The Effect of Perceived Usefulness, Trust, and Digital Literacy on Acceptance of Clinical Decision Support Systems Among Healthcare Workers

Filipo David Tamara

doi:10.58344/ihj.v5i2.866

Authors

Filipo David Tamara Universitas Pelita Harapan

DOI:

https://doi.org/10.58344/ihj.v5i2.866

Keywords:

Acceptance, Clinical Decision Support Systems, Digital Literacy, Perceived Usefulness, Trust

Abstract

Clinical Decision Support Systems (CDSS) are increasingly used to support clinical reasoning, patient management, and healthcare quality. However, their successful implementation depends not only on technical performance but also on acceptance among healthcare workers. This study aimed to analyze the effect of perceived usefulness, trust, and digital literacy on the acceptance of CDSS among healthcare workers. A quantitative analytical study with a cross-sectional design was conducted among healthcare workers involved in clinical services, including physicians, nurses, and midwives. Data were collected using a structured questionnaire measuring perceived usefulness, trust, digital literacy, and CDSS acceptance. The data were analyzed using univariate analysis and bivariate analysis with Fisher’s Exact Test and odds ratio estimation. The findings showed that most respondents had good perceived usefulness, good digital literacy, and good acceptance of CDSS, while trust was also generally positive but had a larger moderate proportion compared with other variables. Perceived usefulness significantly influenced CDSS acceptance, with respondents who perceived CDSS as useful being more likely to show good acceptance. Trust was also significantly associated with acceptance, as all respondents with good trust demonstrated good acceptance of CDSS. Digital literacy significantly influenced acceptance as well, indicating that healthcare workers with stronger digital capability were more prepared to accept CDSS in clinical practice. These findings suggest that improving CDSS acceptance requires clear practical benefits, reliable and transparent system performance, and adequate digital readiness supported by training and technical assistance.

References

Abdellatif, A., Bouaud, J., Lafuente?Lafuente, C., Belmin, J., & Séroussi, B. (2021). Computerized Decision Support Systems for Nursing Homes: A Scoping Review. Journal of the American Medical Directors Association, 22(5), 984–994. https://doi.org/10.1016/j.jamda.2021.01.080

Abdellatif, A., Bouaud, J., Tholomier, M., Belmin, J., & Séroussi, B. (2021). Users’ Assessement of the Visualization With Gauges of a Guideline-Based Decision Support System Output: A Qualitative Study of Focus Groups. https://doi.org/10.3233/shti210367

Abell, B., Naicker, S., Rodwell, D., Donovan, T., Tariq, A., Baysari, M., Blythe, R., Parsons, R., & McPhail, S. (2023). Identifying Barriers and Facilitators to Successful Implementation of Computerized Clinical Decision Support Systems in Hospitals: A NASSS Framework-Informed Scoping Review. Implementation Science, 18(1). https://doi.org/10.1186/s13012-023-01287-y

Ahlan, A. R., & Ahmad, B. I. (2022). An Overview of Patient Acceptance of Health Information Technology in Developing Countries: A Review and Conceptual Model. International Journal of Information Systems and Project Management, 3(1), 29–48. https://doi.org/10.12821/ijispm030102

Albahar, F., Farha, R. A., Alshogran, O. Y., Alhamad, H., Curtis, C., & Marriott, J. (2023). Healthcare Professionals’ Perceptions, Barriers, and Facilitators Towards Adopting Computerised Clinical Decision Support Systems in Antimicrobial Stewardship in Jordanian Hospitals. Healthcare, 11(6), 836. https://doi.org/10.3390/healthcare11060836

Karanikolos, M., Adib, K., Muscat, N. A., Bryndova, L., Busse, R., Colombo, F., Davia, S., Dedet, G., Figueras, J., James, C., Lafortune, G., Lessof, S., Litvinova, Y., Morgan, D., Ortiz, D. N., Panteli, D., Permanand, G., Polin, K., Rajan, D., … Guanais, F. (2023). Assessing Health System Performance. https://doi.org/10.1787/4e6b28c0-en

Ayorinde, A., Mensah, D., Walsh, J., Ghosh, I., Ibrahim, S. A., Hogg, J., Peek, N., & Griffiths, F. (2023). Health Care Professionals’ Experience of Using AI: Systematic Review With Narrative Synthesis (Preprint). https://doi.org/10.2196/preprints.55766

