Abstract
BACKGROUND: Artificial intelligence-driven clinical decision support systems (AI-CDSSs) are pivotal tools for doctors to improve diagnostic and treatment processes, as well as improve the efficiency and quality of health care services. However, not all doctors trust artificial intelligence (AI) technology, and many remain skeptical and unwilling to adopt these systems. OBJECTIVE: This study aimed to explore in depth the factors influencing doctors' willingness to adopt AI-CDSSs and assess the causal relationships among these factors to gain a better understanding for promoting the clinical application and widespread implementation of these systems. METHODS: Based on the unified theory of acceptance and use of technology (UTAUT) and the technology-organization-environment (TOE) framework, we have proposed and designed a framework for doctors' willingness to adopt AI-CDSSs. We conducted a nationwide questionnaire survey in China and performed fuzzy set qualitative comparative analysis to explore the willingness of doctors to adopt AI-CDSSs in different types of medical institutions and assess the factors influencing their willingness. RESULTS: The survey was administered to doctors working in tertiary hospitals and primary/secondary hospitals across China. We received 450 valid responses out of 578 questionnaires distributed, indicating a robust response rate of 77.9%. Our analysis of the influencing factors and adoption pathways revealed that doctors in tertiary hospitals exhibited 6 distinct pathways for AI-CDSS adoption, which were centered on technology-driven pathways, individual-driven pathways, and technology-individual dual-driven pathways. Doctors in primary/secondary hospitals demonstrated 3 adoption pathways, which were centered on technology-individual and organization-individual dual-driven pathways. There were commonalities in the factors influencing adoption across different medical institutions, such as the positive perception of AI technology's utility and individual readiness to try new technologies. There were also variations in the influence of facilitating conditions among doctors at different medical institutions, especially primary/secondary hospitals. CONCLUSIONS: From the perspective of the 6 pathways for doctors at tertiary hospitals and the 3 pathways for doctors at primary/secondary hospitals, performance expectancy and personal innovativeness were 2 indispensable and core conditions in the pathways to achieving favorable willingness to adopt AI-CDSSs.