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Determinants of Electronic Nursing Documentation Adoption using an Integrated HOT-fit and Net Benefit Analysis: a path analysis
Abstract
Introduction
Electronic nursing documentation supports continuity of care, patient safety, and legal accountability, yet adoption remains inconsistent due to socio-technical barriers. Evidence is limited on how Human–Organization–Technology fit (HOT-fit) factors influence adoption through perceived Net Benefit. To examine determinants of electronic nursing documentation adoption using an integrated HOT-fit and perceived Net Benefit framework tested through path analysis.
Methods
A cross-sectional analytic study was conducted among 266 registered nurses from three hospitals in Indonesia. Eligible participants provided direct care or ward-level leadership and had used the electronic nursing documentation system (ENDS) for ≥6 months. Data were collected via a validated HOT-fit–based questionnaire assessing human, organizational, and technological factors, perceived Net Benefit, and adoption behavior (5-point Likert scale). Construct validity was evaluated using confirmatory factor analysis, followed by path analysis in AMOS.
Results
Human (β = 0.28), organizational (β = 0.34), and technological factors (β = 0.31) significantly predicted perceived Net Benefit (all p < .001). Perceived Net Benefit strongly predicted adoption behavior (β = 0.46, p < .001). HOT-fit domains also had significant direct effects on adoption (β = 0.12–0.18). Perceived Net Benefit partially mediated the effects of human (β = 0.13), organizational (β = 0.16), and technological factors (β = 0.14) on adoption (all p < .001). The model explained 62% of the variance in Net Benefit and 58% in adoption.
Discussion
The findings highlight that perceived Net Benefit plays a central mediating role in electronic nursing documentation adoption, indicating that nurses are more likely to use the system when they recognize its practical value in improving efficiency, safety, and workflow integration.
Conclusion
Adoption is primarily driven by perceived Net Benefit shaped by organizational support, usability, and human readiness, underscoring the need for leadership-enabled workflow optimization and competency-based training.