Berge, G. T., Granmo, O., Tveit, T. O., Munkvold, B. E., Ruthjersen, A. L., & Sharma, J. (2023). Machine Learning-Driven Clinical Decision Support System for Concept-Based Searching: A Field Trial in a Norwegian Hospital. BMC Medical Informatics and Decision Making, 23(1). https://doi.org/10.1186/s12911-023-02101-x

Biesen, W. V, Cauwenberge, D. V, Decruyenaere, J., Leune, T., & Sterckx, S. (2022). An Exploration of Expectations and Perceptions of Practicing Physicians on the Implementation of Computerized Clinical Decision Support Systems Using a Qsort Approach. BMC Medical Informatics and Decision Making, 22(1). https://doi.org/10.1186/s12911-022-01933-3

Catho, G., Centemero, N. S., Suter, B. W., Vernaz, N., García-Miguel, J. P., Silva, S. D., Valotti, R., Coray, V., Pagnamenta, F., Ranzani, A., Piuz, M.-F., Elzi, L., Meyer, R., Bernasconi, E., & Huttner, B. (2021). How to Develop and Implement a Computerized Decision Support System Integrated for Antimicrobial Stewardship? Experiences From Two Swiss Hospital Systems. Frontiers in Digital Health, 2. https://doi.org/10.3389/fdgth.2020.583390

Asian Development Bank. (2021). Digital Health Implementation Guide for the Pacific. https://doi.org/10.22617/tim210178-2

Dingel, J., Kleine, A., Cecil, J., Sigl, A., Lermer, E., & Gaube, S. (2024). Predictors of Health Care Practitioners’ Intention to Use AI-Enabled Clinical Decision Support Systems: Meta-Analysis Based on the Unified Theory of Acceptance and Use of Technology. Journal of Medical Internet Research, 26, e57224. https://doi.org/10.2196/57224

Fava, V. M. D., & Lapão, L. V. (2024). Provision of Digital Primary Health Care Services: Overview of Reviews. Journal of Medical Internet Research, 26, e53594. https://doi.org/10.2196/53594

Ghorayeb, A., Darbyshire, J., Wronikowska, M. W., & Watkinson, P. (2023). Design and Validation of a New Healthcare Systems Usability Scale (HSUS) for Clinical Decision Support Systems: A Mixed-Methods Approach. BMJ Open, 13(1), e065323. https://doi.org/10.1136/bmjopen-2022-065323

Jones, C., Thornton, J., & Wyatt, J. C. (2021). Enhancing Trust in Clinical Decision Support Systems: A Framework for Developers. BMJ Health & Care Informatics, 28(1), e100247. https://doi.org/10.1136/bmjhci-2020-100247

Jung, H., Park, H., & Lee, H. (2023). Impact of a Decision Support System on Fall-Prevention Nursing Practices. Journal of Patient Safety, 19(8), 525–531. https://doi.org/10.1097/pts.0000000000001168

Kouri, A., Yamada, J., Cheung, J. L. S., Velde, S. V. d., & Gupta, S. (2022). Do Providers Use Computerized Clinical Decision Support Systems? A Systematic Review and Meta-Regression of Clinical Decision Support Uptake. Implementation Science, 17(1). https://doi.org/10.1186/s13012-022-01199-3

Määttä, J., Lindell, R., Hayward, N., Martikainen, S., Honkanen, K., Inkala, M., Hirvonen, P., & Martikainen, T. J. (2023). Diagnostic Performance, Triage Safety, and Usability of a Clinical Decision Support System Within a University Hospital Emergency Department: Algorithm Performance and Usability Study. Jmir Medical Informatics, 11, e46760–e46760. https://doi.org/10.2196/46760

Marinescu, ?erban A., Oncioiu, I., & Ghibanu, A.-I. (2025). The Digital Transformation of Healthcare Through Intelligent Technologies: A Path Dependence-Augmented–Unified Theory of Acceptance and Use of Technology Model for Clinical Decision Support Systems. Healthcare, 13(11), 1222.

