Adoption of electronic health records by nurses in Africa: A scoping review

Electronic health records (EHRs) are essential to modern nursing practice, enhancing patient care and safety. However, their adoption among nurses in Africa remains limited. Thus, this study aims to map evidence about nurses' adoption of EHRs in Africa.

Guided by the Levac framework, this review thoroughly analysed scholarly publications. Searches were conducted across six databases - CINAHL, Emcare, Medline, PsychINFO, Scopus and Web of Science - covering publications from 2014 to 2024. A manual search was conducted using Google and Google Scholar. A total of 12 studies met the inclusion criteria. The majority of studies were quantitative (n = 6), followed by mixed methods (n = 5) and qualitative (n = 1). Furthermore, of the 12 studies, five adopted interventional designs that introduced training programs in EHRs and decision support tools. Geographically, the research is primarily focused on sub-Saharan Africa, with South Africa contributing the highest number of studies (n = 5), followed by Nigeria (n = 4), Kenya (n = 2) and Ghana (n = 1).

The findings highlighted the suboptimal adoption of EHRs by nurses across Africa. Studies from Nigeria revealed minimal usage of EHRs despite the availability of infrastructure, while those from South Africa showed inconsistent progress. Kenya faced adoption barriers due to funding and infrastructure gaps, especially in rural areas. Eight studies emphasised the importance of standardised digital tools for nursing efficiency and patient care, yet reliance on paper records persisted. Key barriers included insufficient training, workflow disruptions, outdated technology, connectivity issues and resistance to change. Effective strategies involved targeted computer skill training, robust policies and organisational support, with usability optimisation crucial for boosting confidence and adoption.

The integration of EHRs among African nurses is still in its early stages, with a significant reliance on paper-based systems. Developing tailored training programs and exploring sustainable implementation strategies are essential for success.