Implementation process and acceptability of the electronic community health information system among community health...

The electronic Community Health Information System (eCHIS) is a mobile health technology that was scaled nationally to community health workers (CHWs) in Kenya beginning in 2023. Since the rapid scale up, reports on eCHIS uptake show varying adoption rates. The overall purpose of this study was to assess the relationships between implementation process and acceptability of eCHIS by CHWs in Kenya.

A cross-sectional study was conducted in 5 counties in Kenya with 310 CHWs (40 community health assistants and 270 community health promoters) selected through convenience stratified sampling. A structured questionnaire, developed by integrating the Technology Acceptance Model questionnaire and the Normalization MeAsure Development (NoMAD) tool, was administered by trained research assistants using Kobo Collect. The data was analyzed using descriptive statistics and structural equation modelling in STATA version 18.

Implementation process mechanisms were found to have positive and significant relationships with the acceptability of eCHIS. Specifically, cognitive participation had a significant and positive relationship with perceived usefulness of eCHIS (β = .2783, p < .05). Additionally, coherence (β = .3911, p < .001) and reflexive monitoring (β = .3272, p < .05) had significant and positive relationships with perceived ease of use. The study also revealed inadequate training, financial resources, and technical and management support as the key implementation barriers.

Implementation process significantly influences the acceptability of eCHIS. It is therefore important for governments and other implementing partners to strengthen the eCHIS training programs, allocate sufficient financial and technical resources, and provide management support to the CHWs to enhance eCHIS adoption.