Perceived environmental uncertainty and job involvement: the mediating role of digital technology and organizational trust - a cross-sectional study in primary care facilities in the UK

Abstract

Background

Digital maturity can help primary care facilities enhance their processes, communication, and adaptability to change, thereby fostering trust and job involvement. This study aimed to examine the causal relationships between perceived environmental uncertainty, digital maturity, organizational trust, and job involvement among managers of primary care facilities in the UK. The researchers applied socio-technical theory to examine the consequences of technology implementation on work practices and utilized contingency theory to ensure long-term stability in primary care facilities.

Methods

The study was conducted in the second quarter of 2023, surveying 200 managers from primary care facilities in the UK. The survey was conducted using a computer-assisted web interview (CAWI) method based on a purchased panel of respondents. Data were analyzed using descriptive statistics and structural equation modeling.

Results

The results showed that perceived environmental uncertainty moderately impacts digital maturity. A greater level of perceived environmental uncertainty is related to greater organizational digital maturity, although perceived environmental uncertainty explains only 15.0% of the variance in digital maturity. The analysis also showed that the impact of digital maturity on organizational trust is positive, significant, and strong, while its impact on job involvement is positive and significant but rather moderate. Moreover, digital maturity mediates the relationship between environmental uncertainty and job involvement among managers of primary care facilities. The weakest link in the model is the connection between organizational trust and job involvement.

Conclusions

The analysis showed that digital maturity is key in shaping organizational trust in primary care facilities and job involvement among their managers. As organizations progress in their digital capabilities, they are better positioned to cultivate trust within their structures. The results of this research contribute to the literature on human resource management in the healthcare sector by deepening knowledge about the impact of environmental uncertainty and digital transformation on organizational trust and job involvement. This study provides important policy information for managers who seek tools to mitigate the adverse effects of environmental uncertainty and want to increase job involvement within primary care facilities.

Background

The European primary care workforce crisis is marked by a lack of alignment between reform and workforce policies, variations in workforce innovation governance, shortages of doctors, and a steady loss of skilled workers [1]. These factors contribute to a crisis at the level of the entire primary care system and create ongoing uncertainty in the operation of primary care facilities (PCFs). Uncertainty, particularly environmental uncertainty, can significantly impact employees’ perceptions and behaviors. Environmental uncertainty means that employees must cope with complex, unstable, and unpredictable circumstances in their workplace [2]. The literature suggests that organizational trust can reduce uncertainty in the workplace [3]. Trust mitigates ambiguity and uncertainty in social perceptions, fostering cooperative and productive behaviors [4]. A crucial role in building such a workplace is played by employing digital technologies, which can improve communication, reduce costs, and enhance decision-making [5,6,7].

It is known that a high level of job involvement can increase the quality and quantity of work outcomes [8]. In the literature, significant attention is devoted to research on satisfaction and organizational commitment in the workplace context [9]. At the same time, job involvement, according to Kanungo [10], can drive positive outcomes for the organization. Therefore, clarifying the antecedents of job involvement is an important challenge for both science and management practice [11, 12]. Morgan [13] and Alder [14] highlight the importance of organizational trust as a key factor in the digital transformation of these facilities. Andrews [15] further suggests that perceived environmental uncertainty, a concept closely related to trust, can impact organizational effectiveness. However, the link between perceived environmental uncertainty and digital maturity in PCFs has not been explored. Additionally, while Martin [16] discusses the impact of digital maturity on clinical outcomes in secondary care, the connection between digital maturity, organizational trust, and job involvement in primary care settings remains unexplored. Therefore, there is a clear research gap in understanding the relationship between these variables in the context of PCFs in the UK.

