Sociodemographic Moderation of Behavioral and Technological Determinants of Electronic Community Health Information System Use in Western Kenya

Abstract

Background: Digital Health System (DHS) adoption and use remain a challenge globally, especially in low- and middle-income countries due to infrastructural and user related barriers. In Kenya, electronic Community Health Information Systems (eCHIS) was introduced to improve community health data reporting, yet its utilization varies. This study examined how sociodemographic factors moderate behavioral and technological determinants of eCHIS use in Western Kenya. Objective: To examine how age, gender, and education level influence the relationship between behavioral and technological factors and the use of eCHIS among Community Health Promoters (CHPs) in Western Kenya. Methods: A cross-sectional study of 310 CHPs in Western Kenya was conducted using stratified random sampling. Data were collected via a structured Kobo Collect questionnaire guided by the Technology Acceptance Model and Theory of Planned Behavior. Descriptive statistics and Spearman’s correlation assessed relationships, while predictive margins in STATA version 18 examined sociodemographic moderation effects. Results: The study showed a predominantly female sample (81.3%) with most respondents having secondary education. All behavioral and technological constructs were strongly associated with behavioral intention (r > 0.5), but weakly linked to actual eCHIS use (r < 0.2). The results of the moderation analysis revealed that age negatively affects the attitudes towards eCHIS while females are more vulnerable to the effects of social norms. Furthermore, the level of education positively influences the perceived behavioral control and increases system use. While the results reveal that both the behavioral and technological predictors have strong influence on the intention to use eCHIS, its actual use seems to depend on sociodemographic characteristics, indicating an evident intention - behavior gap. Therefore, interventions designed specifically for different age, gender, and educational groups should be considered for promoting the use of eCHIS in Western Kenya.