J O U R N A L O F N U R S I N G I N T E R V E N T I O N S
Nurses computer literacy and attitudes towardsthe use of computers in health care
Sati Grdas Topkaya MSc BSNUnit Charge-Nurse, Orthopaedics and Traumatology Clinic, Taksim Training and Research Hospital, Istanbul, Turkey
Nurten Kaya PhD BSNAssociate Professor, Health Sciences Faculty, Istanbul University, Istanbul, Turkey
Accepted for publication March 2014
Grdas Topkaya S, Kaya N. International Journal of Nursing Practice 2014; : Nurses computer literacy and attitudes towards the use of computers in health care
This descriptive and cross-sectional study was designed to address nurses computer literacy and attitudes towards the useof computers in health care and to determine the correlation between these two variables. This study was conducted withthe participation of 688 nurses who worked at two university-affiliated hospitals. These nurses were chosen using astratified random sampling method. The data were collected using the Multicomponent Assessment of Computer Literacyand the Pretest for Attitudes Towards Computers in Healthcare Assessment Scale v. 2. The nurses, in general, had positiveattitudes towards computers, and their computer literacy was good. Computer literacy in general had significant positivecorrelations with individual elements of computer competency and with attitudes towards computers. If the computer isto be an effective and beneficial part of the health-care system, it is necessary to help nurses improve their computercompetency.
Key words: attitude towards computers, computer competency, computer literacy, nursing.
INTRODUCTIONThe nursing profession advances in step with the healthnecessities of a society, and it is regulated in accordancewith the prevailing health-care system, with provision ofquality services to patients being a top priority. The roleand responsibilities of nurses in health-care services canchange when new technology is introduced or existing
roles are redefined.1 The use of technology and computersin health care has been reported to improve nursesdecision-making and competencies and to increase thequality of health-care practice as a result. Computer-basedinformation systems can provide assistance to nurses inhealth-care environments.2,3 To ensure efficient and effec-tive use of computers in health-care environments, it isnecessary to determine nurses attitudes towards the useof computers.36
The most important determinant of attitudes towardscomputer use in health care is thought to be computerliteracy. Computer literacy is briefly defined as the abilityto use a computer. Nevertheless, various definitions havebeen given for computer literacy, such as the ability tocontrol [a] computer in achieving certain goals, theability to use different computer applications, the ability
Correspondence: Nurten Kaya, Health Sciences Faculty, IstanbulUniversity, Demirkap Cad. Karabal Sk. Bakrky Ruh ve SinirHastalklar Hastanesi Bahesi ii 34740 Bakrky, Istanbul,Turkey. Email: firstname.lastname@example.org, email@example.com,firstname.lastname@example.orgThis article was originally written as a masters thesis for theFundamentals of Nursing programme at Istanbul UniversityInstitute of Health Sciences.
International Journal of Nursing Practice 2014; :
doi:10.1111/ijn.12350 2014 Wiley Publishing Asia Pty Ltd
to comprehend [the] economic, psychological andsocial effects of computer[s] on [the] individual andsociety, and the ability to use [a] computer [for] accessto information, [for] communication and [in the] problemsolution process.79 The ability to use computers is animportant prerequisite for nurses and nurse candidates,who can benefit in clinical practice from acquiring healthand nursing information via computer. We shouldaddress the factors that might affect nurses computerliteracy levels and attitudes towards computer use inhealth care. Using these analyses, we should developstrategies to help nurses benefit from computer use inhealth care.13
Several studies in the international literature haveanalysed nurses computer literacy, their attitudestowards computer use and the determinants of theseattitudes.4,5,1020 Shoham and Gonen,5 Brumini et al.,18
Simpson and Kenrick,20 McNeil et al.21 and Larameeet al.22 reported that nurses computer-related attitudeswere generally positive. On the other hand, Campbell andMcDowell23 reported that the nurses in their study hadlittle to no experience with nearly half of the items in theGassert/McDowell Computer Literacy Survey. Asidefrom that study, it was not possible to access any studythat analysed nurses computer literacy. In addition,studies analysing nurses attitudes towards computer usein Turkey are limited.1,3
This descriptive and cross-sectional study aimed toaddress nurses computer literacy and attitudes towardsthe use of computers in health care and to determine thecorrelation between these two variables.
