Factors Associated With Clinicians' Intention to Use Acute Stroke Telemedicine Service: Perceived Usefulness Critical to Uptake.

Introduction: Benefits of acute telestroke services include improving equity of access to acute therapies. However, these benefits require a change in clinicians’ usual practice and there may be resistance to use of technology. We aimed to examine factors associated with clinicians’ intentions to use a new acute telestroke service within rural hospital settings. Methods: A pre-post 6 month design was used during the implementation of the Victorian Stroke Telemedicine (VST) Program in 16 rural hospitals in a south-eastern state of Australia. A survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in the VST program. Five factors comprised between 4-6 items, with responses on a 7 point Likert scale (1=strongly disagree, 7=strongly agree). Surveys were completed between February 2014 and May 2017. Analyses included t-tests and linear regressions. Results: Participants were 303 clinicians (pre-implementation n=167, 66% female, 46% nurses; post-implementation n=136, 74% female, 68% nurses). Mean scores were significantly higher post-implementation than pre-implementation: Perceived Usefulness (pre 5.91, post 6.27; p<.001), Perceived Ease of Use (pre 5.12, post 5.92; p<.001), Social Influence (pre 5.03, post 5.84; p<.001), Facilitating Conditions (pre 5.17, post 6.16; p<.001) and Intention to Use (pre 5.83, post 6.36; p<.001). Intention to Use Telemedicine pre-implementation [Adj R 2 =.41, F(4, 132)=24.26, p<.001] was predicted by Perceived Usefulness ( β =.29, p<.001), Perceived Ease of Use ( β =.22, p=.02), Social Influence ( β =.20, p=.02) but not Facilitating Conditions ( β =.13, p=.16). Post-implementation [Adj R 2 =.69, F(4, 117)=67.07, p<.001], only Perceived Usefulness ( β =.59, p<.001) predicted intentions to use telemedicine. Conclusion: Factors driving intentions to use acute telestroke vary pre- and post-implementation of a new service. Influential colleagues and managers should emphasise the usefulness and ease of use to facilitate uptake by clinicians.