Differential acceptance of a national digital health platform among community and frontline health workers in Cote d'Ivoire: a cross-sectional study

IntroductionMobile-based digital health solutions are critical technologies that play a significant role in improving the quality of healthcare services. Cote d'Ivoire is digitizing its community-based health information system (CHIS), piloting the mHealth.ci that is composed of an eCHIS and other tools for community health workers (CHWs) and frontline health workers (FHWs) in the Poro health region. This study aimed to compare the determinants of the mHealth.ci acceptance between these two categories of end-users in Cote d'Ivoire.MethodsWe conducted a cross-sectional analytic study from February to March 2025, in the five pilot health districts of the Poro Health Region, using a combined Technology Acceptance Model (TAM) and Louart S et al. framework. Key determinants included perceived usefulness, ease of use, advantages, disadvantages, social influence, personal emotion, context, attitude, intention to use, and actual use. A total of 280 trained end-users (80 FHWs and 200 CHWs) participated in the study. The data was analyzed with R.ResultsOf 280 participants, 85% were male, with an average age of 42 ± 9 years. Significant socio-demographic differences existed between CHWs and FHWs (e.g., CHWs were older, less educated, and had less prior mobile app experience, p < 0.001). mHealth.ci was accepted by end-users, respectively 61.79% and 38.21% of the 280 end-users rated it as “totally acceptable” and “acceptable”. While perceived ease of use, attitude, personal emotion, intention to use, context, and perceived disadvantages showed no significant inter-group difference, CHWs perceived usefulness and advantages better (p < 0.001, p = 0.015 respectively), valued social influence more (p < 0.001), and reported greater actual use (p < 0.001). More FHWs needed time to adapt (p = 0.012) and were less satisfied (p = 0.007). CHWs reported insufficient training (p < 0.001) and paradoxically felt both confident and stressed using the mHealth.ci.ConclusionThe study provides important insights into mHealth.ci acceptance and emphasizes the necessity of adapting training and supervision approaches to the distinct needs of different end-user categories to foster successful adoption of mHealth.ci.