The primary objective of this study was to examine the causal relationships between perceived environmental uncertainty, digital maturity, organizational trust, and job involvement among managers of primary care facilities in the UK. This study employs socio-technical theory to expand the understanding of technology implementation. This theory can increase understanding of the consequences of technology development and implementation on organizational social practices. A better understanding of these phenomena can help to develop better technologies and/or implement them more effectively, resulting in higher quality and quantity of work outcomes. This study also considers the contingency theory perspective. By investigating the relationship between perceived environmental uncertainty, digital maturity, and organizational trust, we contribute to the organization’s long-term stability.

Literature review

This study operationalizes the concept of the organizational environment as perceived environmental uncertainty (PEU). Inspired by Downey and Slocum [17], Galbraith [18], and Weick [19], we posit that an organization’s activities in response to its environment may align more closely with its perceptions of the environment than with objective indicators of environmental conditions. According to Andrews [2], PEU arises from managers’ perceptions of environmental complexity, instability, and unpredictability. The literature suggests that PEU may impact an organization’s inclination to employ digital technologies to mitigate uncertainty [20]. Appropriately employing digital technology can lead to attaining digital maturity (DM). DM is characterized by the extensive transformation of services, processes, workforce skills, organizational culture, and the capacity to effectively manage change [21]. Chen [22] and Lin [23] both underscore the significance of digital transformation in this context, with Chen exploring the relationship between environmental uncertainty and resource orchestration, and Lin emphasizing the importance of digital technology-business alignment. Boström and Celik [24] further corroborate this by discussing the need for organizations to navigate the digital era. In contrast, Haarhaus and Liening [25]) posit that strategic foresight, a crucial component of digital maturity, can improve decision-making in uncertain environments.

• H1: PEU of primary care managers has a significant, positive impact on DM of PCF

Research suggests that investigating PEU in the context of OT is justified [26]. Trust is a psychological state in which an individual accepts vulnerability based on positive expectations of another’s intentions or behavior [27]. In this study, trust refers to a positive expectation of the intent and behavior of multiple organizational roles, relationships, experiences, and interdependencies [28]. Andrews [2] found that higher PEU can lead to increased attention to strategies, structures, and processes, while Zanini [29] and Gaur [30] both noted a negative relationship between PEU and OT. Walker [31] further explored this, finding that as trust is built, concerns about risks diminish and that trust is crucial for joint action. These findings highlight the need for strategies to mitigate the impact of PEU on OT in PCFs.

• H2: PEU of primary care managers has a significant, negative impact on OT

Job involvement (JINV) is a psychological concept that refers to an individual’s identification with, or belief in, the importance of their job [10]. Kanungo’s [10] conceptualization is limited to the cognitive dimension of attitudes towards a specific job. The understanding of JINV in this work aligns with this conceptualization. Lefkowitz et al. [32] posited that this narrow understanding of JINV is based on the potential of a job to fulfill an individual’s essential needs, which are determined by their situation. Hoole and Boshoff [33] and Tee [34] suggested the need for a framework that outlines the antecedents and outcomes of this construct. In the context of digital transformation and its challenges, digital maturity (DM) may affect managers’ job involvement [35]. On one hand, DM can support managers’ job involvement by improving communication, reducing costs, and enhancing decision-making [5, 6, 36,37,38,39]. On the other hand, digitalization also presents cognitive challenges, such as choice overload and pressure from digitalization [40]. Considering these factors and our understanding of DM, we believe it will positively impact JINV.

• H3: DM of PCF has a significant, positive impact on the JINV of primary care managers

Trust plays a vital role in initiating, building, and maintaining social interactions and relationships [3]. Mayer et al. [41] posited that perceived risk moderates the behavioral manifestation of trust and subsequent outcomes. Trust decreases ambiguity and uncertainty in social perceptions, facilitating cooperative or productive behaviors [4]. However, building and maintaining trust in digitized work environments, which inherently pose risks and uncertainties, is challenging [42]. Further research is needed to explore the interplay between digital maturity and organisational trust, as emphasized by Tong [43] and Matyuk [44].

