Predictors of physicians’ intentions to use clinical practice guidelines on antimicrobial in tertiary general hospitals of China: a structural equation modeling approach

Abstract

Background With inappropriate use of antimicrobials becoming a great public health concern globally, the issue of applying clinical practice guidelines (CPGs) to regulate the rational use of antimicrobials has attracted increasing attention. Taking tertiary general hospitals in China for example, this study aimed to identify factors to investigate the comprehensive influencing mechanism for physicians’ intention to use CPGs on antimicrobials. Methods Based on the integration of Theory of Planned Behavior (TPB), Technology Acceptance Model (TAM), and Technology-Organization-Environment framework (TOE), a questionnaire survey was conducted covering potential determinants of affecting physicians’ intentions to use CPGs on antimicrobials at the individual level (attitude, subjective norms and perceived risk), technical level (relative advantage and ease of use), and organizational level (top management support and organizational implementation). Data were collected from 644 physicians in tertiary general hospitals in eastern, central and western China, which were obtained by multi-stage random sampling. The structural equation modeling (SEM) was used to link three-level factors with physicians’ behavioral intentions. Results The majority of the participants (94.57%) showed a positive tendency toward intention to use CPGs on antimicrobials. The reliability and validity analysis showed the questionnaire developed from the theoretical model was acceptable. SEM results revealed physicians’ intentions to use CPGs on antimicrobials was associated with attitude (β = 0.166, p < 0.05), subjective norms (β = 0.244, p < 0.05), perceived risk (β = − 0.113, p < 0.05), relative advantage (β = 0.307, p < 0.01), top management support (β = 0.200, p < 0.05) and organizational implementation (β = 0.176, p < 0.05). Besides, subjective norms, perceived risk, relative advantage, ease of use, and top management support showed their mediating effects from large to small on the intentions, which were 0.215, 0.140, 0.103, 0.088, − 0.020, respectively. Conclusions This study revealed the significance of multifaceted factors to enhance the intention to use CPGs on antimicrobials. These findings will not only contribute to the development of targeted intervention strategies on promoting the use of CPGs on antimicrobials, but also provide insights for future studies about physicians’ adoption behaviors on certain health services or products.

Effect of multifaceted social norms on physicians’ use of clinical practice guidelines on antimicrobials: Evidence from secondary and tertiary general hospitals in central-western China

“…TNSB believes that organizational criterion is one of the most important factors in uencing the behavior intention of organization members, which subsequently in uence the nal practice (14). Meanwhile, the indirect effect of organizational criterion on behavior intention with attitude as a key intermediate factor was also con rmed in previous studies (21,24).…”

Differences in influencing mechanism of clinicians’ adoption behavior for liver cancer screening technology between the leading and subordinate hospitals within medical consortiums

“…Furthermore, this effect manifested consistently in leading hospitals and subordinate hospitals. It appeared that when clinicians recognized the value of adopting hepatic CEUS and perceived less resistance to its application in clinical practice, they would form favorable attitudes and perceived behavioral control, which in turn improved their intentions to adopt corresponding behaviors [ 42 , 43 ]. Thus, it reminds us that more importance can be stressed on taking measures to make clinicians’ attitudes more positive toward regarding technologies and optimize their evaluation of the use.…”

Using Multilevel Structural Equation Modeling (MSEM) to Identify the Predictors and Influencing Mechanism of Technology Use Among Chinese Physicians: An Example from Des-Gamma-Carboxy Prothrombin (DCP)

“… 47 The “invisible norms” formed by the hospital’s long-term readiness to adopt new technologies can unknowingly affect physicians’ perceptions and even actual technology use behavior. 48 On the other hand, the implementation of technology use promotion often occurs when hospitals advocate self-innovation.…”

“…47 The "invisible norms" formed by the hospital's long-term readiness to adopt new technologies can unknowingly affect physicians' perceptions and even actual technology use behavior. 48 On the other hand, the implementation of technology use promotion often occurs when hospitals advocate self-innovation. Notably, although no direct effects of TA and PEP on technology use were found, their mediation effects were observed through VC and EOP, respectively.…”