Extending the expectation-confirmation model with quality and flow to explore nurses' continued blended e-learning intention

Purpose - The purpose of this paper is to propose a hybrid model based on the expectation-confirmation model (ECM), flow theory, and updated DeLone and McLean information system (IS) success model to examine whether quality factors as the antecedents to nurse beliefs affected nurses' intention to continue using the blended electronic learning (e-learning) system. Design/methodology/approach - Sample data for this study were collected from nurses at five hospitals in Taiwan. A total of 500 questionnaires were distributed, 396 (79.2 percent) questionnaires were returned. Consequently, 378 usable questionnaires were analyzed in this study, with a usable response rate of 75.6 percent. Collected data were analyzed using structural equation modeling. Findings - Information quality, system quality, support service quality, and instructor quality contribute significantly to perceived usefulness (PU), confirmation, and flow, which together explain nurses' satisfaction with the usage of the blended e-learning system, and this in turn leads to their continued system usage intention. Originality/value - First, the application of the ECM with the view of updated DeLone and McLean IS success model reveals deep insights into quality evaluation (including information quality, system quality, and support service quality) in the field of nurses' e-learning continuance intention. Especially, this study additionally contributes to the identification of instructor quality that may lead to nurses' continued blended e-learning usage intention. Next, the empirical evidence on capturing both extrinsic motivator (i.e. PU) and intrinsic motivator (i.e. flow) for completely explaining quality antecedents of nurses' blended e-learning continuance intention is well documented.