Factors associated with clinical coders’ intention to use the international classification of diseases 11th revision (ICD-11): a cross-sectional study in Iran

Given the pivotal role of clinical coders’ intention to use (ITU) in the adoption of the International Classification of Diseases, 11th Revision (ICD-11), this study aimed to examine their ITU concerning ICD-11 in teaching hospitals in Iran. A descriptive and correlational cross-sectional study was conducted in 2025. 516 clinical coders in 250 Iranian teaching hospitals comprising the population. We estimate 165 required samples by employing the proportion estimation formula. Data were collected via electronic questionnaires distributed through social platforms, which may have introduced sampling bias and compromised response validity due to the non-randomized nature of these channels. We reassessed the validated questionnaire including 53 questions with a seven-point Likert scale. The data were analyzed using SPSS software, with a focus on descriptive statistics and Pearson’s correlation coefficients (r). AMOS 24 was used to derive the modeling outcome, and the Path Analysis model was applied to evaluate the structural model. A total of 156 coders replied to the electronic questionnaires (87.2% female) with response rate of 94.5%. The CFI was reported as 0.93, indicating an excellent model fit. The path model findings show that perceived usefulness (β = 0.42, p < 0.05), perceived ease of use (β = 0.36, p < 0.05), and facilitating conditions (β = 0.69, p < 0.05) exerted a significant positive indirect influence, while attitude (β = 0.63, p < 0.05) and perceived behavioral control (β = 0.19, p < 0.05) demonstrated a significant positive direct effect on clinical coders’ intention to use (ITU) ICD-11. The study indicated strong intention among clinical coders to adopt ICD-11, driven by perceived usefulness, ease of use, and facilitating conditions. The findings highlighted the need for targeted interventions to ensure a smooth transition, including training programs, peer collaboration initiatives, and integrating ICD-11 into digital health infrastructures. Policymakers and healthcare institutions should prioritize these elements to optimize implementation outcomes in Iran’s health information systems.