title: Moderating effects of voluntariness on the actual use of electronic health records for allied health professionals.
abstract: BACKGROUND
  Mandatory versus voluntary requirement has moderating effect on a person's intention to use a new information technology. Studies have shown that the use of technology in health care settings is predicted by perceived ease of use, perceived usefulness, social influence, facilitating conditions, and attitude towards computer. These factors have different effects on mandatory versus voluntary environment of use. However, the degree and direction of moderating effect of voluntariness on these factors remain inconclusive.
  
  
  OBJECTIVE
  This study aimed to examine the moderating effect of voluntariness on the actual use of an electronic health record (EHR) designed for use by allied health professionals in Hong Kong. Specifically, this study explored and compared the moderating effects of voluntariness on factors organized into technology, implementation, and individual contexts.
  
  
  METHODS
  Physiotherapists who had taken part in the implementation of a new EHR were invited to complete a survey. The survey included questions that measured the levels of voluntariness, technology acceptance and use, and attitude towards technology. Multiple logistic regressions were conducted to identify factors associated with actual use of a compulsory module and a noncompulsory module of the EHR.
  
  
  RESULTS
  In total, there were 93 participants in the study. All of them had access to the noncompulsory module, the e-Progress Note, to record progress notes of their patients. Out of the 93 participants, 57 (62%) were required to use a compulsory module, the e-Registration, to register patient attendance. In the low voluntariness environment, Actual Use was associated with Effort Expectancy (mean score of users 3.51, SD 0.43; mean score of non-users 3.21, SD 0.31; P=.03). Effort Expectancy measured the perceived ease of use and was a variable in the technology context. The variables in the implementation and individual contexts did not show a difference between the two groups. In the high voluntariness environment, the mean score of Actual Use was associated with Performance Expectancy (P=.03), Organization Facilitating Condition (P=.02), and Interest in Internet and Computer (P=.052) in univariate analyses. The only variable left in the logistic regression model was Organization Facilitating Conditions (mean score of users 3.82, SD 0.35; mean score of non-users 3.40, SD 0.48; P=.03), a variable in the implementation context. The factors affecting actual use were different in mandatory and voluntary environments, indicating a moderating effect of voluntariness.
  
  
  CONCLUSIONS
  The results of this study have provided preliminary supports of moderating effects of voluntariness on the use of EHR by allied health professionals. Different factors were identified to be associated with actual use: (1) Ease of Use in mandatory environment, and (2) Organization Facilitating Conditions in voluntary environment. More studies are needed to examine the direction of moderating effects. The findings of this study have potential practical implications. In sum, voluntariness can be a highly relevant and important moderating factor not to be ignored in the design and evaluation of EHR.
authors.affiliation: Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong kong, China (Hong Kong). teresa.ml.chiu@gmail.com.
authors.forename: Teresa Ml
authors.identifier: http://orcid.org/0000-0003-4507-9077
authors.initials: TM
authors.lastname: Chiu
authors.forename: Benny Ps
authors.identifier: http://orcid.org/0000-0002-5947-058X
authors.initials: BP
authors.lastname: Ku
keywords: allied health; attitude towards technology; health information technology; technology acceptance; user behavior