• H4: DM of PCF has a significant, positive impact on OT

The literature suggests that trust between individuals and groups is critical to an organization’s long-term stability and members’ well-being [36]. Theoretically, trust at work tends to result in more positive feelings, leading to increased effort and, ultimately, greater positive work outcomes, such as job satisfaction or commitment [45]. According to Lambret et al. [46], trust within the workplace is essential for a healthy organization. Thus, they broadly examined the effects of organizational trust on job satisfaction, involvement, and commitment among various groups of workers [46, 47], confirming the important role that organizational trust plays in shaping job involvement. However, there is little research on the impact of organizational trust on the job involvement of primary care managers.

• H5: OT has a significant, positive impact on JINV of primary care managers

Digital maturity (DM) represents a profound shift in services, processes, workforce skills, organizational culture, and the ability to effectively manage change [21]. Therefore, DM equips organizations with the necessary resources to address the challenges of perceived environmental uncertainty (PEU) [22]. DM is also a critical asset that requires continuous investment. In the context of German hospitals, managing directors’ perspectives on digital maturity play a significant role in overcoming barriers to digitalization [48]. According to Hertel et al. [49], digitalization enhances accessibility to information, facilitates interactive communication, provides automatic documentation with high levels of automation, and transcends boundaries. These features improve work process efficiency and decision-making, and expand the scope of collaboration and innovation by connecting humans, technology, and various entities. As DM enables managers to navigate uncertainty more effectively, it is worth examining whether DM is a mediating factor in the relationship between PEU and job involvement (JINV).

• H6: DM of PCF is a mediator of the relationship between PEU and JINV of primary care managers

Research has revealed a significant link between organizational justice and job performance, with trust considered to play a mediating role in these connections [50]. According to Luhmann’s (1995) social systems theory, trust reduces complexity [51]. Complexity arises when individuals navigate the social world and is characterized by excessive potential events and threats to stability. Trust simplifies this complexity by mitigating certain risks [51]. By decreasing uncertainty, trust can lead to more favorable emotions, resulting in increased effort and better job performance outcomes, including heightened JINV.

• H7: OT is a mediator of the relationship between PEU and JINV of primary care managers

DM, as defined by the degree to which an organization effectively integrates digital technologies into its processes and culture, has been shown to significantly impact employees’ responses to PEU. Research suggests that organizations with higher DM provide their employees with enhanced access to information, more streamlined processes, and greater agility in decision-making, which in turn can buffer the negative effects of PEU [52]. This improved digital infrastructure fosters a work environment where employees feel more competent and in control, thereby enhancing their JINV [53]. The mediating role of DM, therefore, lies in its ability to transform uncertainty into opportunities for growth and JINV, rather than threats, by empowering employees through improved tools and processes. OT serves as a critical mediator by influencing how employees perceive and react to environmental uncertainty. Trust within an organization, defined as the employees’ belief in the reliability, integrity, and competence of the organization, can mitigate the anxiety and stress associated with PEU [54]. High levels of OT promote a sense of psychological safety and stability, which can reduce the negative impact of PEU on JINV. Studies have demonstrated that when employees trust their organization, they are more likely to remain committed and involved in their roles, as trust fosters a supportive environment that encourages open communication and a shared vision [55]. Thus, OT mediates the relationship by cushioning the adverse effects of PEU and promoting a positive organizational climate that enhances JINV. When DM and OT are present together, their combined mediating effects can significantly strengthen JINV even in the face of high PEU. DM facilitates the flow of information and operational flexibility, while OT enhances interpersonal and organizational relationships. This synergy creates a resilient work environment where uncertainty is managed more effectively, allowing employees to stay engaged and committed to their jobs despite external fluctuations.

