{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:56:06Z","timestamp":1791482166348,"version":"4.3.4"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosdigitalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Digit Health"],"abstract":"<jats:p>Electronic Health Records (EHRs) are pivotal for improving healthcare data quality and service delivery. Despite the introduction of the Impilo EHR system at St Anne\u2019s Mission Hospital in Brunapeg, utilisation remains low. This study aimed to explore healthcare workers\u2019 (HCWs) experiences and identify the key barriers and facilitators to Impilo\u2019s utilisation. A descriptive qualitative study was conducted at St Anne\u2019s Mission Hospital. In-depth interviews were conducted with 20 HCWs authorised to use Impilo, selected via purposive sampling until thematic saturation was achieved. Thematic analysis, following the Braun and Clarke approach, was used to analyse the data. Trustworthiness was ensured through multi-coder analysis, the maintenance of an audit trail, and thick descriptive reporting. HCWs reported positive experiences related to ease of data access, improved communication, and better inventory management. However, significant barriers undermine utilisation. The analysis revealed three key themes: (1) Benefits of Impilo, (2) Multifaceted Challenges, and (3) Suggested Improvements. Challenges included pervasive technical and infrastructural issues (e.g., frequent network downtime, lack of offline functionality), human resource constraints leading to dual documentation and increased workload, and subsequent compromised data quality due to inconsistent entry. The underutilisation of the Impilo system is not due to a lack of perceived value but is primarily driven by remediable barriers related to infrastructure, training, and workflow design issues. For successful implementation, interventions must be multifaceted, addressing technical reliability (e.g., offline functionality), human capacity (continuous training and support), and organisational processes (dedicated data clerks and inclusive system redesign). This study provides a framework for improving EHR adoption in similar low-resource rural settings.<\/jats:p>","DOI":"10.1371\/journal.pdig.0001765","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:29:21Z","timestamp":1791480561000},"page":"e0001765","update-policy":"https:\/\/doi.org\/10.1371\/journal.pdig.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perceived value but persistent barriers: A qualitative study of healthcare worker experiences with the Impilo electronic health record system in rural Zimbabwe"],"prefix":"10.1371","volume":"5","author":[{"given":"Shalom Rudorwashe","family":"Dube","sequence":"first","affiliation":[{"name":"National University of Science and Technology","place":["Bulawayo, Zimbabwe"],"department":["Department of Environmental Health, Faculty of Environmental Science"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7501-0611","authenticated-orcid":true,"given":"Perez Livias","family":"Moyo","sequence":"additional","affiliation":[{"name":"National University of Science and Technology","place":["Bulawayo, Zimbabwe"],"department":["Department of Environmental Health, Faculty of Environmental Science"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Methembe Yotamu","family":"Khozah","sequence":"additional","affiliation":[{"name":"National University of Science and Technology","place":["Bulawayo, Zimbabwe"],"department":["Department of Environmental Health, Faculty of Environmental Science"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"pdig.0001765.ref001","doi-asserted-by":"crossref","DOI":"10.2196\/41446","article-title":"Data Quality in Health Research: Integrative Literature Review","volume":"25","author":"FA Bernardi","year":"2023","journal-title":"J Med Internet Res"},{"key":"pdig.0001765.ref002","unstructured":"Elahi E. Data quality in healthcare - benefits, challenges, and steps for improvement. https:\/\/dataladder.com\/data-quality-in-healthcare-data-systems\/ 2022. Accessed 2024 August 24."},{"key":"pdig.0001765.ref003","unstructured":"Ministry of Health and Child Welfare. Zimbabwe Health Information System Strategy - 2009-2014. 2009. https:\/\/extranet.who.int\/countryplanningcycles\/sites\/default\/files\/planning_cycle_repository\/zimbabwe\/mohcw_national_health_information_system_strategy.pdf"},{"issue":"10","key":"pdig.0001765.ref004","doi-asserted-by":"crossref","first-page":"2594","DOI":"10.3390\/biomedicines10102594","article-title":"Medical Records: A Historical Narrative","volume":"10","author":"J Lorkowski","year":"2022","journal-title":"Biomedicines"},{"key":"pdig.0001765.ref005","unstructured":"Cwiek M, Kikano G, Cline J, Griffin C, Maher V, Roth B. Electronic health records: the wonders and the worries. 2024."},{"key":"pdig.0001765.ref006","doi-asserted-by":"crossref","unstructured":"Records C, Practice B, Medicine I. Capturing social and behavioral domains in electronic health records: Phase 1. 2014. https:\/\/doi.org\/10.17226\/18709","DOI":"10.17226\/18709"},{"issue":"1","key":"pdig.0001765.ref007","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1093\/eurpub\/ckv122","article-title":"The impact of electronic health records on healthcare quality: a systematic review and meta-analysis","volume":"26","author":"P Campanella","year":"2016","journal-title":"Eur J Public Health"},{"issue":"1","key":"pdig.0001765.ref008","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s40537-019-0217-0","article-title":"Big data in healthcare: management, analysis and future prospects","volume":"6","author":"S Dash","year":"2019","journal-title":"J Big Data"},{"key":"pdig.0001765.ref009","first-page":"7341841","article-title":"Utilisation of Electronic Health Records for Public Health in Asia: A Review of Success Factors and Potential Challenges","author":"L Dornan","year":"2019","journal-title":"Biomed Res