Health Workers' Knowledge of and Attitudes Towards Computer Applications in Rural African Health Facilities

Background: The QUALMAT (Quality of Maternal and Prenatal Care: Bridging the Know-do Gap) project has introduced an electronic clinical decision support system (CDSS) for pre-natal and maternal care services in rural primary health facilities in Burkina Faso, Ghana, and Tanzania.

Objective: To report an assessment of health providers' computer knowledge, experience, and attitudes prior to the implementation of the QUALMAT electronic CDSS.

Design: A cross-sectional study was conducted with providers in 24 QUALMAT project sites. Information was collected using structured questionnaires. Chi-squared tests and one-way ANOVA describe the association between computer knowledge, attitudes, and other factors. Semi-structured interviews and focus groups were conducted to gain further insights.

Results: A total of 108 providers responded, 63% were from Tanzania and 37% from Ghana. The mean age was 37.6 years, and 79% were female. Only 40% had ever used computers, and 29% had prior computer training. About 80% were computer illiterate or beginners. Educational level, age, and years of work experience were significantly associated with computer knowledge (p<0.01). Most (95.3%) had positive attitudes towards computers - average score (±SD) of 37.2 (±4.9). Females had significantly lower scores than males. Interviews and group discussions showed that although most were lacking computer knowledge and experience, they were optimistic about overcoming challenges associated with the introduction of computers in their workplace.

Conclusions: Given the low levels of computer knowledge among rural health workers in Africa, it is important to provide adequate training and support to ensure the successful uptake of electronic CDSSs in these settings. The positive attitudes to computers found in this study underscore that also rural care providers are ready to use such technology.