• H8: DM of PCF and OT are the serial mediators of the relationship between PEU and JINV of primary care managers

Methods

Data collection and respondent characteristics

This study aimed to examine the causal relationships between perceived environmental uncertainty (PEU), digital maturity (DM), organizational trust (OT), and job involvement (JINV) among managers of primary care facilities (PCFs) in the UK. To achieve this aim, we surveyed 200 managers from primary healthcare facilities operating in the UK in the second quarter of 2023. We used the computer-assisted web interview (CAWI) method and a purchased panel of respondents to ensure anonymity and compliance with privacy principles. All respondents provided informed consent to participate in the study. Before completing the questionnaire, respondents indicated their consent with the following statement: "I hereby declare that I, of my own free will, agree to participate in this study, and I know that I can withdraw at any time for reasons I do not have to specify and without facing any consequences." Providing consent was a condition for proceeding with the rest of the questionnaire. The questionnaire was divided into two parts: Part I collected information on manager characteristics such as age, gender, education, and experience, while Part II focused on PEU, DM, OT, and JINV. The Research Ethics Committee at Wroclaw University of Science assessed the questionnaire and the research procedure, issuing a Certificate of Ethics Approval (certificate dated April 7, 2023, No. O-23–11). To mitigate potential common method bias, we employed several procedural remedies, including the use of reverse-coded questions and the interspersing of items from different constructs within the survey instrument. Additionally, we assessed the presence of common method bias by conducting Harman’s one-factor test. The results indicated that the first factor accounted for 39.50% of the total variance, which is below the commonly accepted threshold of 50%. Consequently, common method bias does not pose a significant concern in this study.

The socio-demographic characteristics of the study participants are presented in Table 1.

Table 1 Demographic and socio-economic characteristics of respondents

Research variables description

The following variables were used to verify the proposed hypotheses: perceived environmental uncertainty (PEU), digital maturity (DM), organizational trust (OT), and job involvement (JINV) – see Table 2. The survey questionnaire was designed based on a comprehensive review of the existing literature.

Table 2 Rotated factor matrix – the final result

PEU was developed based on the concept from Waldman et al. [56] and was refined to two items to ensure reliability and internal consistency.

DM was developed based on the concept from Herceg, Kuč, Mijušković & Herceg [57].

OT was developed based on the concept from Shockey et al. [28], who created a five-dimensional construct of OT, including concern for employees, competence, identification, reliability, and openness/honesty.

A ten-item JINV scale was taken from Kanungo [10] to assess the cognitive belief state of psychological identification with one’s job. A detailed description of the research variables used can be found in Appendix 1.

All constructs used in this study were rated on a 7-point Likert scale (from strongly disagree to strongly agree with the middle point: neither agree nor disagree).

Descriptive statistics, reliability analysis of scales and measurement model fit

As a first step, a preliminary analysis of the scales was conducted using Exploratory Factor Analysis (EFA) with the Principal Components method and Varimax rotation through SPSS v. 29. The factor structure and correlations between items included in the scale were analyzed. Initially, more items were included in the analysis. However, some items had insufficient factor loadings, and others loaded on different factors. The final results of the rotated factor matrix (after removing PEU2, PEU4, JINV2, JINV3, and JINV7 from the original scales) are presented in Table 2.

The Kaiser–Meyer–Olkin (KMO) Measure of Sampling Adequacy indicates that the criteria for sampling adequacy are met (with a value above 0.6), and the Bartlett test of sphericity is statistically significant (p-value < 0.05), demonstrating that the correlation matrix is statistically different from an identity matrix as desired. The results of the Exploratory Factor Analysis (EFA) show that the solution is based on four factors, with all items loading on their respective factors, except for one item (DM1) that has cross-loadings. The four-factor solution explains 70.02% of the total variance. The results of the EFA suggest that the factors have a good level of validity.

In the next step, the internal consistency of responses for all the variables used in the research was assessed. The results of Cronbach’s alpha analysis are presented in Table 3. For all tested variables, Cronbach’s α was over 0.7, indicating high internal reliability of the scales and measurements. The scale measuring PEU had good internal consistency (α = 0.750), while the scales measuring DM, OT, and JINV exhibited excellent internal consistency (α = 0.863, α = 0.935, and α = 0.882, respectively).

