Sadao Otsuka, Toshiya Murai
The unique contribution of handwriting accuracy to literacy skills in Japanese adolescents
Reading and writing
adoption digital health technologies improve quality care polypharmacy patients underlying complex implementation mechanisms better understood context effects play critical role relation implementation mechanisms primary care research evidence effects context adoption digital innovation polypharmacy management lacking study aims identify contextual factors relevant physician behavior might mediate adoption process physicians participated formative evaluation study n 218 part intervention group clusterrandomized controlled trial adam intervention group implemented digital innovation clinical decision making polypharmacy threestep methodological approach used 1 realist inquiry approach involves description contextmechanismoutcome configuration primary care setting 2 belief elicitation approach involves qualitative content analysis development quantitative latent contextualized scale 3 mediation analysis using structural equation modeling sem based quantitative survey data physicians assess mediating role contextualized scale n 179 key dimensions 1 contextmechanismoutcome model mapped refined 2 latent construct physicians innovation beliefs related effectiveness polypharmacy management practices identified innovation beliefs play 3 mediating role organizational readiness implement change p 001 desired behavioral intent physicians adopt digital innovation p 001 r2 0645 contextualized model estimated significant mediation relative size 38 mediation effect overall model demonstrated good fit indices cfi 0985 rmsea 0034 physician adoption directly affected readiness primary care organizations implementation change addition mediation analysis revealed relationship indirectly influenced primary care physicians beliefs regarding effectiveness digital innovation individual physician beliefs practice organizational capacity could equally prioritized developing implementation strategies methodological approach used suitable evaluation complex implementation mechanisms proven advantageous approach formative evaluation nct03430336 first registration 12022018 gov