title: Development and validation of a scale to assess attitudes of health care administrators toward the use of e-mail communication between patients and physicians.
abstract: BACKGROUND
  The medical profession has been slow in embracing the e-mail as a means of improving patient communications. Today, most physicians work in group practices where administrators seek to develop standard procedures for care delivery. To understand the slow adoption of e-mail technology among physicians when communicating with their patients, it is important to understand these administrators' attitudes.
  
  
  OBJECTIVE
  The purpose of this study was to develop and purify a scale to measure health care administrators' attitudes toward the use of e-mail communication and identify associations between e-mail communication attitudes and administrators' demographic and practice-related characteristics.
  
  
  METHODS
  A preliminary list of features for e-mail communication was generated by reviewing the literature and Rogers' diffusion theory. The features were grouped initially into 5 hypothesized dimensions: relative advantage, norms (established rules of the social system), complexity, compatibility, and infrastructure. Following pilot testing, the main survey instrument was mailed to a total of 1500 health care administrators. Attitudes toward features of e-mail communication scale were analyzed using exploratory factor analysis with promax rotation. Internal consistency of the scale and its subscales was determined using Cronbach's alpha and item-total correlations.
  
  
  RESULTS
  The overall response rate was 8.7%. Scale purification procedures reduced the preliminary scale of 22 items to a final scale of 20 items. The reliability of the scale measured by Cronbach's alpha was 0.81. Norms was considered the major barrier to e-mail communication, whereas infrastructure was considered a facilitator, and other features like relative advantage, complexity, and compatibility issues were perceived more as a barrier than a facilitator. The item related to and usage of e-mail by staff was statistically significant with the overall scale score (P=0.0095), complexity subscale score (P=0.0168), and infrastructure subscale score (P=0.0480). The relationship between number of years of experience of the administrator and infrastructure subscale score was statistically significant (P=0.0480).
  
  
  CONCLUSIONS
  A scale developed to determine the attitudes of health care administrators regarding e-mail communication between patients and physicians demonstrated adequate content validity and reliability.
authors.affiliation: Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Purdue University, West Lafayette, IN 47907-2051, USA. menakabh@pharmacy.purdue.edu
authors.forename: Menaka
authors.initials: M
authors.lastname: Bhor
authors.forename: Holly L
authors.initials: HL
authors.lastname: Mason
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D004059:Diffusion of Innovation; D034742:Electronic Mail; D005260:Female; D006270:Health Facility Administrators / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D015203:Reproducibility of Results; D012107:Research Design; D011795:Surveys and Questionnaires; D035502:Trust