Information systems can improve organizational productivity and efficiency, but their success is predicated on engaged user adoption. Most information technology (IT) acceptance research has focused on voluntary adoption concepts. However, increasingly, new IT usage in organizational contexts is explicitly mandated, leaving users without volitional control over their usage decisions. Such mandated imposition can engender a diverse range of emotional and behavioral user responses, some of which can impede IT adoption and organizational effectiveness. Despite this fact, little is known about employee adaptation responses to mandated IT use, the cognitive appraisal processes that predict the development of these responses, as well as whether, why and how they can transition over time. This research answers calls to consider the role of emotions on IT use. It synthesizes two theoretic lenses to illuminate the multistage causal process that engenders diverse user responses to the recent mandatory implementation of a new health IT in public hospitals in Jeddah, Saudi Arabia. A framework harnessing the Transactional Model of Stress and Coping (TMSC) and Equitable Needs Fulfilment (ENF) theory guides the study and provides key propositions. Qualitative case studies involving detailed interviews with 38 doctors were conducted in three distinctively different medical care centres and one general hospital. Data was analyzed using thematic analysis and a deductive approach. The research findings confirm a taxonomy of multivalent user responses that co-emerge during mandated IT implementation. Moreover, they illuminate three need fulfilment factors: self–development, Work performance, and Relatedness, showing how they motivate positive transition (or, in their absence, negative transition) of these responses over time. The findings also provide actionable insights for practitioners seeking to effectively augment IT adoption to leverage greater organizational value from these systems.