{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:51:43Z","timestamp":1791485503172,"version":"4.3.4"},"reference-count":27,"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.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Electronic Community Health Information System (eCHIS) is Kenya\u2019s flagship digital health solution rolled out to strengthen community health service delivery and accelerate progress towards achieving universal health coverage. Despite its widespread rollout, evidence from global health initiatives affirms that the mere presence of a system doesn\u2019t guarantee meaningful use. Consistent eCHIS usage by frontline health workers remains a critical determinant of realising anticipated benefits, underscoring the need to understand the context-dependent enablers and barriers influencing such consistent usage, based on users\u2019 lived experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study employed a qualitative phenomenological design in three counties, conducting 22 interviews. A total of 12 Community Health Promoters (CHPs), 6 Community Health Assistants (CHAs), and 4 county focal persons participated in the study. The qualitative data were transcribed and analysed thematically using NVivo, guided by the Work System Framework (WSF), which examined usage across four dimensions: participants, information, technology, and processes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The findings showed that sustained eCHIS usage is influenced by a set of interrelated socio-technical enablers and barriers across the WSF dimensions. The key enablers included incentives, supportive supervision, training opportunities, real-time data access, improved accuracy, device portability, transparency, and data ownership. The major barriers included inadequate and unequal training, household resistance to disclosing sensitive information, financial constraints, device failures, data synchronisation issues, missed household visits due to environmental challenges, and delayed system updates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study\u2019s contribution was to show that sustained system use is shaped by interactions among work system dimensions rather than by technology availability alone. Through the WSF, the study provides a holistic understanding of the socio-technical determinants that influence the sustained use of national digital health systems. The findings affirm the need for refresher training, infrastructure support, workflow alignment, and community trust to ensure sustained use of digital health systems in low-resource settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358994","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:51:01Z","timestamp":1791481861000},"page":"e0358994","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enablers and barriers to Electronic Community Health Information System (eCHIS) usage in Kenya: A Work System Framework Analysis of frontline health worker experiences"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8179-839X","authenticated-orcid":true,"given":"Michael","family":"Kagiri","sequence":"first","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of Computing & Informatics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9597-1170","authenticated-orcid":true,"given":"Peter","family":"Wagacha","sequence":"additional","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of Computing & Informatics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ochieng","sequence":"additional","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of Computing & Informatics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3539-9596","authenticated-orcid":true,"given":"Salome","family":"Ireri","sequence":"additional","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of Computing & Informatics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Anindo","sequence":"additional","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of Computing & Informatics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Adoyo","sequence":"additional","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of HealthIT"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Wanjiru","sequence":"additional","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of HealthIT"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Kirui","sequence":"additional","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of HealthIT"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Pundo","sequence":"additional","affiliation":[{"name":"University of Nairobi","place":["Nairobi, Kenya"],"department":["Department of HealthIT"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Kimani","sequence":"additional","affiliation":[{"name":"Ministry of Health","place":["Nairobi, Kenya"],"department":["Division of Community Health Services"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Wanyungu","sequence":"additional","affiliation":[{"name":"Ministry of Health","place":["Nairobi, Kenya"],"department":["Division of Community Health Services"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"pone.0358994.ref001","volume-title":"Kenya Community Health Strategy 2020\u20132025","author":"Ministry of Health, Republic of Kenya","year":"2020"},{"issue":"1","key":"pone.0358994.ref002","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1186\/s12939-020-01284-3","article-title":"Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: A county-level case study in Kenya","volume":"19","author":"J Munywoki","year":"2020","journal-title":"Int J Equity Health"},{"key":"pone.0358994.ref003","unstructured":"Yohannes F. 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