Adopting and validating a technology acceptance model-based paradigm to assess acceptance and satisfaction with electronic health information system by healthcare providers in resource-limited governmental and non-governmental hospitals

Abstract

In resource-limited healthcare settings, adoption of electronic health information systems (EHIS) depends on provider acceptance and satisfaction. This study extended the Technology Acceptance Model (TAM) with Technology-Organization-Environment (TOE) factors to capture contextual influences in Palestinian hospitals. A cross-sectional survey of 220 healthcare professionals (December 2023-June 2024) assessed eight TOE constructs, including relative advantage, system quality, compatibility, complexity, top management support, IT support/training, and competitive pressure, alongside TAM beliefs (perceived usefulness, perceived ease of use) and behavioral intention. Partial least squares structural equation modeling (PLS-SEM) confirmed reliability and validity (indicator loadings 0.76-0.96; Cronbach’s α 0.72-0.91; AVE 0.64-0.91; SRMR 0.075-0.079). The model explained 68% of variance in perceived usefulness, 57% in ease of use, and 74% in behavioral intention. Both ease of use (β = 0.43, p < 0.001) and usefulness (β = 0.39, p < 0.001) significantly predicted intention. System quality positively influenced usefulness (β = 0.30, p < 0.001) and ease of use (β = 0.23, p < 0.001). Competitive pressure was strongly associated with both constructs (PU: β = 0.23, p = 0.004; PEOU: β = 0.37, p < 0.001). Complexity showed no significant effect. Hierarchical regression confirmed TOE-TAM constructs explained 51–76% additional variance beyond demographics. The validated TAM-TOE instrument demonstrated robust psychometric properties and strong explanatory power for EHIS acceptance in resource-constrained contexts. Key levers for implementation include enhancing system quality, leveraging competitive pressure, aligning EHIS with workflows, and reinforcing organizational support. This tool provides evidence-based guidance to accelerate EHIS uptake, optimize clinical processes, and improve patient outcomes.