Currently submitted to: JMIR Human Factors
Date Submitted: Jun 4, 2026
Open Peer Review Period: Jun 9, 2026 - Aug 4, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Determinants of perceived sustainability of Electronic Medical Records among nurses in Kenya: A Modified Technology Acceptance Model analysis
ABSTRACT
Background:
Background:
Sub-Saharan Africa has historically experienced the highest disease burdens and increasingly high shortages of health workforce. Digital public Health Interventions (DPHIs) have exponentially increased in the rates of adoption and scope of implementation across organisations. However, the fragmented nature of the approaches to rollout of the digital public health interventions and systems have resulted in poor rates of adoption, weak perceived sustainability of use, and limited scalability to meet changing patient expectations and user needs.
Objective:
This study assesses the determinants for sustained use of Electronic Medical Record (EMR) using Technology Acceptance Model (TAM) among nurses in Kenya's public health settings.
Methods:
A quantitative, cross-sectional correlational design was employed. Primary data were collected from 330 nurses sampled from public health facilities across eleven high HIV/TB burden counties in Kenya. Data analysis was performed using Structural Equation Modelling (SEM). The modified TAM framework primarily incorporated two additional constructs DPHI Rollout and Perceived.
Results:
The final measurement model demonstrated satisfactory psychometric properties, including reliability, convergent validity, and discriminant validity. Structural model results indicated that DPHI Rollout was positively associated with Perceived Ease of Use (PEOU; β=0.43, p<.001) and Perceived Usefulness (PU; β=0.31, p=.001). PEOU was positively associated with both PU (β=0.47, p<.001) and Perceived Sustainability (β=0.38, p<.001). In contrast, PU was not significantly associated with Perceived Sustainability (β=0.02, p=.876), and DPHI Rollout did not demonstrate a significant direct association with Perceived Sustainability (β=-0.02, p=.860). The model explained 28.9% of the variance in Perceived Sustainability.
Conclusions:
Perceived Ease of Use emerged as the strongest factor associated with perceived sustainability of EMRs among nurses in Kenyan public health facilities. The findings suggest that implementation approaches that prioritise usability, user training, and ongoing support may contribute to the perceived long-term sustainability of digital health systems. The study provides empirical support for a contextually adapted TAM for evaluating digital health interventions in low- and middle-income country settings.
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