Research That Matters (January 17 - 20, 2008)

Background Social workers process large amounts of assessment and referral information when working with clients. Due to the ever-changing network of social services and the limits of human cognition, it is nearly impossible for workers to develop and manage a comprehensive knowledge of available services necessary to fully meet client need. Decision support systems can mitigate the complexities associated with these processes and enhance the quality of care provided. However, social workers have demonstrated reticence toward the adoption of technology. This paper addresses the research question, what are the facilitators and barriers to social workers' adoption of decision support systems?

Methods This research question was pursued through the analysis of qualitative interview data gathered over a twelve-month study period as part of a mixed-methods study (N=28) of child welfare workers implementing a computer program that accesses referral resources via keywords or assessment outcomes. Data on technology users were gathered from initial field observations using shadowing (n=19), six-month focus groups (n=13), twelve-month focus groups (n=11), and individual cognitive interviews (n=4). The observations utilized a semi-structured qualitative guide and were transcribed, and then analyzed with NVivo software. Data were gathered on use/nonuse of the technology, the workers' reaction to the technology, and the impact of the technology on assessment and referrals. Analyses involved the identification of similarities/themes and differences in the data across user groups and changes in attitude toward and use of the technology over time.

Results Analysis of the initial shadowing revealed that social workers most often noted not having enough time to integrate the software into their work (36.8%), preference for using known providers (36.8%), and reticence toward changing work patterns (52.6%) as reasons for not adopting the technology. Facilitators included perceived time savings through streamlining work (15.8%) and enhanced referral options (31.6%). Technology barriers included software malfunctions (26.3%), cumbersome referral lists (26.3%), and inadequate search criteria (26.3%). Data from focus groups and cognitive interviews revealed that facilitators and barriers did not change over time. Data revealed that only workers who had integrated the technology into their practice within the period between training and field shadowing continued to utilize it.

Conclusions These findings suggest that social workers' reticence to adopt technology reported in the literature is a byproduct of external costs limiting incentives to adopt and have little relationship to the worker's attitude toward the technology. Some literature suggests that with proper training, workers will readily adopt new technology into their practice; however, our findings suggest that the costs involved with negotiating a new resource pool and new assessment and referral techniques outweigh the benefits of increased provider options and decreased referral linkage times. Length of exposure to the technology, in-vivo training, and periodic encouragement to use the technology did not influence the rate of adoption. We conclude that facilitators and barriers to adoption of technology rest not with the technology or in training, but in its ability to restructure the work environment by providing the social worker with a single, seamless technology for case management.