Health workers’ adoption of digital health technology in low- and middle-income countries: a systematic review and meta-analysis
Author(s)
Type
Journal Article
Abstract
Objective: To conduct a systematic review and meta-analysis of the facilitators of and barriers to the acceptance and use of digital health technology by health workers in low- and middle-income countries.
Methods: We searched several databases for relevant articles published until 25 April 2024. We extracted data on four unified theories of acceptance and use of technology factors (performance expectancy, effort expectancy, social influence and facilitating conditions) and six additional factors (attitude, habit, incentive, risk, trust and self-efficacy); how these affected the outcomes of behavioural intention and actual use; and the strength of association if reported. We conducted a meta-analysis of the quantitative studies.
Findings: We reviewed 36 publications, 20 of which were included in our meta-analysis. We observed that performance expectancy was the most frequently reported facilitator (in 21 studies; 58.3%) and that lack of facilitating conditions was the most cited barrier (10; 27.8%). From our meta-analysis, trust (r = 0.53; 95% confidence interval, CI: 0.18 to 0.76) and facilitating conditions (r = 0.42; 95% CI: 0.27 to 0.55) were the leading facilitators of behavioural intention and actual use, respectively. We identified concerns with performance expectancy (r = -0.14, 95% CI: -0.29 to 0.01) as the primary barrier to both outcomes.
Conclusion: Our approach of clustering the facilitators of and barriers to the acceptance and use of digital health technology from the perspective of health workers highlighted the importance of creating an enabling ecosystem. Supportive infrastructure, tailored training programmes and incentive policies should be incorporated in the implementation of digital health programmes in low- and middle-income countries.
Methods: We searched several databases for relevant articles published until 25 April 2024. We extracted data on four unified theories of acceptance and use of technology factors (performance expectancy, effort expectancy, social influence and facilitating conditions) and six additional factors (attitude, habit, incentive, risk, trust and self-efficacy); how these affected the outcomes of behavioural intention and actual use; and the strength of association if reported. We conducted a meta-analysis of the quantitative studies.
Findings: We reviewed 36 publications, 20 of which were included in our meta-analysis. We observed that performance expectancy was the most frequently reported facilitator (in 21 studies; 58.3%) and that lack of facilitating conditions was the most cited barrier (10; 27.8%). From our meta-analysis, trust (r = 0.53; 95% confidence interval, CI: 0.18 to 0.76) and facilitating conditions (r = 0.42; 95% CI: 0.27 to 0.55) were the leading facilitators of behavioural intention and actual use, respectively. We identified concerns with performance expectancy (r = -0.14, 95% CI: -0.29 to 0.01) as the primary barrier to both outcomes.
Conclusion: Our approach of clustering the facilitators of and barriers to the acceptance and use of digital health technology from the perspective of health workers highlighted the importance of creating an enabling ecosystem. Supportive infrastructure, tailored training programmes and incentive policies should be incorporated in the implementation of digital health programmes in low- and middle-income countries.
Date Issued
2025-02-01
Date Acceptance
2024-12-01
Citation
Bulletin of the World Health Organization, 2025, 103 (02), pp.126-135F
ISSN
0042-9686
Publisher
World Health Organization
Start Page
126
End Page
135F
Journal / Book Title
Bulletin of the World Health Organization
Volume
103
Issue
02
Copyright Statement
© 2025 The authors; licensee World Health Organization. This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39882495
PII: BLT.24.292157
Subjects
Humans
Developing Countries
Digital Technology
Health Personnel
Attitude of Health Personnel
Digital Health
Publication Status
Published
Coverage Spatial
Switzerland
Date Publish Online
2024-12-03