Bridging the Gap Between Community Health Workers’ Digital Health Acceptance and Actual Usage in Uganda: Exploring Key External Factors based on Technology Acceptance Model.

Abstract Background Community health systems are poised to play a prominent role in achieving universal health coverage in low- and middle-income countries, as demonstrated during the COVID-19 pandemic response. The advent of health information technology has provided an opportunity to optimize the community health space and improve efficiency. However, there is limited knowledge about the acceptance and usage of health information technology among community health workers, a prerequisite for scaled implementation. We aimed to use the technology acceptance model (TAM) to predict the acceptance and usage of health information technology among CHWs, identify external factors and understand the impact on community health systems. Methods We conducted semistructured interviews with community health workers who were recruited through both convenience and snowball sampling. Data were entered using an ODK form. Codes were induced or deduced from open-ended responses. Cross-tabulation, correlation and regression analysis was performed using SPSS version 28. Results The technology acceptance model was a good predictor of behavioral intention to use digital health tools among CHWs. However, actual usage was not well predicted, and there was a mismatch between high behavioral intention and low actual usage. Access to smartphones was found to have an oversized influence on the actual usage of digital health tools. Conclusion According to TAM, CHWs have accepted the use of digital health tools but are limited by access to smartphones. There is also a need to ensure equitable digitization of community health systems. Last, the study further emphasizes the impact of digital health tools on community health systems.