WHAT SHAPES ACCEPTANCE OF REALISTIC SIMULATION IN HEALTHCARE? A QUALITATIVE TEMPLATE ANALYSIS AND ACCEPTANCE-MODEL DEVELOPMENT
Author(s)
Ricardo Tiecher, Master of Business Administration, Fabio de Paula, Doctor of Business Administration, Marcelo Dionisio, Doctor of Business Administration, Jorge Moll, Doctor of Medicine, Andreia Escudeiro, Doctor of Defense Engineering.
Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
OBJECTIVES: Technology-enabled realistic simulation (TERS) improves clinical competence and patient safety when healthcare professionals accept it and organizations integrate it into routine practice. Established technology-acceptance models (TAM, UTAUT) were designed for general information systems and do not fully capture acceptance of TERS. This study develops a conceptual model of TERS acceptance, its antecedents, and outcomes, to ground a measurement instrument.
METHODS: We conducted a qualitative study at a Brazilian public hospital with an established simulation program. Using purposive maximum-variation sampling, we analyzed semi-structured interviews with 42 professionals across clinical, managerial, educational, and non-clinical roles. A hierarchical coding template was developed through Template Analysis, combining five theoretical lenses (UTAUT; Diffusion of Innovations; Technology-Organization-Environment; Resource-Based View; Learning Transfer) with inductive coding. Rigor was supported by an audit trail, template version, and change rationale; theme definitions fixed before coding; reflexive notes; and iterative revision to thematic saturation.
RESULTS: Analysis yielded seven themes spanning individual evaluation, simulation experience, organizational conditions, and collective benefit. From these, TERS acceptance was modeled as a higher-order construct of seven facets: perceived professional value, perceived practical access, perceived manageability, perceived experiential quality, compatibility, social influence, and social legitimacy. The model positions acceptance between three organizational antecedents (institutional support, simulation infrastructure, and external legitimacy) and its outcomes (sustained participation; self-assessed competence and practice change; and collective benefits for patients, teams, and the organization). Professional value and experiential quality were the most strongly endorsed facets; limited practical access and institutional support were the dominant barriers to participation.
CONCLUSIONS: The content domain of TERS acceptance is more extensive and multidimensional than general technology-acceptance frameworks capture. The model provides a theoretically grounded basis for a TERS-acceptance instrument, developed in a subsequent quantitative validation phase, and for addressing organizational conditions that constrain simulation's benefit to patient care quality.
METHODS: We conducted a qualitative study at a Brazilian public hospital with an established simulation program. Using purposive maximum-variation sampling, we analyzed semi-structured interviews with 42 professionals across clinical, managerial, educational, and non-clinical roles. A hierarchical coding template was developed through Template Analysis, combining five theoretical lenses (UTAUT; Diffusion of Innovations; Technology-Organization-Environment; Resource-Based View; Learning Transfer) with inductive coding. Rigor was supported by an audit trail, template version, and change rationale; theme definitions fixed before coding; reflexive notes; and iterative revision to thematic saturation.
RESULTS: Analysis yielded seven themes spanning individual evaluation, simulation experience, organizational conditions, and collective benefit. From these, TERS acceptance was modeled as a higher-order construct of seven facets: perceived professional value, perceived practical access, perceived manageability, perceived experiential quality, compatibility, social influence, and social legitimacy. The model positions acceptance between three organizational antecedents (institutional support, simulation infrastructure, and external legitimacy) and its outcomes (sustained participation; self-assessed competence and practice change; and collective benefits for patients, teams, and the organization). Professional value and experiential quality were the most strongly endorsed facets; limited practical access and institutional support were the dominant barriers to participation.
CONCLUSIONS: The content domain of TERS acceptance is more extensive and multidimensional than general technology-acceptance frameworks capture. The model provides a theoretically grounded basis for a TERS-acceptance instrument, developed in a subsequent quantitative validation phase, and for addressing organizational conditions that constrain simulation's benefit to patient care quality.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
OP8
Topic
Health Service Delivery & Process of Care, Medical Technologies, Organizational Practices
Topic Subcategory
Academic & Educational
Disease
No Additional Disease & Conditions/Specialized Treatment Areas