METHODSPopulation and sample
This study was conducted between September andDecember 2011 with nurses who worked at twouniversity-affiliated hospitals (referred to as A and B) inIstanbul. The population consisted entirely of nursesfrom hospitals A and B. For 95% reliability, 95% powerand 3% sampling error margin, the necessary samplesize was determined to be 688 nurses by statisticalmethods. An additional 50 nurses were included in thesample population as a backup plan in case of missingdata. Accordingly, 384 nurses from Hospital A and 354nurses from Hospital B were included in the study.Thus, the total sample population consisted of 738nurses.
Nurses included in the study were chosen using thestratified random sampling method. The sample wasstratified according to nurses working units. The onlyinclusion criterion for participation in this studywas consent to participate. There was no exclusioncriterion.
A total of 688 nurses from the sample of 738 wereincluded in the final analysis; 34 nurses could not bereached for reasons such as annual leave or maternityleave, and 16 surveys could not be evaluated because ofincomplete data. Consequently, the survey response ratewas 93.22%. The necessary sample size calculated wasalready 688. Thus, the target nurse number wasreached.24
InstrumentsNurse identification form
Nurses gender, age, educational attainment, nursingexperience, working unit and job title were recorded on anurse identification form.
Multicomponent Assessment of Computer LiteracyThe Multicomponent Assessment of Computer Literacy(MACL) was developed by Robin Kay25 in 1990 andwas translated into Turkish by Kln and Salman9 in 2006.The MACL is a seven-point Likert-type scale that consistsof four subscales, and each subscale consists of sixstatements about attitudes towards computers. Thesubscales are Basic Skills (BS), Application SoftwareSkills (ASS), Programming (P) and Computer Aware-ness (CA).25 To determine scale reliability, Kay25 calcu-lated Cronbachs alpha coefficient for each subscale; thefollowing coefficients were found: 0.93 for BS, 0.91 forASS, 0.90 for CA and 0.95 for P. Kln and Salman9
calculated the alpha coefficients 0.91, 0.93, 0.94 and 0.91for BS, ASS, CA and P, respectively. In the present study,the general reliability coefficient was 0.96; the coefficientvaried between 0.88 and 0.94 for the subscales (Table 1).The reliabilities of the scale and subscales were observedto be fairly high, and a similarity in study findings wasnoticed between the studies of Kay25 and Kln andSalman.9
Pretest for Attitudes Towards Computers inHealthcare Assessment Scale
The Pretest for Attitudes Towards Computers inHealthcare (PATCH) Assessment Scale was developed by
2 S Grdas Topkaya and N Kaya
2014 Wiley Publishing Asia Pty Ltd
Kaminski,26 and its second version was released in 2007.In this study, we used the second version. The scaleconsists of 40 questions to determine nurses feelings andattitudes towards the use of computers in environmentswhere health-care services are provided. Possible scoresrange from 40 to 40. Additionally, the classification andinterpretation of the findings were performed accordingto Table 2. The validity and reliability of the Turkishversion of PATCH v.2 were established by Kaya and Ast.1
The adaptation of the scale to the Turkish language wasperformed via back-translation, and the translated scalewas submitted for expert review to determine the contentvalidity. Its testretest reliability, internal consistency andcriterion-related validity (concurrent validity) wereexamined. The testretest reliability ranged from 0.20 to0.77 for individual PATCH items and was 0.85 for thetotal scale. For internal consistency, corrected itemtotalcorrelations ranged from 0.06 to 0.68, and Cronbachsalpha was 0.92. Concurrent validity was examined withcorrelation between the Attitudes Towards ComputersQuestionnaire and PATCH Assessment Scale scores, andthere was a significant positive correlation (r = 0.66,P < 0.01). The findings concerning the reliability andvalidity of the Turkish version of the PATCH AssessmentScale indicate that this instrument can be used in studiesconducted in Turkey.1 In the present study, Cronbachsalpha was determined to be 0.93 for the PATCH Assess-ment Scale (Table 1). The data in the present study par-alleled those in the study by Kaya and Ast.1 Therefore,the PATCH Assessment Scale data obtained from thesampling group in the present study were concluded tobe reliable.
Study variablesIn this study, the independent variable was the MACLscore and the dependent variable was the PATCH Assess-ment Scale score.
ProcedureNumbers of working nurses, with their names, the unitsthey worked in and task lists, were obtained from twohospitals for sample estimation. Nurses were selected forthe study using numbers from these lists. The nursesworking schedules were obtained from the unit headnurses. Nurses were interviewed individually face to face.The study was explained to them, and they were askedwhether they wanted to participate in the study. It wasemphasized that they could withdraw from the study, andthose who agreed to participate gave oral and written in-formed consent. Participants were given a specific date forthe completion of questionnaires, and these questionnaireswere collected on the due date by a researcher. Each parti-cipant nurse was rewarded with a gift after data collection.