Table 3 Defined variables along with the results of the reliability analysis of scales

A confirmatory factor analysis (CFA) was conducted to assess the constructs’ validity and test the model fit (see Table 4). The model was evaluated to test its reliability, convergent validity, and discriminant validity using IBM SPSS AMOS v. 29. All constructs are characterized by high composite reliability (CR > 0.7), indicating that they are reliable. The average variance extracted (AVE) for all constructs exceeds the required 0.5 and is consistently lower than CR. The standardized factor loadings of all operational items exceeded the proposed minimum level of 0.5 and were statistically significant. Together, these findings indicate the convergent validity of the constructs. Additionally, AVE exceeds the maximum shared variance (MSV) in all cases, indicating the scales’ discriminant validity. Theoretical validity is achieved when both convergent and discriminant validity are present, which is the case for all constructs. The measurement model fit is good, with incremental fit indices such as CFI = 0.958, NFI = 0.908, and TLI = 0.948 all above 0.9. The RMSEA indicator equals 0.062, χ² = 242.041, df = 138, p = 0.000, and χ²/df = 1.754.

Table 4 CFA results for constructs in the examined theoretical model

Results

As the next step in the research, path analysis was performed using IBM SPSS AMOS v. 29 to verify the theoretical model and hypotheses H1-H6. The model was constructed with perceived environmental uncertainty (PEU) as the independent variable, digital maturity (DM) and organizational trust (OT) as intermediate variables, and job involvement (JINV) as the dependent variable. Due to the limitation of the sample size (n = 200), the hierarchical variable OT was reduced to meta-features reflecting the complexity of the constructs, thereby simplifying the model and reducing its degrees of freedom. The final model consists of nineteen observable variables and four latent variables. Various models were calculated during the research process. The statistically significant model (χ² = 243.731; df = 140; p = 0.000) was obtained after introducing the correlation of measurement errors, and it exhibited a good fit. A summary of the model fit indices is presented in Table 5, and the obtained structural model can be seen in Fig. 1.

Table 5 Summary of model-fit indices for structural model

Fig. 1

Source: own research

The obtained structural model.

The calculated regression coefficients for the measurement and structural model are presented in Tables 6 and 7.

Table 6 Pathway coefficients of measurement equation model (n = 200)

Table 7 Pathway coefficients of structural equation model (n = 200)

The obtained results allow for the formulation of conclusions constituting the basis for verifying the proposed set of hypotheses and the theoretical model. The regression coefficients in Table 7, determining the importance of each relation within the model, show that all assumed variables were statistically significant elements of the model.

The results of the path analysis performed on the given sample provide support for the proposed hypotheses. The first hypothesis, which validates the relationship between an organization’s perceived environmental uncertainty (PEU) and digital maturity (DM), is supported. The results indicate that PEU has a statistically significant, positive, but moderate impact on DM (path coefficient = 0.39, p < 0.001), validating hypothesis H1. A higher level of PEU is associated with greater DM in the organization, although PEU explains only 15.0% of the variance in DM. PEU was not found to be a statistically significant predictor of organizational trust (OT) (path coefficient = -0.078, p > 0.05), so hypothesis H2 is not supported. The analysis also showed that DM has a positive, significant, and strong impact on OT (path coefficient = 0.75, p < 0.001) and a positive, significant, but moderate impact on job involvement (JINV) (path coefficient = 0.36, p = 0.002). These results support hypotheses H4 and H3, respectively. The weakest link in the model is the connection between OT and JINV. The impact of OT on JINV is weak (path coefficient = 0.19, p = 0.049) but still statistically significant, providing support for hypothesis H5.

