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.
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