Education and Human Sciences, College of (CEHS)


Date of this Version



A DISSERTATION Presented to the Faculty of The Graduate School at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Human Sciences, Under the Supervision of Professor John DeFrain. Lincoln, Nebraska: February, 2011
Copyright 2011 Nancy C. Shank


The widespread adoption of electronic health records (EHRs) is a public policy strategy to improve healthcare quality and reduce accelerating health care costs. Much research has focused on medical providers’ perceptions of EHRs, but little is known about those of behavioral health providers. This research was informed by the theory of reasoned action, and the technology acceptance model. This mixed methods research was conducted in two studies. The first study interviewed behavioral health providers (n = 32) to elicit beliefs about EHRs. Using the elicited beliefs from the first study, a survey of 38 Likert-scaled belief statements was administered to all behavioral health providers in Nebraska (N = 2,010). Using data from the sample (n = 667) the belief statements were reduced to four factors. The factors were used as a basis for a cluster analysis to create two market segments.

In the first study, most providers (81%) identified themselves as having positive overall opinions about EHRs and three themes emerged: (a) safety and quality of care, (b) security and privacy, and (c) delivery of services. Benefits and barriers were mentioned for each of these three areas, with the most frequently mentioned being benefits to client safety and quality of care (100%), privacy and security barriers (100%), delivery of services barriers (97%), and benefits to delivery of care in their practices (66%). 667 providers participated in the statewide survey to identify salient beliefs, reduced to four factors, that EHRs would (a) improve care and communication, (b) add cost and time burdens, (c) present access and vulnerability concerns, and (d) improve workflow and control. Using the factors as clustering variables returned a two-cluster solution: providers who had overall positive beliefs about EHRs (67%) and providers who had overall negative beliefs about EHRs (33%).

Based on the research, five key areas are highlighted that will likely impact behavioral health providers’ perceptions of EHRs: (1) usability, (2) ease of use, (3) privacy and confidentiality, (4) cost, and (5) marketing.