The mediation analysis used direct and indirect effects with bootstrap procedures (5000 samples) and bias-corrected bootstrap confidence intervals (95%). The total, indirect, and direct effects presented in Table 8 show that both mediators positively contribute to the influence of PEU on JINV, indicating serial mediation. The indirect (mediated) effect of PEU on JINV significantly differs from zero at the 0.01 level (p = 0.001, two-tailed). This bootstrap approximation is obtained by constructing two-sided bias-corrected confidence intervals. The results revealed a significant indirect effect of PEU on JINV through DM (b = 0.106, t = 1.893, p = 0.002), supporting hypothesis H6. Moreover, the indirect effect of PEU on JINV through both DM and OT is also significant (b = 0.041, t = 1.367, p = 0.040), although weaker, supporting hypothesis H8. However, the indirect effect of PEU on JINV through OT alone is not significant (b = -0.011, t = -0.786, p = 0.160), leading to the rejection of hypothesis H7. A summary of the mediation analysis is presented in Table 8.

Table 8 Standardised total, direct and indirect effects within the structural model

In summary, JINV is explained by the direct impact of the organization’s DM and OT, as well as by the indirect impact of PEU through DM and OT, indicating total mediation. However, it should be noted that the predictors of JINV together explain only 26% of its variance, demonstrating the model’s limited explanatory power.

Discussion

In recent years, healthcare systems have faced increasing environmental uncertainty alongside rapid advancements in digital technologies. These dynamics pose significant challenges to the development of human capital within the healthcare sector. This study explored the causal relationships between Perceived Environmental Uncertainty (PEU), Digital Maturity (DM), Organizational Trust (OT), and Job Involvement (JINV) among managers of Primary Care Facilities (PCF) in the UK. We also conducted causal mediation analyses to identify how DM and OT mediate the relationship between PEU and JINV. Organizational trust is a critical factor influencing job commitment, as it fosters a supportive work environment that can enhance employees’ psychological connection to their roles. The relationship between OT and JINV is particularly important because trust within an organization can directly impact an individual’s willingness to be involved and committed to their job. This study found a statistically significant, albeit weak, positive effect of OT on JINV (path factor = 0.19, p = 0.049), providing evidence that trust does indeed play a role in enhancing job involvement. The findings align with existing literature that emphasizes the importance of trust as a foundation for commitment in organizational settings. According to Shockey et al. [28], OT is a multidimensional construct encompassing concern for employees, competence, identification, reliability, and openness/honesty. These dimensions collectively create a trustworthy environment, which is essential for cultivating job involvement. The positive relationship between OT and JINV observed in this study underscores the importance of building and maintaining trust within organizations to support employee engagement and commitment. Our results indicate that while PEU directly influences DM positively (supporting H1), it does not significantly impact OT (H2 not supported). This suggests that the factors contributing to organizational trust may be more complex and not solely driven by external uncertainties. The complexity of the relationship between PEU and OT has been noted in the literature, with varying findings across different contexts. For instance, some studies have suggested that high levels of uncertainty can undermine trust due to perceived instability, while others have found that uncertainty may actually bolster trust when organizations respond with transparent and supportive leadership [26, 29, 30]. Despite PEU’s lack of direct influence on OT, DM was found to be a strong predictor of OT (H4 accepted). This indicates that the integration of digital technologies not only enhances operational efficiency but also contributes to building trust within the organization by improving communication, transparency, and decision-making processes [30]. The strong positive relationship between DM and OT (path factor = 0.75, p < 0.001) demonstrates that organizations that effectively leverage digital maturity can foster a more trustworthy environment, which in turn enhances job involvement. DM is a critical factor in shaping OT within healthcare entities. As PCF progress in digital capabilities, they are better positioned to cultivate trust within their structures. Advancements in digital capabilities enable healthcare organisations to improve service delivery, patient experience, and overall quality of care [16]. Moreover, the influence of DM on OT extends beyond operational aspects to patient care. Digital technologies offer a wide range of treatment options for patients, presenting both opportunities and challenges for healthcare providers. The successful implementation of digital tools enhances patient outcomes and necessitates healthcare entities to address organisational challenges to maintain trust and ensure the benefits of digital transformation are realised [45, 58]. Moreover, the mediation analysis revealed that DM serves as a mediator between PEU and JINV, indicating that while PEU might not directly affect job involvement, it can do so indirectly through DM. This highlights the role of digital maturity as a critical pathway through which external uncertainties translate into internal organizational benefits, including higher levels of job involvement (H6 supported). The finding that OT partially mediates the relationship between DM and JINV further supports the notion that trust is a crucial factor linking digital maturity to job commitment. However, OT does not mediate between PEU and JINV (hypothesis H7 rejected). The results show that DM, which refers to the level at which an organisation has adopted and integrated digital technologies into its operations, significantly impacts JINV (H3 supported). This is because using digital technologies can improve communication and decision-making processes, affecting work-life balance and, consequently, various aspects of JINV [6, 7, 36]. The results are consistent with the results of several studies that have shown the positive impact of DM on JINV in various organisations, including public institutions [37], small and medium-sized enterprises [38], and digitally transformed home offices [16]. The results show that the effect of OT on JINV is rather weak but still statistically significant, which provides a basis for accepting the fifth hypothesis. The results are consistent with those of several studies that have found positive effects of OT on JINV among employees in various organisations [46]. Particularly in healthcare organisations, fostering OT is essential for improving job satisfaction and, therefore, organisational commitment and JINV among employees [45, 58]. The positive impact of OT on JINV has been associated with trends in reduced turnover tendencies, increased communication effectiveness, promotion of innovative behaviour, and improved job performance [58].