Mlakar, I., Smrke, U., Flis, V., Bergauer, A., Kobilica, N., Kampi?, T., Horvat, S., Vidovi?, D., Musil, B., & Plohl, N. (2022). A Randomized Controlled Trial for Evaluating the Impact of Integrating a Computerized Clinical Decision Support System and a Socially Assistive Humanoid Robot Into Grand Rounds During Pre/Post-Operative Care. Digital Health, 8, 205520762211290. https://doi.org/10.1177/20552076221129068

Moghadam, S. T., Sadoughi, F., Velayati, F., Ehsanzadeh, ?Seyed J., & Poursharif, S. (2021). The Effects of Clinical Decision Support System for Prescribing Medication on Patient Outcomes and Physician Practice Performance: A Systematic Review and Meta-Analysis. BMC Medical Informatics and Decision Making, 21(1). https://doi.org/10.1186/s12911-020-01376-8

Morton, K., Santillo, M., Velthoven, M. H. v., Yardley, L., Thomas, M., Wang, K., Ainsworth, B., & Tonkin?Crine, S. (2025). Promoting the Implementation of Clinical Decision Support Systems in Primary Care: A Qualitative Exploration of Implementing a Fractional Exhaled Nitric Oxide (FeNO)-guided Decision Support System in Asthma Consultations. Plos One, 20(2), e0317613. https://doi.org/10.1371/journal.pone.0317613

Murali, M., Ni, M., Karbing, D. S., Rees, S. E., Komorowski, M., Marshall, D. C., Ramnarayan, P., & Patel, B. (2024). Clinical Practice, Decision-Making, and Use of Clinical Decision Support Systems in Invasive Mechanical Ventilation: A Narrative Review. British Journal of Anaesthesia, 133(1), 164–177. https://doi.org/10.1016/j.bja.2024.03.011

Nascimento, I. J. B. do, Abdulazeem, H. M., Vasanthan, L., Martínez, E. Z., Zucoloto, M. L., Østengaard, L., Azzopardi?Muscat, N., Zapata, T., & Novillo-Ortiz, D. (2023). Barriers and Facilitators to Utilizing Digital Health Technologies by Healthcare Professionals. NPJ Digital Medicine, 6(1). https://doi.org/10.1038/s41746-023-00899-4

Olakotan, O., & Yusof, M. M. (2021). The Appropriateness of Clinical Decision Support Systems Alerts in Supporting Clinical Workflows: A Systematic Review. Health Informatics Journal, 27(2). https://doi.org/10.1177/14604582211007536

Peiffer?Smadja, N., Descousse, S., Courrèges, E., Nganbou, A., Jeanmougin, P., Birgand, G., Lenaud, S., Beaumont, A., Durand, C., Delory, T., Bel, J. L., Bouvet, É., Lariven, S., D’Ortenzio, É., Konaté, I., Akotet, M. K. B., Ouédraogo, A., Kouakou, G., Poda, A., … Tanon, A. (2024). Implementation of a Clinical Decision Support System for Antimicrobial Prescribing in Sub-Saharan Africa: Multisectoral Qualitative Study. Journal of Medical Internet Research, 26, e45122. https://doi.org/10.2196/45122

Schwartz, J., George, M., Rossetti, S. C., Dykes, P. C., Minshall, S., Lucas, E., & Cato, K. (2022). Factors Influencing Clinician Trust in Predictive Clinical Decision Support Systems for in-Hospital Deterioration: Qualitative Descriptive Study. Jmir Human Factors, 9(2), e33960. https://doi.org/10.2196/33960

Shermock, S. B., Shermock, K. M., & Schepel, L. (2023). Closed-Loop Medication Management With an Electronic Health Record System in U.S. And Finnish Hospitals. International Journal of Environmental Research and Public Health, 20(17), 6680. https://doi.org/10.3390/ijerph20176680

Silva, A. d., Merolli, M., Fini, N. A., Granger, C. L., Gustafson, O., & Parry, S. M. (2025). Digital Health Interventions in Adult Intensive Care and Recovery After Critical Illness to Promote Survivorship Care. Journal of the Intensive Care Society, 26(1), 96–104. https://doi.org/10.1177/17511437241311105

Sultan, H., Najjar, S., Awartani, F., & Abu?Odah, H. (2024). The Unmet Needs of Adopting Clinical Decision Support System Among Physicians in Palestinian Hospitals. Plos One, 19(12), e0310765. https://doi.org/10.1371/journal.pone.0310765

