Health professionals’ acceptance of mobile-based clinical guideline application in a resource-limited setting: using a modified UTAUT model

“Hence, AVE for each associated construct should exceed 0.50, and the items loading above 0.6 [102, 103].”

“The UTAUT model consists of four key construct elements that directly affect the users’ BI of acceptance of mobile-based clinical guideline applications: performance expectancy, effort expectancy, social influence, and facilitating conditions [51, 56].”

“PE is identified as a strong determinant of BI’s use of ICT applications in different settings [67–69].”

“The square root of the AVE in the diagonal elements must be greater than the entire corresponding columns and rows to satisfy the discriminant validity [104].”

“Currently, technology has become commonplace in a healthcare setting, and there has been rapid growth in the development of medical application software [18–20].”

“It needs huge physical space for storage, is exposed to fire and easily lost, and is inaccessible to health professionals [12].”

“A unified theory of acceptance and use of technology (UTAUT) is one of the known theoretical models that is extensively used and practically tested on a wide range of ICT applications according to the end-users viewpoint [51].”

“This study’s findings were similar to those of previous studies [72, 120, 121].”

“…fit indices (GFI > 0.9), adjusted goodness of fit indices (AGFI > 0.8), normal fit indices (NFI > 0.95), Tucker–Lewis index (TLI > 0.9), comparative fit indices (CFI > 0.95), root mean square of standardized residual (RMSSR 0.08), and (RMR 0.08) model fit indices assessment criteria [86, 106].”

“Similarly, sex has moderating effects on the modified UTAUT model’s construct elements [69, 93].”

“Composite reliability is acceptable and considered good if it ranges between 0.60 and 0.90 [104, 105].”

“It is also important to provide critical insight for the development of effective strategies to increase the efficiency and effectiveness of healthcare personnel [41, 42].”

“…are not equally accessible in all health institutions in low-income countries; their educational and training qualifications vary; providing the training is expensive [8], their job function performance is limited, and treatment and medication errors are common in healthcare practice [9, 10].”

“Other studies also proved that effort expectancy had a significant influence on the adoption of healthcare information technology, and MHealth applications [71, 108, 109].”

“Studies depicted that EE influences users BI to accept and use new ICT applications, and it does not require efforts to work through new technology [39, 74, 75].”

“Several platforms are available to assist health professionals, such as patient information management and access, communication, and consulting [21, 22], reference and information gathering, distance medical education and training, and clinical support systems for accurate decision-making [23, 24].”

“This study’s findings were similar to those of previous studies [72, 120, 121].”

“PE is identified as a strong determinant of BI’s use of ICT applications in different settings [67–69].”

“…applications are difficult to use, the benefits of using mobile applications are offset by the effort to use the mobile application, as well as the more complex an innovation is, the lower its rate of acceptance, and adoption of the mobile-based clinical guideline application again [110, 111].”

“In Sweden, a variety of wireless technologies such as mobile computing, wireless networks, and global positioning systems have been applied to ambulance care [27], and these are also functional for emergency patient care in the Netherlands [28].”

“Studies show in China that age has significant moderating effects on effort expectancy and behavioural intention to use health technology [62], home telehealth acceptance [69], and mobile health services adoption [63].”

“Currently, technology has become commonplace in a healthcare setting, and there has been rapid growth in the development of medical application software [18–20].”

“…are an essential tool that fosters and promotes progress in healthcare and drastically reforms healthcare practices, the healthcare system in low-income countries is recognized as having lagged behind other industries in the use and adoption of information communication technologies [30, 31].”

“However, it is manual (paper-based) and vigorously promoted as a means to improve the effectiveness of the healthcare system, patient outcomes, and healthcare costs [11].”

“Additionally, mobile clinical guidelines applications could also provide health professionals with real-time information on the patient’s specific health condition [118, 119].”

“In the last decade, numerous theoretical models have been projected to assess and explain the end-user’s acceptance of information and communication technology (ICT) [50].”

“This finding was supported by similar studies conducted in different geographical areas [107, 108].”

