Bridging the gap between community health workers’ digital health acceptance and actual usage in Uganda: Exploring key external factors based on technology acceptance model

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. This study 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. Specifically, we conducted semi-structured interviews with 170 community health workers who were recruited through both convenience and snowball sampling. We then performed response coding and cross-tabulation, correlation, and regression analysis. As a result, the TAM effectively predicted CHWs’ behavioral intention to use digital health tools. However, actual usage was not well predicted, and there was a mismatch between high behavioral intention and low actual usage. Access to smartphones emerged as a major determinant of actual usage, overshadowing other variables in the TAM. In conclusion, while CHWs show strong acceptance of digital health tools, structural barriers, particularly limited access to smartphones, hinder their actual use. These findings highlight the importance of addressing infrastructural inequities to enable the effective and equitable digitization of community health systems.Author summary: Community Health Workers (CHWs) are the foundation of healthcare delivery in many low- and middle-income countries, including Uganda. As digital health technologies expand globally, governments and organizations are working to digitize community health systems to improve efficiency and access to care. However, despite widespread enthusiasm, many digital health initiatives fail to move beyond pilot phases, often because actual technology use among CHWs remains low even when acceptance is high. In this study, we applied the Technology Acceptance Model (TAM) to understand why CHWs in Uganda accept digital health tools but do not always use them in practice. We conducted semi-structured interviews with 170 CHWs across urban and rural communities. While most CHWs expressed strong willingness and positive attitudes toward using digital tools, our analysis revealed that limited access to smartphones was the main barrier preventing regular use, especially when sharing smartphones with acquaintances is common. Our findings show that improving CHWs’ access to smartphones and addressing structural inequalities are essential for successful and equitable digital transformation of community health systems. Efforts to digitize healthcare must therefore go beyond training and motivation to include infrastructure equity and sustained support mechanisms that empower CHWs to use digital health tools effectively.