Factors Influencing Usability and Perceived Satisfaction with Continuous Monitoring and Deterioration Alerting in Non-ICU Settings

Abstract

Abstract Background: Patient deterioration is a major safety concern in non-ICU settings. Continuous monitoring devices with deterioration alerting offer potential for early detection, but their effectiveness remains uncertain, partly due to usability challenges. A scoping review of 34 studies conducted in this thesis revealed that most focused-on effectiveness, while only 40% addressed usability—particularly from clinicians' perspectives, with just six studies. Aims: To understand the factors influencing clinicians' usability of continuous monitoring devices with deterioration alerting in non-ICU setting. Design: A mixed-methods study using quantitative questionnaires and qualitative interviews. Methods: Data were collected from 111 clinicians through an online questionnaire and 10 follow-up interviews. Analysis was based on the Unified Theory of Acceptance and Use of Technology (UTAUT) framework, combining quantitative tests (Kruskal-Wallis H-Test, Spearman correlation) and thematic analysis, with integration through narrative weaving. Results: Performance expectancy showed the strongest correlation (r=0.415) with behavioural intention, highlighting perceived benefits like improved monitoring, decision-making, and workflow efficiency. Effort expectancy (r=0.252) also influenced intention, though concerns about alert fatigue, device reliability, and usability were noted. Social influence (r=0.314) had a weaker impact, with senior staff reluctance and patient-family concerns affecting adoption. Facilitating conditions (r=0.016) showed no significant correlation, indicating gaps in training and technical support. Use experience (r=0.223) and voluntariness of use (r=0.379) positively influenced intention, while age and gender had no significant impact. Conclusion: Perceived benefits were the most significant factor influencing usability, followed by ease of use and important others. Longer use experience improved familiarity, confidence, and voluntariness of use, enhancing adoption. However, organizational support, including training and maintenance, had limited impact, likely due to irregular maintenance schedules and inadequately designed training programs. Impact: This study provides new insights into usability factors overlooked in previous research. It identifies clinical benefits as primary drivers of adoption, highlights barriers like design flaws and poor compatibility, and emphasises the role of social dynamics, including peer influence and patient concerns. It also challenges the applicability of the UTAUT framework, calling for adaptations to reflect mandatory use and patient-centred priorities. The findings offer practical recommendations for improving device design, training, support, and guiding future research. KEYWORDS: continuous monitoring, healthcare technology, UTAUT framework, non-ICU settings, clinician adoption, device usability, patient outcomes, mixed-methods research.

Date of Award	10 Mar 2025
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Dawn Dowding (Main Supervisor) & David Wong (Co Supervisor)