These studies emphasised the importance of DM in achieving organisational success. Therefore, based on the synthesised information, DM can act as a mediator in managing the impact of PEU on JINV—the factor which, among others, impacts this organisational success. The level of digital transformation in healthcare organisations can, therefore, significantly impact how employees engage with their work in the face of environmental uncertainties. Based on research on the relationship between eHealth use and healthcare workers’ motivation and job satisfaction, it was found that eHealth technology integration can play a role in increasing overall JINV [36]. Digital tools and platforms can streamline processes, provide timely information, and improve communication, all of which are essential to mitigating the impact of environmental uncertainty on JINV.

The practical implications of these findings are clear: organizations, especially within the healthcare sector, should prioritize building digital maturity as a means to enhance both trust and job involvement among employees. Investment in digital tools and technologies can lead to better communication, increased transparency, and improved decision-making processes, all of which contribute to a more trustworthy and engaging workplace. Furthermore, fostering a culture of trust through transparent leadership, competence, and consistent support for employees can significantly impact their commitment and involvement in their roles.

The study faced several limitations that may impact the generalizability and robustness of its findings. One notable limitation is the relatively small sample size of 200 participants, which restricts the extent to which the results can be applied to a broader population. Moreover, the sample is not evenly distributed across demographic categories, exhibiting a significant gender imbalance with 71.4% female participants and a complete absence of individuals aged 65 or older. This uneven distribution suggests that certain demographic perspectives, particularly those of older managers and males, might be underrepresented, potentially skewing the results. To address this limitation, future studies should aim to include a larger and more diverse sample, employing a stratified sampling approach to ensure a balanced representation across gender, age groups, and other relevant demographic factors. This would enhance the representativeness and generalizability of the findings, making them more applicable to the diverse range of managers in healthcare settings. Another limitation of the study lies in its cross-sectional design, which captures data at a single point in time and consequently limits the ability to draw definitive causal inferences between the variables of interest. The cross-sectional nature of the data makes it difficult to establish temporal precedence, which is crucial for understanding the directionality of relationships, such as whether changes in perceived ease of use (PEU) or digital maturity (DM) precede changes in organizational trust (OT) and job involvement (JINV). To overcome this issue, future research should consider implementing a longitudinal design, which involves collecting data across multiple time points. A longitudinal approach would allow for a more detailed examination of causal pathways and changes over time, helping to clarify whether shifts in PEU or DM indeed lead to variations in OT and JINV, thereby strengthening the evidence for causal inferences. The study’s reliance on self-reported data is another significant limitation. Self-reported data are susceptible to various biases, including social desirability, recall bias, and common method variance, which can affect the accuracy of responses and the validity of the findings. Participants may inadvertently provide answers that are more socially acceptable or misremember past experiences, leading to potential inaccuracies. To mitigate these biases, future research should incorporate objective measures or third-party assessments where feasible, such as performance metrics, digital maturity audits, or peer evaluations of trust levels. Additionally, employing a time-lagged survey design or utilizing multiple data sources, such as qualitative interviews or observations, could help reduce the common method bias and improve the overall validity of the findings. Due to sample size limitations, the study also simplified the hierarchical variable of organizational trust (OT) into broader meta-features, potentially