The effect of voluntariness on the acceptance of e-learning by nursing students Boštjan Žvanut a, ⁎, Patrik Pucer a , Sabina Ličen a , Irena Trobec a , Nadja Plazar a , Damjan Vavpotič b a University of Primorska, College of Health Care Izola, Polje 42, 6310 Izola, Slovenia b University of Ljubljana, Faculty of Computer and Information Science, Tržaška 25, 1000 Ljubljana, Slovenia summary article info Article history: Accepted 17 July 2010 Keywords: E-learning Acceptance Voluntariness Nursing students Although e-learning is an innovation that is worth making generally available, it is not always accepted by nursing students. Many researchers state that voluntariness is closely related to the individual level of adoption of innovations. Hence, we hypothesized that voluntariness moderates the effect of perceived attributes of innovations (e.g. relative advantage, compatibility, complexity, trialability, and observability), which determines the acceptance of e-learning. To test the hypothesis a survey involving two groups of nursing students was carried out. For the first group the usage of e-learning was mandatory, for the second group it was optional. The results confirm our hypothesis. Institutions, interested in e-learning initiatives, should consider the effect of voluntariness when implementing e-learning. This paper provides a useful reference that can help e-learning providers to develop guidelines that can improve the acceptance of e-learning. © 2010 Elsevier Ltd. All rights reserved. Introduction With rapid changes in health care environments nurses constantly need to update their professional knowledge and skills to ensure the quality of health care provision (Yu & Yang, 2006). The UK Department for Education and Skills (2003) suggested that, in ten years' time, effective learning will be impossible without e-learning skills. The potential of e-learning to deliver flexible and innovative approaches in nurse education is recognized internationally (Moule, 2006). Several studies demonstrate positive attitude of nurses toward e-learning (Yu & Yang, 2006; Paladino & Peres, 2007; Yu et al. 2007; Žvanut et al. 2008). When introducing e-learning in nursing, the risk of unsuccessful implementation has to be considered. For example, Yu et al. (2007) report nursing students that reject e-learning. McVay Lynch (2002) reports that drop-out rates of e-learning programmes have been estimated at between 30 and 75%. In the future, the refusal of nursing students to make use of e-learning might be a barrier in gaining knowledge. Furthermore, organizations' investments in new technol- ogies are “inherently risky” if end-users refuse to use available tools (Davis et al., 1989). Background In order to provide sufficient background we undertook a thematic review of relevant sources (books, journal articles, and websites). We focused our search on keywords: innovation adoption, individual level of adoption of innovations, e-learning adoption, voluntariness, and nursing. E-learning, when used by nurses for the first time, represents an innovation. According to Rogers (2003), an innovation is an idea, practice, or object that is perceived as new by an individual or other unit of adoption. When introducing innovations in organizations it is important to focus not only on the organizational level but also on the individual level of adoption (Frambach & Schillewaert, 2002). This paper focuses on the individual level of adoption of e-learning. Many relevant studies that regard the individual level of adoption of innovations (Huisman & Iivari, 2002; Vavpotič & Bajec 2009) use the Rogers' Diffusion Of Innovations (DOI) theory when explaining the acceptance of innovations. Recently, the DOI theory was also used by Tung and Chang (2008) to explain the acceptance of e-learning by nursing students. According to the DOI theory, there are five groups of factors (thereafter referred as DOI factors) that explain the adoption of innovation (Rogers, 2003): perceived attributes of innovations, types of innovation-decision, communication channels, the nature of social system, and the extent of change agents' promotion efforts. Perceived attributes of innovations are: relative advantage, compatibility, complexity, trialability, and observability (Rogers, 2003). These attributes are further presented in Table 2. The three types of innovation-decision are of optional, collective, and authority nature. Thus, the choice to adopt or reject an innovation is made indepen- dently by individuals, by consensus among the members of a social system, or by a small number of individuals who possess power in a social system. The communication channels by which an innovation diffuses could be of various types: e.g. interpersonal communication or mass media. The nature of the social system with its norms, degree of network interconnectedness etc., should have a significant effect on the adoption of innovation. Finally, the extent of change agents' Nurse Education Today 31 (2011) 350–355 ⁎ Corresponding author. Tel.: + 386 56626460; fax: + 386 56626480. E-mail address: bostjan.zvanut@vszi.upr.si (B. Žvanut). 0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.07.004 Contents lists available at ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/nedt