“Therefore, properly handling these clinical guidelines using easily accessible mobile-based applications with a good format for accessibility and readability of clinical guidelines efficiently and effectively regardless of the health professional’s location [97, 98].”

“This finding was supported by similar studies conducted in different geographical areas [107, 108].”

“The UTAUT model is an extension of other models and therefore has a strong ability to explain the acceptance and use of technology as compared with other single models [54, 55].”

“UTAUT is a combination of activity theory and technology acceptance models (TAM) and has been constructed as a framework to study end-users acceptance and use of new ICT applications [52].”

“Other studies show that age has a moderating effect on performance and effort expectancy, social influence, and behavioural intention to use health information communication technology, smart equipment, and wearable devices [91, 92].”

“…guideline application, a lack of system user self-efficacy, a lack of outcome expectations, health professionals’ attitudes and perceptions [36, 37], lack of commitment and motivation [34, 38], lack of organizational support, the constructs of the technology acceptance model (TAM) [34,…”

“The tool of the study was adapted in reviewing previously similar studies [39, 75, 96].”

“As a result, eHealth technology adoption and dissemination in Ethiopia are still in their infancy [39, 47, 48].”

“Performance expectancy enhances the productivity of health professionals and is efficient for the time spent in operation, patient management, and the care provider’s intention and attitude toward mobile-based clinical guideline application acceptance [39].”

“A study in a low-resource setting shows that effort expectancy is a key determinant of health professionals’ intention toward telemedicine [76].”

“Other studies also proved that effort expectancy had a significant influence on the adoption of healthcare information technology, and MHealth applications [71, 108, 109].”

“Mobile devices and mobile health applications are also among the fastest and most convenient ways for health professionals to access educational materials, including medication information, electronic clinical guidelines, and books [25, 26].”

“This finding was consistent with previous studies [39, 86].”

“Hence, mobile-based clinical gaudiness-receiving users are required to have specific basic skills such as how to operate and use mobile phones, and how users react to the basic function of a mobile device (phone calls, sending and receiving text messages) [81, 82].”

“This study’s findings were similar to those of previous studies [72, 120, 121].”

“Several platforms are available to assist health professionals, such as patient information management and access, communication, and consulting [21, 22], reference and information gathering, distance medical education and training, and clinical support systems for accurate decision-making [23, 24].”

“This finding was consistent with similar studies conducted in Ethiopia [60, 86], Nigeria [122], South Africa [123], and Malaysia [124].”

“Another study in Canada shows that information systems and technology acceptance and use are significantly influenced by effort expectancy [77].”

“It is a belief that whether there is the availability of ICT, technical infrastructure, and trustworthy support in the organization for system users [56, 80].”

“According to studies, attitude is appropriate in studying behavioural intention to accept and use new technologies, and it he one of the fundamental constructs for the successful implementation and adoption of a new technology [88–90].”

“This finding was consistent with similar studies conducted in Ethiopia [60, 86], Nigeria [122], South Africa [123], and Malaysia [124].”

“It was concluded that the viewpoints and opinions of others regarding the use of information technology in education and learning were affected by health professionals’ behavioral intentions for the frequent and daily use of technology [115].”

“…are not equally accessible in all health institutions in low-income countries; their educational and training qualifications vary; providing the training is expensive [8], their job function performance is limited, and treatment and medication errors are common in healthcare practice [9, 10].”

“The manuals are poorly designed, present incomplete explanations that are difficult to read, have comprehension levels beyond the user’s capabilities, lack explicit workflow, and increase the user’s workload [13–15].”

“This might be because health professionals’ attitudes toward using mobile-based systems have improved over time, and individuals’ sociodemographic characteristics and educational level affect their attitudes which further affect their behavioral intention of technology acceptance [125, 126].”

“…user self-efficacy, a lack of outcome expectations, health professionals’ attitudes and perceptions [36, 37], lack of commitment and motivation [34, 38], lack of organizational support, the constructs of the technology acceptance model (TAM) [34, 38], and socioeconomic characteristics of the…”

“Therefore, mobile-based clinical guidelines applications are used as job aid tools for real-time information and knowledge access and update, improving health professionals’ performance by directing and guiding in an interactive and structured manner using mobile devices [32, 33].”