overlooking the nuanced effects of its individual components, such as concern for employees and perceived competence. This simplification may obscure important insights into how different aspects of OT uniquely impact job involvement. Future research, particularly studies with larger sample sizes, should retain the full dimensionality of OT to explore the differential impacts of its various components. By examining each dimension of organizational trust, researchers can gain a more detailed understanding of how specific elements influence job involvement, providing more nuanced and actionable insights. Cultural bias is another concern, as the study was conducted solely among managers in the UK, which may limit the applicability of the findings to other contexts. Cultural norms, management practices, and healthcare systems can vary significantly across different regions, potentially influencing the relationships between digital maturity, trust, and job involvement. To enhance the external validity of the findings, future studies should replicate the research in diverse cultural settings or conduct cross-cultural comparisons. By examining whether the observed relationships hold across various healthcare systems and cultural contexts, researchers can gain a broader perspective on the constructs and provide more generalizable insights that are applicable in a wider range of environments. the study does not explore potential moderators that could affect the relationships between the constructs, such as individual differences (e.g., digital literacy, adaptability) or organizational factors (e.g., support for digital transformation). Without examining these moderators, it is difficult to understand the conditions under which PEU, DM, and OT influence job involvement. Future research should investigate possible moderating variables to provide more tailored insights into managing digital maturity and trust in healthcare settings. Identifying and exploring these moderating factors could reveal under what conditions the primary relationships are strengthened or weakened, offering more strategic guidance for practitioners. Finally, while the study reports good model fit indices, the overall explanatory power of the model is relatively low, explaining only 26% of the variance in job involvement. This suggests that important predictors might be missing, limiting the model’s ability to fully explain the factors influencing job involvement among managers in primary care facilities. To address this, future studies should expand the theoretical model to include additional predictors or mediators that could better explain the variance in job involvement. Integrating broader organizational factors, such as leadership style, workplace culture, or external environmental influences, may provide a more comprehensive understanding of the dynamics at play. By addressing these limitations in future research, the evidence base can be strengthened, improving the robustness of the findings and providing more actionable insights for enhancing job involvement among healthcare managers in uncertain and digitally evolving environments. This approach will help ensure that the findings are not only robust and reliable but also relevant and applicable across diverse contexts, ultimately supporting the effective management of digital maturity and organizational trust in healthcare settings.

Conclusion

This study aimed to fill the knowledge gap in healthcare management research regarding the causal relationships between PEU, DM, OT, and JINV among managers of PCF. A mediation analysis was conducted to check whether DM mediates the relationship between PEU and JINV. The results of this study suggest that DM positively impacts OT and JINV among managers of PCF. This study also shows that DM is necessary to eliminate the negative impact of PEU on JINV. Overall, the findings suggest that DM allows PHC to improve processes and communication and adapt to a changing environment, which can contribute to building OT and JINV. DM further moderates the influence of environmental conditions on JINV, highlighting the complex interplay of these factors in organisational settings. As organisations implement a digital transformation, they are better equipped to meet changing environmental conditions and create a foundation of trust essential for long-term JINV. By effectively leveraging digital tools and technologies, PCF can overcome uncertainty, foster OT, and strengthen JINV to achieve sustainable growth.