Physicians' Perceptions as Predictors of the Future Use of the National Death Information System in Peru: Cross-sectional Study

Javier Vargas-Herrera, Giovanni Meneses, Juan Cortez-Escalante

Research output: Contribution to journalArticlepeer-review


Background: A computer application called the National Death Information System (SINADEF) was implemented in Peru so that physicians can prepare death certificates in electronic format and the information is available online. In 2018, only half of the estimated deaths in Peru were certified using SINADEF. When a death is certified in paper format, the probability being entered in the mortality database decreases. It is important to know, from the user's perspective, the factors that can influence the successful implementation of SINADEF. SINADEF can only be successfully implemented if it is known whether physicians believe that it is useful and easy to operate. Objective: The aim of this study was to identify the perceptions of physicians and other factors as predictors of their behavioral intention to use SINADEF to certify a death. Methods: This study had an observational, cross-sectional design. A survey was provided to physicians working in Peru, who used SINADEF to certify a death for a period of 12 months, starting in November 2019. A questionnaire was adapted based on the Technology Acceptance Model. The questions measured the dimensions of subjective norm, image, job relevance, output quality, demonstrability of results, perceived usefulness, perceived ease of use, and behavioral intention to use. Chi-square and logistic regression tests were used in the analysis, and a confidence level of 95% was chosen to support a significant association. Results: In this study, 272 physicians responded to the survey; 184 (67.6%) were men and the average age was 45.3 (SD 10.1) years. The age range was 24 to 73 years. In the bivariate analysis, the intention to use SINADEF was found to be associated with (1) perceived usefulness, expressed as "using SINADEF avoids falsifying a death certificate" (P<.001), "using SINADEF reduces the risk of errors" (P<.001), and "using SINADEF allows for filling out a certificate in less time" (P<.001); and (2) perceived ease of use, expressed as "I think SINADEF is easy to use" (P<.001). In the logistic regression, perceived usefulness (odds ratio [OR] 8.5, 95% CI 2.2-32.3; P=.002), perceived ease of use (OR 10.1, 95% CI 2.4-41.8; P=.001), and training in filling out death certificates (OR 8.3, 95% CI 1.6-42.8; P=.01) were found to be predictors of the behavioral intention to use SINADEF. Conclusions: The behavioral intention to use SINADEF was related to the perception that it is an easy-to-use system, the belief that it improves the performance of physicians in carrying out the task at hand, and with training in filling out death certificates.

Original languageEnglish
Article numbere34858
JournalJournal of Medical Internet Research
Issue number8
StatePublished - 1 Aug 2022

Bibliographical note

Funding Information:
Medical death certification is the main source of information on causes of death in a population [1]. Various studies worldwide report that there is low coverage of deaths that have medical certification of death [2,3], and those deaths that have certification of the causes of death do not have the desired quality [4,5]. In 2016, the coverage of deaths with medical certification of the causes of death in Peru was 56% [6] and the quality, measured as the proportion of codes of causes of death in the International Classification of Diseases classified as “garbage code,” was among the highest in the world [7]. In 2017, a computer application called the National Death Information System (SINADEF) [8] was implemented in Peru, which is used by physicians to prepare death certificates online. This system was the result of coordinated work between the National Institute of Statistics and Informatics, the National Registry of Identification and Civil Status, and the Ministry of Health, supported by the Bloomberg “Data for Health” initiative. Before implementing SINADEF, physicians performed death certification on paper forms, which were entered into computer applications installed on computers with local databases, which were then sent through email messages at the regional and national levels. In addition to the lack of opportunity for data availability, this system has many other problems: it does not verify the identity of the deceased by consulting a database, it does not identify the hospital where the person died, it does not unequivocally locate the district where the death occurred, and often, the cause of death written by the doctor is illegible.

Publisher Copyright:
© 2022 Journal of Medical Internet Research. All rights reserved.


  • Technology Acceptance Model
  • acceptance model
  • analysis
  • certificates
  • cross-sectional study
  • death
  • death certificates
  • health information system
  • information system
  • model
  • mortality
  • physicians
  • predictors
  • vital statistics


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