Cultural mediation of the impact of professional identity and social influence on clinical decision support system adoption: a study of European general practitioners

Purpose Clinical decision support systems (CDSS) are digital systems that enhance patient care by integrating established clinical knowledge with real-time patient information. Yet, CDSS face persistent challenges in achieving widespread adoption by physicians. This study seeks to deepen the understanding of general practitioners' (GPs) adoption behaviour by integrating micro-level determinants, namely the perceived support of GPs' professional identity and social influence with macro-level determinants of national culture. Design/methodology/approach This quantitative study used repeated cross-sectional data from 27 European countries. Structural equation modelling (SEM) was used to examine the effects of perceived support of professional identity, social influence and national culture on CDSS adoption by European GPs. Findings The findings from SEM suggest that GPs' perceptions of the support of their professional identity and of social influence as well as the values and beliefs of their national culture affect their adoption of CDSS, and that the effects of perceived support of professional identity and social influence are mediated by values and beliefs of national culture. Originality/value This study contributes to cross-cultural and information systems (IS) adoption research by addressing gaps in institutional theory and health IS (HIS) adoption. It examines both micro-level determinants (i.e., professional identity and social influence) and macro-level cultural factors as normative and cognitive institutional influences, offering a multi-level perspective on CDSS adoption. Using the updated Minkov–Hofstede model, the research provides a modern framework for understanding cultural effects on digital technology adoption. Furthermore, it disentangles the distinct mediation mechanisms through which cultural values shape the effects of professional identity and social influence on CDSS adoption.