“…are not equally accessible in all health institutions in low-income countries; their educational and training qualifications vary; providing the training is expensive [8], their job function performance is limited, and treatment and medication errors are common in healthcare practice [9, 10].”

“In Ethiopia, various studies confirmed that the modified UTAUT model is suitable for the acceptance of electronic medical and personal health record systems among the health professionals perspective [59, 60], the adoption of e-learning [61], and the sustainable adoption of the eHealth system [39].”

“Plus, effort expectancy is associated with diagnosis and medication error reduction [113], applications’ flexibility, friendliness, familiarity, and its easiness of individuals to use.”

“The development of mobile-based medical applications and technology-based healthcare practices is still in its premature stages [34].”

“The acceptable value of composite reliability (0.6) was considered for the internal reliability test [100, 101].”

“In Sweden, a variety of wireless technologies such as mobile computing, wireless networks, and global positioning systems have been applied to ambulance care [27], and these are also functional for emergency patient care in the Netherlands [28].”

“Therefore, this may promote distorted health information so that health professionals cannot access appropriate guidelines at the point of patient care [17].”

“Computer literacy (CL) is health professionals’ basic information communication technology skill and knowledge, the ability they have, and how system users are technically good at using mobile-based clinical guideline applications [60, 83].”

“The UTAUT model is an extension of other models and therefore has a strong ability to explain the acceptance and use of technology as compared with other single models [54, 55].”

“An individual also can seek, evaluate, and communicate information using media across a range of digital platforms, and influence acceptance of mobile-based clinical guidelines applications [59, 84, 85].”

“…are an essential tool that fosters and promotes progress in healthcare and drastically reforms healthcare practices, the healthcare system in low-income countries is recognized as having lagged behind other industries in the use and adoption of information communication technologies [30, 31].”

“It enhances health professionals’ communications and evidence-based practice [4–6].”

“An individual also can seek, evaluate, and communicate information using media across a range of digital platforms, and influence acceptance of mobile-based clinical guidelines applications [59, 84, 85].”

“According to studies, attitude is appropriate in studying behavioural intention to accept and use new technologies, and it he one of the fundamental constructs for the successful implementation and adoption of a new technology [88–90].”

“…organizational setting, preliminary skill, and knowledge they had on a mobile device, resources, and availability of training for information sharing [122], and system quality might have an important role in predicting users’ actual acceptance of mobile-based clinical guideline applications [86].”

“So, understanding why healthcare professionals could not accept and use mobile-based healthcare systems would accelerate hospital competition and enhance the acceptance and utilization of mobile devices and the Internet in healthcare practices [27, 40].”

“However, a study in Australia confirmed that performance expectance does not affect individuals’ intention to use cloud-based mHealth services [73].”

“This might be because health professionals’ attitudes toward using mobile-based systems have improved over time, and individuals’ sociodemographic characteristics and educational level affect their attitudes which further affect their behavioral intention of technology acceptance [125, 126].”

“…applications are difficult to use, the benefits of using mobile applications are offset by the effort to use the mobile application, as well as the more complex an innovation is, the lower its rate of acceptance, and adoption of the mobile-based clinical guideline application again [110, 111].”

“It enhances health professionals’ communications and evidence-based practice [4–6].”

“Electronic medical record system, district health information system version 2 (DHIS2), routine health information system [43, 44], interactive voice response system, patient appointment reminder system, electronic community-based health information system, and international classification of…”

“In Finland, an authorized and secured mobile healthcare services system was tested in 2003 and is available nationwide, that is used for con-sultation, electronic prescription, and easy access to health information via mobile devices [29].”

“An individual also can seek, evaluate, and communicate information using media across a range of digital platforms, and influence acceptance of mobile-based clinical guidelines applications [59, 84, 85].”

