© 2008 The authors
Journal compilation © 2008 Health Libraries Group.

Health Information and Libraries Journal

,

25

, pp.81–97

81

DOI: 10.1111/j.1471-1842.2008.00777.x

Blackwell Publishing Ltd
The attitudes of health care staff to information
technology: a comprehensive review of the
research literature

Rod Ward*, Christine Stevens*, Philip Brentnall† & Jason Briddon‡, *Faculty of Health and Social Care,
University of the West of England, Bristol, †Healthcare Software Systems, Mansfield Woodhouse and
‡Library Services, University of the West of England, Bristol, UK

Abstract

Objectives

: What does the publicly available literature tell us about the
attitudes of health care staff to the development of information technology in
practice, including the factors which influence them and the factors which may
be used to change these attitudes?

Methods

: Twelve databases were searched for literature published between
2000 and 2005 that identified research related to information technology (IT),
health professionals and attitude. English language studies were included
which described primary research relating to the attitudes of one or more
health care staff groups towards IT. Letters, personal viewpoints, reflections
and opinion pieces were not included.

Results

: Complex factors contribute to the formation of attitudes towards IT.
Many of the issues identified were around the flexibility of the systems and
whether they were ‘fit for purpose’, along with the confidence and experience
of the IT users. The literature suggests that attitudes of practitioners are a
significant factor in the acceptance and efficiency of use of IT in practice. The
literature also suggested that education and training was a factor for encour-
aging the use of IT systems.

Conclusions

: A range of key issues, such as the need for flexibility and usability,
appropriate education and training and the need for the software to be ‘fit for
purpose’, showed that organizations need to plan carefully when proposing the
introduction of IT-based systems into work practices. The studies reviewed did
suggest that attitudes of health care professionals can be a significant factor in
the acceptance and efficiency of use of IT in practice. Further qualitative and
quantitative research is needed into the approaches that have most effect on the
attitudes of health care staff towards IT.

Background

The use of information technology (IT) in the
UK’s National Health Service (NHS) has a long
history. Since the publication of the

Information
for Health

Strategy

1

and more recently England’s
‘National Programme for IT’ (NPfIT), computer
applications within the NHS have been increasing.

2

In Wales related developments have been undertaken
by Informing Healthcare

3

and in Scotland by
eHealth for NHS Scotland.

4

These developments
are not limited to the UK but have international
significance. Around the world similar developments
in IT use are taking place with increased
employment of electronic health records (EHRs),

Correspondence: Rod Ward, Faculty of Health and Social Care,
University of the West of England, Glenside Campus, Blackberry Hill,
Stapleton, Bristol BS16 1 DD, UK. E-mail: rod.ward@uwe.ac.uk

Attitudes of health care staff to IT,

Rod Ward

et al

.

© 2008 The authors
Journal compilation © 2008 Health Libraries Group.

Health Information and Libraries Journal

,

25

, pp.81–97

82

automated administration and increased electronic
sharing of patient information. The importance of
IT in the NHS modernization agenda has been
underpinned by several reports (such as those led
by Derek Wanless in 2002

5

and 2007

6

) and its role
in increasing patient safety and reducing errors
made clear.

7

There is also a large and growing body of liter-
ature about aspects of health informatics related
to policy, hardware, software and implementation.
One of the factors identified as significant in the
introduction of information technology into health
care practice is the attitude of staff that will be
required to use it. In the UK surveys undertaken
by Medix (a market research company in the health
sector) found that the attitudes of doctors and nurses
have shown increasingly negative attitudes.

8,9

The Technology Acceptance Model (TAM)

10,11

may provide a context to study the acceptance,
or otherwise, of IT in the NHS. It has also been
extended by Dixon and Dixon into the Informa-
tion Technology Adoption Model (ITAM),

12,13

which may provide a more comprehensive theoretical
model for this study.
Over twenty years ago, Stronge and Brodt

14

were studying this area in the USA with their
Nurses’ Attitudes Towards Computers (NATC)
questionnaire and others have continued this
work, using similar instruments with different
findings. Sultana

15

and McBride and Nagle

16

found more positive attitudes than Stronge and
Brodt.

14

Schumacher

et al

.

17

found that students
showed more positive attitudes than qualified
staff, but Scarpa and Smeltzer

18

found no dif-
ferences in attitude with nursing experience or
educational level, but had found that experience
with computers was significant. In addition, Schwirian

et al

.

19

had shown gender differences in attitude.
A recent review of the literature on eHealth has
been carried out,

20

but little was included on the
attitudes of staff and students towards these
emerging technologies.

Methods

Literature search

In developing a search strategy, bias may arise
from a number of factors, including the
predilection of journals to publish research with
(statistically) significant findings; for example,



bias for excluding papers not indexed in



and ‘language bias’ from exclusion of
non-English publications.

21

In our review, the
selection of appropriate sources and the
development of the search strategy was a dynamic,
iterative process balancing the expertise and
neutrality of the librarian with the knowledge and
experience of the researchers. The key principle in
our selection was to be as inclusive as possible
within the resources and timescales for the project
whilst being open to the possibility of bias. In
developing our search strategy, we continually traded
sensitivity (recall) against specificity (precision).
Thirteen databases (see Table 1) were identified
as covering relevant material for this review. These
databases were explored in a series of discussions
between the researchers and librarian, which
balanced the knowledge of the librarian on their
characteristics (for example, accessibility, currency
and potential relevance) and the researchers’
knowledge of the subject area. Potential search
terms were applied across all these databases,
enabling us to explore the suitability and function-
ality of their search interface and the significance
of their output to our review.

Developing the search strategy

In tandem with our exploration of databases, a
cyclic, iterative approach to identifying appropriate
search terms was undertaken. Search terms were
Table 1 Databases included in the review
Allied and Complementary Medicine Database (AMED)*
British Nursing Index (BNI)*
Cumulative Index to Nursing and Allied Health Literature (CINAHL)*
EMBASE*
Health Management Information Consortium (HMIC)*
Index to theses
ISI proceedings
Maternity and Infant Care (MIDIRS)*
MEDLINE*
NHS National Research Register
PSYCINFO*
SPORTDISCUS*
ZETOC conference search
*Databases searched via Ovid interface.