Tai, A. M. Y., Kim, J. J., Schmeckenbecher, J., Kitchin, V., Wang, J., Kazemi, A., Masoudi, R., Fadakar, H., Iorfino, F., & Krausz, M. (2024). Clinical Decision Support Systems in Addiction and Concurrent Disorders: A Systematic Review and Meta?analysis. Journal of Evaluation in Clinical Practice, 30(8), 1664–1683. https://doi.org/10.1111/jep.14069

Thiruchelvam, K., Hasan, S. S., Pudmenzky, A., Wong, P. S., & Kairuz, T. (2022). Development, Validation and Evaluation of an Online Medication Review Tool (MedReview). Plos One, 17(6), e0269322. https://doi.org/10.1371/journal.pone.0269322

Tromp, J., Jindal, D., Redfern, J., Bhatt, A. B., Séverin, T., Banerjee, A., Ge, J., Itchhaporia, D., Jaarsma, T., La?as, F., Lopez?Jimenez, F., Mohamed, A., Perel, P., Pérez, G., Pinto, F. J., Vedanthan, R., Verstrael, A., Yeo, K. K., Zulfiya, K., … Cowie, M. (2022). World Heart Federation Roadmap for Digital Health in Cardiology. Global Heart, 17(1). https://doi.org/10.5334/gh.1141

Tun, H. M., Rahman, H. A., Naing, L., & Malik, O. A. (2025). Trust in Artificial Intelligence–Based Clinical Decision Support Systems Among Health Care Workers: Systematic Review. Journal of Medical Internet Research, 27, e69678–e69678. https://doi.org/10.2196/69678

Voigt, W., & Trautwein, M. (2022). Improved Guideline Adherence in Oncology Through Clinical Decision-Support Systems: Still Hindered by Current Health IT Infrastructures? Current Opinion in Oncology, 35(1), 68–77. https://doi.org/10.1097/cco.0000000000000916

Wang, D., Wang, L., Zhang, Z., Wang, D., Zhu, H., Gao, Y., Fan, X., & Tian, F. (2021). “Brilliant AI Doctor” in Rural Clinics: Challenges in AI-Powered Clinical Decision Support System Deployment. 1–18. https://doi.org/10.1145/3411764.3445432

Wang, J., Zhou, Y., Tan, K., Zhigang, Y., & Li, Y. (2025). Acceptance of Artificial Intelligence Clinical Assistant Decision Support System to Prevent and Control Venous Thromboembolism Among Healthcare Workers: An Extend Unified Theory of Acceptance and Use of Technology Model. Frontiers in Medicine, 12. https://doi.org/10.3389/fmed.2025.1475577

Westerbeek, L., Bruijn, G. d., Weert, H. v., Abu?Hanna, A., Medlock, S., & Weert, J. C. v. (2022). General Practitioners’ Needs and Wishes for Clinical Decision Support Systems: A Focus Group Study. International Journal of Medical Informatics, 168, 104901. https://doi.org/10.1016/j.ijmedinf.2022.104901

Wingfield, L., Salaün, A., Khan, A., Webb, H., Zhu, T., & Knight, S. (2023). Clinical Decision Support Systems Used in Transplantation: Are They Tools for Success or an Unnecessary Gadget? A Systematic Review. Transplantation, 108(1), 72–99. https://doi.org/10.1097/tp.0000000000004627

Withall, J., Schwartz, J., Usseglio, J., & Cato, K. (2022). A Scoping Review of Integrated Medical Devices and Clinical Decision Support in the Acute Care Setting. Applied Clinical Informatics, 13(05), 1223–1236. https://doi.org/10.1055/s-0042-1759513

Zhang, X., Jiang, H., & Ozanich, G. (2023). Clinical Decision Support Systems for Diabetes Care: Evidence and Development Between 2017 and Present. https://doi.org/10.5772/intechopen.108509

Zhao, C., Liang, N., Zhang, H., Li, H., Yang, Y., Zong, X., Chen, Y., Wang, Y., & Shi, N. (2023). Harnessing the Power of Clinical Decision Support Systems: Challenges and Opportunities. Open Heart, 10(2), e002432. https://doi.org/10.1136/openhrt-2023-002432