Application of the diffusion of innovations theory and the health belief model to describe EMR use among Alabama family medicine physicians: a rural and urban analysis
The Alabama Black Belt region consists of twelve counties which are characterized by a high percentage of African Americans, acute poverty, rural decline, inadequate education programs, and significantly poor health outcomes. The Alabama Black Belt region suffers significantly with health disparities which, in part, may be attributed to low physician/patient ratio and physician isolation. These physicians tend to practice in private, solo establishments, which often lead to limited communication with other physicians and medical educators. Without continued communication and continuing medical education, rural physicians could lag behind their urban counterparts. In fact it has been shown that some physician practices lag as far as two decades behind their urban counterparts due to such things as limited access to new technologies. With the advent of the electronic medical record (EMR) this lag is likely to decrease exponentially for those in rural areas and could lead to an increase in quality of care for the rural communities. The purpose of this study was to evaluate the adoption and implementation of electronic medical records (EMR) by rural and urban Alabama Family Medicine physicians. The Diffusion of Innovations Theory and Health Belief Model were used to guide the study and develop the survey questions. EMR adoption was assessed in rural areas and compared to their urban counterparts while evaluating the individual characteristic (gender, race, age, and years of practice), organizational characteristics (practice size, patients seen per day, practice location) and individual perceptions regarding adoption (perceived threat, perceived barriers and self-efficacy). Thirty percent (30%) of the 1,205 Alabama Family Medicine physicians responded to the electronic or paper survey. Almost half (49.3%) of the physicians surveyed reported having EMR in their practice; however, 16.3% reported using it to its fullest capacity. Significant differences emerged with respect to EMR use among physicians based on age, years in practice, patients seen per day, practice size and with respect to elements of perceived threat, barriers to adoption and the self-efficacy. Throughout the analysis, differences emerged between Family Medicine physicians from urban Alabama settings and their counterparts from rural and Black Belt region practices.