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Development and Initial Validation of an Instrument to Measure Physicians' Use of, Knowledge about, and Attitudes Toward Computers

Affiliations of the authors: University of North Carolina, Chapel Hill, NC (RDC); University of Virginia, Charlottesville, VA (WMD); University of Pittsburgh, Pittsburgh, PA (CPF).

Correspondence and reprints: Randy D. Cork, MD, Oceania, Suite 103, 3145 Porter Drive, Palo Alto, CA 94304. e-mail: <rcork{at}oceania.com>.

Abstract This paper describes details of four scales of a questionnaire—"Computers in Medical Care"—measuring attributes of computer use, self-reported computer knowledge, computer feature demand, and computer optimism of academic physicians. The reliability (i.e., precision, or degree to which the scale's result is reproducible) and validity (i.e., accuracy, or degree to which the scale actually measures what it is supposed to measure) of each scale were examined by analysis of the responses of 771 full-time academic physicians across four departments at five academic medical centers in the United States. The objectives of this paper were to define the psychometric properties of the scales as the basis for a future demonstration study and, pending the results of further validity studies, to provide the questionnaire and scales to the medical informatics community as a tool for measuring the attitudes of health care providers.

Methodology: The dimensionality of each scale and degree of association of each item with the attribute of interest were determined by principal components factor analysis with othogonal varimax rotation. Weakly associated items (factor loading <.40) were deleted. The reliability of each resultant scale was computed using Cronbach's alpha coefficient. Content validity was addressed during scale construction; construct validity was examined through factor analysis and by correlational analyses.

Results: Attributes of computer use, computer knowledge, and computer optimism were unidimensional, with the corresponding scales having reliabilities of.79,.91, and.86, respectively. The computer-feature demand attribute differentiated into two dimensions: the first reflecting demand for high-level functionality with reliability of.81 and the second demand for usability with reliability of.69. There were significant positive correlations between computer use, computer knowledge, and computer optimism scale scores and respondents' hands-on computer use, computer training, and self-reported computer sophistication. In addition, items posited on the computer knowledge scale to be more difficult generated significantly lower scores.

Conclusion: The four scales of the questionnaire appear to measure with adequate reliability five attributes of academic physicians' attitudes toward computers in medical care: computer use, self-reported computer knowledge, demand for computer functionality, demand for computer usability, and computer optimism. Results of initial validity studies are positive, but further validation of the scales is needed. The URL of a downloadable HTML copy of the questionnaire is provided.

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