We developed BEAR by employing an iterative process in which two investigators (JC and MZM) mapped constructs reported in the literature as determinants of behavioral change and acceptance of CDSSs
Summary
Significant amounts of resources are invested in medical research globally, an average of 0.19% of the gross domestic product in high-income countries [1]. The ability of a CDSS to provide patient-specific decision support empowers health professionals to make timely decisions at the point of care while reducing medical errors [8,9]. Another benefit of this technology is that the transformation of clinical knowledge into algorithms allows for the correction of areas where documents (eg, clinical practice guidelines) are ambiguous or unclear [10,11,12,13]. Conclusions: We proposed BEAR (BEhavior and Acceptance fRamework), an integrated framework that bridges the gap between behavioral change and technology acceptance, thereby widening the view established by current models
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