Pathways to Utilisation: Structural Equation Models Comparing Intranet Guidelines and a CDSS

The implementation of evidence-based practice continues to pose significant challenges across healthcare settings. This study investigated how factors influencing the use of an intranet folder system (IFS) providing evidence-based guidelines change during the transition to a Clinical Decision Support System (CDSS). A two-wave survey was conducted among nursing staff at a Swiss hospital, assessing system utilisation, Evidence-Based Nursing (EBN) related factors, selected variables from the Unified Theory of Acceptance and Use of Technology (UTAUT), and demographic information. Structural equation modelling was applied to identify key determinants of utilisation. Facilitating Conditions and Social Influence significantly influenced utilisation in both systems. EBN factors, specifically Trust and Knowledge, impacted Effort Expectancy only in the CDSS model. These results suggest that while organisational and social factors consistently promote system use, the successful adoption of a CDSS additionally requires the development of new trust in the technology and expanded knowledge of its functions to reduce perceived effort and enhance utilisation. The findings highlight the need for structural support, social endorsement, and targeted training to facilitate the effective implementation of CDSS in clinical practice.