Acceptance by Nurses in Morocco : Application of a Modified Unified Theory of Acceptance and Use of Technology

Since 2001, Morocco has embarked on an ambitious reform process to enable the health system to be able to satisfy the care demand, and improve the performance of healthcare organizations. For this issue the Project Financing and Managing Health Sector was adopted. This project establishes an integrated and standardized care services to the Moroccan population. It seeks to give better support to healthcare professionals in their daily activities and to improve the quality and efficiency of the promulgated care services. Health Information System (HIS) was considered the main goal of this project; Nurses, as the core of the each healthcare process, were the first actors concerned with this project.


Introduction
Since 2001, Morocco has embarked on an ambitious reform process to enable the health system to be able to satisfy the care demand, and improve the performance of healthcare organizations.For this issue the Project Financing and Managing Health Sector was adopted.This project establishes an integrated and standardized care services to the Moroccan population.It seeks to give better support to healthcare professionals in their daily activities and to improve the quality and efficiency of the promulgated care services.Health Information System (HIS) was considered the main goal of this project; Nurses, as the core of the each healthcare process, were the first actors concerned with this project.____________________________________________________________________________________ ______________ Az-Eddine Bennani and Rachid Oumlil (2014), IBIMA Business Review, DOI: 10.5171/2014.849383working in health public and private organizations located in Agadir city, South of Morocco.
The first paragraph will review the literature on the UTAUT Model, and present recent application of this model in healthcare context.The second one will describe the research model and cite the hypothesis.The third will explain the research methodology.The fourth paragraph will point out data analysis and results.The last paragraph will contain conclusion and managerial implication and limits of this research.

Theoretical Background
The following paragraph presents the Unified Theory Acceptance and Use of Technology and highlights some of its recent applications in healthcare context.

UTAUT in Healthcare Context
The UTAUT model has been tested in many areas such as mobile services among consumers (Carlsson, Carlsson 2) Performance expectancy is defined as "the degree to which an individual believes that using the system will help to attain gain in job performance" (Venkatesh et   completed and retained for the analysis representing 80% of the response rate.Most of the respondents were female (60%) and aged less than 25 years old (51.5%).75.5% of these respondents got an IT training and most of them (57.5%)worked at private healthcare organization (Table 1).
Scales used for this study were adapted from the works of Venkatesh et al (2003) and Tung et al (2008).The measurement items were anchored on a 7-point Likert scale from "strongly disagree" (1) to "strongly agree" (7) in which respondents indicated an appropriate response.

Table1. Demographic profile of the sample (N=200) Data Analysis and Results
To test the research model, authors used the Partial Least Squares (PLS) technique, which is appropriate to validate predictive models using reflective latent constructs (Chin, 1998).This technique also places minimal demands on sample sizes and data distribution assumptions.Authors used SmartPLS software version 2.0M3 to assess both of the measurement model and the structural model.

Measurement Model
The reliability of construct measurement was assessed by the composite reliability and internal consistency.The internal consistence was assessed the Cronbach's Alpha coefficient.It is verified when the alpha is above 0.7.Regarding table 2, all constructs indicated composite reliability above 0.7.Moreover, internal consistency of the scales is verified, because their Cronbach's Alpha exceeded threshold value and confirmed a satisfactory reliability.(1995) recommended that an observed principle for convergent validity is to retain items with loadings of 0.70 or more.Table 2 showed that all items, except EE1 (0.651849) and TRUST2 (0.682373), indicated a loading value above 0.7.Discriminate validity is assured when the AVE value is above the threshold value of 0.50 and square root of the AVE is larger than all other cross correlations (Gefen and Straub, 2005).Table 3

Structural Model
The structural model provides information about the model's predictive power given by R 2 and information about path significance.
Results showed that the research model explained 35% of total variance in the intention to use IT by nurses (figure 2).
Hypothesis 1 (H1), supposing that Performance expectancy will have a positive influence on nurses intention to use IT was not supported (β=0.42).It means that Moroccan nurses don't give more importance to the utilitarian aspect of Information technology.
Hypothesis 2 (H2), suggesting that Effort expectancy will have a positive influence on nurses intention to use IT, was not supported (β=1.50).Hence, Moroccan nurses will not be ready to use ITs even these technologies are understandable and easy to use.Hypothesis 3 (H3), predicting that Social influence will have a positive influence on nurses intention to use IT, was supported (β=3.29).This result suggests that Moroccan nurses are significantly influenced by their peers and their decisions to use IT depend on others healthcare professionals.

Conclusion
This communication aims to identify factors influencing IT acceptance by nurses working in public and private Moroccan healthcare organizations.Results suggest that both of the reduced version of the UTAUT model, and the Trust construct were able to provide an explanation of nurses IT acceptance.These results showed that only two factors seem to be significant for this acceptance.The first one, Social influence implies that nurses are very influenced by social norms in their professional field.Hence their IT acceptance decision is firstly influenced by opinions of their peers.The second, Trust, posits the nurses' confidence in quality and reliability of the services offered by using IT in their administrative and healthcare tasks.
As managerial implication the current study, it proposed a useful tool for hospital managers needing to assess the integration of the new technologies in their organizations, and helped them to understand factors fostering IT acceptance especially by nurses.

Hypothesis 4 (Figure 2 :
H4), supposing that Trust will have a positive influence on nurses intention to use IT, was supported (β=2.10).This result indicates that while the Moroccan nurses trust in IT, it will foster its acceptance.*p < 0.05, **p < 0.01 Structural model ____________________________________________________________________________________ ______________ Az-Eddine Bennani and Rachid Oumlil (2014), IBIMA Business Review, DOI: 10.5171/2014.849383 They used a cross-sectional survey to collect data.Their survey rate was 82% with 1323 respondents, 54% of them were male.Results showed that the proposed model explain 54% of variance for intention to use and 27% for Actual.Moreover, intention to use health IT is determined by Performance expectancy, Effort expectancy and Social influence.In 2009,(Aggelidis & Chatzoglou)based on UTAUT constructs to examine HIS acceptance by Greek hospital personnel.The study concerned the whole population if HIS users in the region with 341 persons, but only 283 respondents had completed the questionnaire.Authors found that, Effort expectancy, Performance expectancy, Social influence and Facilitating condition affected significantly hospital personnel behavioral Intention.