JMIR Publications

ABSTRACT

Background:

Digital health has the potential to improve maternal and child health (MCH), particularly during the first 1,000 days of life. However, its successful implementation and adoption depend not only on the availability of technology but also on organizational readiness, governance, and the broader sociotechnical context. Evidence on how these factors interact in low- and low-middle income settings remains limited.

Objective:

This study examined the interplay of sociodemographic context, facility governance, and ICT readiness in shaping the adoption of a digital health tool for MCH in Manila, Philippines.

Methods:

A qualitative descriptive study underpinned by a constructivist paradigm was conducted in Manila, Philippines. The study sites included two outpatient departments in the Philippine General Hospital (PGH) and government primary healthcare facilities. Participants were selected through purposive sampling. Data were collected through a desk review, facility observations, and semi-structured in-depth interviews and focus group discussions. Qualitative data were analyzed using a two-phase approach combining rapid qualitative analysis and reflexive thematic analysis, guided by the Network of Influence Framework.

Results:

Readiness for digital health adoption was shaped by the interaction of favorable user-level factors and persistent organizational and governance constraints. Manila demonstrated high levels of digital engagement, with widespread smartphone ownership and internet access among potential users. However, fragmented health information systems and limited interoperability continue to constrain digital transformation across healthcare facilities. Six themes emerged from the qualitative analysis. Barriers included limited internet connectivity, inadequate availability of digital devices, usability challenges, and the lack of localized and integrated digital health tools. Enablers included interoperability across health information systems and positive attitudes toward technology adoption among mothers and healthcare providers. Although participants expressed strong willingness to adopt digital health innovations, structural and governance constraints limited their routine implementation. Overall, the findings indicate that the study sites currently exhibit more barriers than enablers, reflecting an imbalance in readiness to support the implementation of the Kalinga application. These findings provide important considerations for prioritizing context-responsive features and developing implementation strategies to address identified readiness gaps.

Conclusions:

Despite high levels of digital engagement among potential end users, structural and governance factors continue to impede digital health adoption for MCH in Manila. Bridging the gap between user readiness and system capacity requires investments in digital infrastructure, interoperability, localized digital solutions, and integrated health information systems.