Factors affecting actual individual usage of electronic patient records in three developing countries of the Middle East: Lebanon, Jordan and Syria

  • Hala Badredine

Student thesis: Doctoral ThesisPhD


All conferences' proceedings of the latest EMRO-WHO have recommended amelioration of actual individual usage of Electronic Patient Record (AIU-EPR) and E-health in the Middle East for a better future. To begin, how can we apply these recommendations without knowledge of basic E-health and Electronic Patient Records/Electronic Health Records (EPR/EHR) status in countries under study? This study provides an exploratory database of factors influencing usage and adoption in The Fertile Crescent; three developing 'Water-People' countries, namely The Republic of Lebanon, The Kingdom of Jordan and The Arabic Syrian Republic. No research or study has yet explored and established matters concerning health care managers' attitudes, habits, involvement, development, technical readiness and accessibility towards AIU-EPR.

The main dependent variable AIU-EPR refers to the number of hours per week EPR-supported functions are used among functions performed in a hospital department. This research tests four independent variables with their own observed variable loadings affecting the one dependent variable AIU-EPR, as follows.

The relationships between individual characteristics and AIU-EPR. Age, sex and education are taken as the exogenous or upstream variables affecting the mediating dependent variable, individual personality characteristic (Indivpers). While, individual personality characteristic is also considered, at the same time, according to the structural equation modelling and regression theory (SEM) model-1 an exogenous variable for the endogenous main dependent variable AIU-EPR.The relationships between individual organisational characteristics and AIU-EPR. Centralisation of decision making, communication and technical readiness in a health care organisation are considered to be the upstream variables to the downstream variable individual organisational characteristics (Indivorg). On the other hand, the Indivorg variable is considered the upstream variable affecting the main dependent downstream variable AIU-EPR.The relationships between Attitudes and Habits of health care professionals and AIU-EPR. Attitudes toward involvement, attitudes toward development, awareness of accessibility and hospitals' departmental needs for EPR usage values are considered to be the upstream variables to the downstream variable Attitudes and Habits (Attitudhab). At the same time Attitudhab as considered the upstream variable affecting the main dependent downstream variable AIU-EPR.EPR Usefulness as the last exogenous variable affecting the mediating the dependent variable AIU-EPR.

Data collection was performed using a questionnaire and on-site interviewing of hospital and Ministry of Health managers. One thousand managers from 100 hospitals in the three countries were interviewed personally by the researcher. Multivariate general hypotheses are proposed and tested simultaneously through structural equation modelling and regression on different levels using AMOS version 7 and SPSS version 15.

As expected the results confirm that the cultural and political environment in each country affected the outcome of this study in relation to all factors analysing AIU-EPR. Irrespective of Country specific variation, the findings also reveal that organisational factors contribute to a greater degree in understanding AIU-EPR than the individual characteristics. Moreover, attitudes of professionals play important roles in explaining AIU-EPR. However, there is strong evidence of a ‘halo’ effect (Nisbett R., 1980) between individual characteristics and AIU-EPR at this early stage of AIU-EPR in the Middle East leading to exaggerated perceptions of actual usage. Additional findings appear in the text and implications are considered for researchers and policy makers. This research lays the groundwork and presents exciting possibilities for conducting more detailed actual individual usages of EPR studies and cross-national comparisons of innovations especially in the legal, ethical, political, and cultural arenas.

Date of Award13 Jun 2008
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorClifford Stevens (Supervisor) & Gordon Taylor (Supervisor)

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