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Adoption of Clinical Decision Support Systems (CDSS) is a crucial step towards the digital transition of the healthcare sector. This review aims to determine and synthesise the influential factors in CDSS adoption in inpatient healthcare settings in order to grasp an understanding of the phenomenon and identify future research gaps.

A systematic literature search of five databases (Medline, EMBASE, PsycINFO, Web of Science and Scopus) was conducted between January 2010 and June 2023. The search strategy was a combination of the following keywords and their synonyms: clinical decision support, hospital or secondary care and influential factors. The quality of studies was evaluated against a 40-point rating scale.

Thirteen papers were systematically reviewed and synthesised and deductively classified into three main constructs of the Technology–Organisation–Environment theory. Scarcity of papers investigating CDSS adoption and its challenges, especially in developing countries, was evident.

This study offers a summative account of challenges in the CDSS procurement process. Strategies to help adopters proactively address the challenges are: (1) Hospital leaders need a clear digital strategy aligned with stakeholders' consensus; (2) Developing modular IT solutions and conducting situational analysis to achieve IT goals; and (3) Government policies, accreditation standards and procurement guidelines play a crucial role in navigating the complex CDSS market.

To the best of the authors’ knowledge, this is the first review to address the adoption and procurement of CDSS. Previous literature only addressed challenges and facilitators within the implementation and post-implementation stages. This study focuses on the firm-level adoption phase of CDSS technology with a theory refining lens.

First-generation college students in the United States are a unique demographic that is often characterized by the institutions that serve them with a risk-laden and deficit-based model. However, our analysis of the transcripts of open-ended, semi-structured interviews with 22 “first-gen” respondents suggests they are actively deft, agentic, self-determining parties to processes of identity construction that are both externally imposed and potentially stigmatizing, as well as exemplars of survivance and determination. We deploy a grounded theory approach to an open-coding process, modeled after the extended case method, while viewing our data through a novel synthesis of the dual theoretical lenses of structural and radical/structural symbolic interactionism and intersectional/standpoint feminist traditions, in order to reveal the complex, unfolding, active strategies students used to make sense of their obstacles, successes, co-created identities, and distinctive institutional encounters. We find that contrary to the dictates of prevailing paradigms, identity-building among first-gens is an incremental and bidirectional process through which students actively perceive and engage existing power structures to persist and even thrive amid incredibly trying, challenging, distressing, and even traumatic circumstances. Our findings suggest that successful institutional interventional strategies designed to serve this functionally unique student population (and particularly those tailored to the COVID-moment) would do well to listen deeply to their voices, consider the secondary consequences of “protectionary” policies as potentially more harmful than helpful, and fundamentally, to reexamine the presumption that such students present just institutional risk and vulnerability, but also present a valuable addition to university environments, due to the unique perspective and broader scale of vision their experiences afford them.