“…guideline application, a lack of system user self-efficacy, a lack of outcome expectations, health professionals’ attitudes and perceptions [36, 37], lack of commitment and motivation [34, 38], lack of organizational support, the constructs of the technology acceptance model (TAM) [34, 38],…”

“Performance expectance is one of the possible predictors for mHealth adoption in Burundi [57].”

“Other studies show that age has a moderating effect on performance and effort expectancy, social influence, and behavioural intention to use health information communication technology, smart equipment, and wearable devices [91, 92].”

“This [116].”

“So, there is a high demand for an easily accessible electronic system for daily healthcare practice and challenges to patient care [47].”

“Additionally, mobile clinical guidelines applications could also provide health professionals with real-time information on the patient’s specific health condition [118, 119].”

“Electronic medical record system, district health information system version 2 (DHIS2), routine health information system [43, 44], interactive voice response system, patient appointment reminder system, electronic community-based health information system, and international classification of…”

“Several platforms are available to assist health professionals, such as patient information management and access, communication, and consulting [21, 22], reference and information gathering, distance medical education and training, and clinical support systems for accurate decision-making [23, 24].”

“Moderators such as age [62, 63], sex [64–66], and experience could influence the model predictors and health professionals’ intention to accept mobile-based clinical guideline applications.”

“It is also important to provide critical insight for the development of effective strategies to increase the efficiency and effectiveness of healthcare personnel [41, 42].”

“Moreover, the clinical guidelines are available in voluminous text files and are very laborious and time-consuming to access [16].”

“Studies show in China that age has significant moderating effects on effort expectancy and behavioural intention to use health technology [62], home telehealth acceptance [69], and mobile health services adoption [63].”

“In Tanzania, the UTAUT model is used to test accredited drug dispensing outlet programs and to identify factors that would impact system users [58].”

“The manuals are poorly designed, present incomplete explanations that are difficult to read, have comprehension levels beyond the user’s capabilities, lack explicit workflow, and increase the user’s workload [13–15].”

“In his study, [7] identified factors affecting medical student adoption of the rain classroom, extending UTAUT with anxiety, motivation, and self-efficacy, while [8] extended UTAUT with attitude and computer literacy.”

“It encompasses both four fundamental constructs, PE, EE, SI and FC, and four moderator variables to facilitate the explanation of the acceptability of technology in its multifaceted nature and subsequently, on that basis, an enhanced knowledge of adoption factors [46–48].”

“Previous research has shown [33] revealed that SI significantly influenced health professionals’ acceptance of mobile-based clinical guideline applications in resource-limited settings, highlighting the importance of colleagues and organizational culture in driving adoption.”

“PE significantly predicts the BI of various information and communication technologies (ICTs), including mobile health applications (Demsash et al., 2024; Diel et al., 2023).”

“…the original UTAUT framework, which posits that age and experience can moderate the effects of major constructs: older individuals tend to be more influenced by ease of use, social influence, and facilitating conditions, whereas younger individuals respond positively to performance expectancy [48].”

“…Technology emphasizes the influence of performance expectancy, effort expectancy, social influence, and facilitating conditions on usage intention [18], while the Theory of Planned Behavior proposes that behavioral intention is jointly determined by attitudes toward the behavior, subjective…”

“Likewise, the study by Demsash et al. (2024) investigated the healthcare professionals’ tendency to use mobile-based clinical guideline applications by referring to the modified UTAUT model.”

“Prior studies on behavioral intention toward technology highlight the impact of facilitating conditions on users’ intention to adopt it [27,28,30,32,33].”

“%) is similar with previous research carried out among health professionals in Ethiopia, which reported similar levels of willingness to use mobile-based clinical guidelines [61.1% [36] and 63.3% [37] ].”

“In line with the work and proposals formulated in international context (Demsash et al., 2024; Edo et al., 2023; Garavand et al., 2022; Lee et al., 2025; Rahi et al., 2019) and Morroccan context (Abbassi, 2025; Mirdasse, 2024; Mounchayane & Edaoudi, 2019; Rouidi & Elouadi, 2020) our model includes…”