Int"},{"issue":"2","key":"pdig.0001765.ref010","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.09.020427","volume":"9","author":"TH Payne","year":"2019","journal-title":"Journal of Global Health"},{"key":"pdig.0001765.ref011","volume-title":"From innovation to implementation","author":"World Health Organisation E","year":"2016"},{"issue":"1","key":"pdig.0001765.ref012","first-page":"1","article-title":"Use of Electronic Health Records in sub-Saharan Africa: Progress and challenges","volume":"14","author":"MO Akanbi","year":"2012","journal-title":"J Med Trop"},{"key":"pdig.0001765.ref013","article-title":"Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region","author":"F Odekunle","year":"2017","journal-title":"Eur J Public Health"},{"key":"pdig.0001765.ref014","unstructured":"Mhembere TB. Lack of adoption of electronic medical records systems in developing countries: A case study of Zimbabwe. http:\/\/hdl.handle.net\/11427\/31093 2019. Accessed 2024 August 24."},{"issue":"8","key":"pdig.0001765.ref015","doi-asserted-by":"crossref","DOI":"10.2196\/33491","article-title":"Implementing Electronic Health Records in Primary Care Using the Theory of Change: Nigerian Case Study","volume":"10","author":"T Adedeji","year":"2022","journal-title":"JMIR Med Inform"},{"key":"pdig.0001765.ref016","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1186\/s13690-025-01735-9","article-title":"Negligence in data recording during institutional birth: exploring health workers\u2019 perspectives on the barriers and enablers of data documentation practices","volume":"83","author":"BK Taye","year":"2025","journal-title":"Arch Public Health"},{"issue":"1","key":"pdig.0001765.ref017","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1186\/s12913-024-11378-1","article-title":"Understanding the predictors of health professionals\u2019 intention to use electronic health record system: extend and apply UTAUT3 model","volume":"24","author":"HS Ngusie","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"pdig.0001765.ref018","unstructured":"Mwogosi A, Mambile C. Insights into the current state of electronic health records adoption and utilisation in Tanzanian public primary healthcare facilities: a survey study. researchgate.net. https:\/\/www.emerald.com\/insight\/0956-5698.htm 2024. Accessed 2024 November 13."},{"key":"pdig.0001765.ref019","unstructured":"Impilo. Modules. https:\/\/impilo.mohcc.gov.zw\/modules\/ 2023. Accessed 2024 August 27."},{"key":"pdig.0001765.ref020","doi-asserted-by":"crossref","unstructured":"Mugauri HD, Chimsimbe M, Shambira G, Shamu S, Nyamasve J, Munyanyi M, et al. From paper to pixels: A pre\u2010 and post-implementation analysis of electronic health records in maternal and child health in Zimbabwe. Research Square. 2025. https:\/\/doi.org\/10.21203\/rs.3.rs-7026812\/v1","DOI":"10.21203\/rs.3.rs-7026812\/v1"},{"issue":"3","key":"pdig.0001765.ref021","doi-asserted-by":"crossref","first-page":"393","DOI":"10.18267\/j.aip.265","article-title":"Electronic Health Record Systems in Limited Resource Settings: A Comprehensive Evaluation of the Impilo Platform","volume":"14","author":"HD Mugauri","year":"2025","journal-title":"AIP"},{"key":"pdig.0001765.ref022","volume-title":"Qualitative Interviewing: Conversational Knowledge Through Research Interviews","author":"S Brinkmann","year":"2022","edition":"2"},{"issue":"4","key":"pdig.0001765.ref023","first-page":"597","article-title":"Understanding reliability and validity in qualitative research","volume":"8","author":"N Golafshani","year":"2003","journal-title":"Qual Rep"},{"key":"pdig.0001765.ref024","unstructured":"ZIMSTAT, Zimbabwe UNFPA. 2022 Population and Housing Census Preliminary Results. https:\/\/zimbabwe.unfpa.org\/en\/publications\/2022-population-and-housing-census-preliminary-results 2022. Accessed 2023 November 16."},{"issue":"1","key":"pdig.0001765.ref025","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough?: An experiment with data saturation and variability","volume":"18","author":"G Guest","year":"2006","journal-title":"Field Methods"},{"issue":"4","key":"pdig.0001765.ref026","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1080\/2159676X.2019.1628806","article-title":"Reflecting on reflexive thematic analysis","volume":"11","author":"V Braun","year":"2019","journal-title":"Qualitative Research in Sport, Exercise and Health"},{"issue":"1","key":"pdig.0001765.ref027","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"LJ Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"pdig.0001765.ref028","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1186\/1748-5908-8-139","article-title":"Implementation strategies: recommendations for specifying and reporting","volume":"8","author":"EK Proctor","year":"2013","journal-title":"Implement Sci"},{"key":"pdig.0001765.ref029","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13012-015-0209-1","article-title":"A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project","volume":"10","author":"BJ Powell","year":"2015","journal-title":"Implement Sci"},{"issue":"3","key":"pdig.0001765.ref030","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1177\/0038038509103208","article-title":"Implementing, embedding, and integrating practices: An outline of normalization process theory","volume":"43","author":"C May","year":"2009","journal-title":"Sociology"}],"container-title":["PLOS Digital Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pdig.0001765","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:29:26Z","timestamp":1791480566000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pdig.0001765"}},"subtitle":[],"editor":[{"given":"Phat Kim","family":"Huynh","sequence":"first","affiliation":[{"name":"North Carolina A&T State University: North Carolina Agricultural and Technical State University","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pdig.0001765","relation":{},"ISSN":["2767-3170"],"issn-type":[{"value":"2767-3170","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]}}}