Statistical data analysisThe SPSS 17 software package was used to performstatistical analysis of the findings obtained in the study.The median, minimum and maximum values, arithmeticmean and standard deviation were used to evaluateordinal data, whereas frequency and percentage valueswere used to evaluate nominal data. To determinewhether the distribution was normal or not, we used theKolmogorovSmirnov distribution test. We observedthat PATCH Assessment Scale scores displayed normal
Table 1 Cronbachs alpha and Kolmogorov-Smirnov analysis results for MACL and PATCH Assessment Scale (n = 688)
Number of items Cronbachs alpha KolmogorovSmirnov
MACLBasic Skills 6 0.94 3.77 0.000Application Software Skills 6 0.93 2.61 0.000Programming 6 0.94 3.97 0.000Computer Awareness 6 0.88 2.13 0.000
Total 24 0.96 1.87 0.002PATCH Assessment Scale 40 0.93 0.93 0.354
MACL, Multicomponent Assessment of Computer Literacy; PATCH, Pretest for Attitudes Towards Computers in Healthcare.
Views of computer use in nursing 3
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distribution (P = 0.354; P > 0.05), whereas MACL totaland subscale scores did not (P < 0.05) (Table 1). Todetermine the interscale correlation, we used Spearmanscorrelation analysis. Averages of the two groups werecompared using the independent-samples t-test for nor-mally distributed variables and MannWhitney U-testfor comparison of non-normally distributed variables.Pearsons 2-test was used for comparison of nominaldata. A 95% confidence limit and a significance level ofP < 0.05 were used for the analysis.
Ethical and legal aspectsWe obtained written permission to conduct the studyfrom the Istanbul University Faculty of Medicine ClinicalResearch Ethics Committee. We obtained institutionalpermission to conduct the study in hospitals A and B.Permission for the use of the scales was obtained fromKay,26 Kln10 and Kaya.5
RESULTSNurses demographic variables are shown in Table 3. Thenurses at hospital A and B were compared in terms ofthese variables and were found not to be statisticallydifferent in terms of gender, age, educational attainment,nursing experience, working unit or job title (Table 3).
Nurses computer literacy levels andattitudes towards the use of computers
in health careWe found the following average scores for each MACLsubscale: 32.52 for the BS subscale, 29.11 for the ASSsubscale, 15.20 for the P subscale and 24.42 for the CAsubscale. The total average score for the MACL was101.26. Nurses average score on the PATCH AssessmentScale was 15.18 (Table 4).
When nurses PATCH Assessment Scale scores wereinterpreted according to the classification categories in thescale manual (Table 2), the majority of nurses were ingroup 4 (36.6%) and group 5 (43.2%), whereas a smallpercentage of nurses were in groups 1 (0.6%), 2 (1.3%)and 3 (1.5%). The percentage of nurses in group 6, whichaccounted for the most positive attitudes towards the useof computers in health care, was 16.9%, which was inter-preted to be favourable (Fig. 1).
Correlations between nurses computerliteracy and attitudes towards the use of
computers in health careThere was a significant positive correlation betweenPATCH Assessment Scale and MACL total scores(r = 0.454). The PATCH Assessment Scale also hadsignificant positive correlations with the ASS, BS, CAand P subscales (r = 0.478, 0.476, 0.358 and 0.185,respectively; Table 5). These data showed that as MACLtotal and subscale scores increase, PATCH AssessmentScale scores increase.
Table 2 PATCH Assessment Scale score interpretations
40 to 28(Group 1)
Positive indication of cyberphobia.
Beginner-stage in experience with computer
basics or applications. Ambivalence or anxiety
may occur related to the use of computers in
health care. May appreciate help in learning
basic computer skills.27 to 15
Indicates some uneasiness about using computers.
Very basic knowledge of computer basics and
applications. Unsure of usefulness of
computers in health care.14 to 4
Moderate comfort in using computers. Has basic
knowledge of computers and applications.
Limited awareness of applications of computer
technology in health care.3 to 12
Feels comfortable using user-friendly computer
applications. Aware of the usefulness of
computers in a variety of settings. Has a
realistic view of current computer capabilities
in health care.13 to 26
Confident of ability to use a variety of computer
programs. Sees computers as beneficial in the
development of society. Enthusiastic view of
the potential of computer use in health care.27 to 40
Very confident that they can learn to use a