| dc.description.abstract | Electronic Health Record (EHR) is an interoperable digital system used by the healthcare providers to comprehensively manage patients’ health information. When applied sustainably, EHR can improve care coordination, reduce healthcare costs, support planning, and enhance decision making through timely, accurate, and accessible patient data. However, in many developing countries, including Kenya, EHR sustainability remains a challenge. In Siaya County, although development partners supported setting up EHR in public health facilities, utilization has been inconsistent. Issues such as lack of system integration, prolonged patient waiting times and data inaccuracies have hindered effective use, potentially compromising patient outcomes. Despite these challenges, limited studies exist on factors determining sustainability. This study investigated factors influencing the sustainable use of EHR in Siaya County public health facilities. Specifically, the study assessed staff attributes influencing the sustainable use of EHR; determined the infrastructural factors influencing the sustainable use of EHR; and measured the association between institutional culture and the sustainable use of EHR in Siaya County public health facilities. System operating and EHR training manuals were identified as the intervening variables. To achieve the objectives, a cross-sectional study design was adopted utilizing quantitative techniques. The Leslie Kish’s method was used to calculate the sample size setting the power of the test to 80% giving a total sample size of 224 healthcare providers. Of these 220 consented to participate giving 98% participation rate. Stratified sampling was used, with stratification based on health facilities and cadre of respondent. Quantitative data was collected using a semi-structured questionnaire. Data was analyzed using SPSS Version 25. Descriptive statistics generated frequencies and percentages, while Chi-Square tests determined the initial associations between categorical independent and dependent variables. Logistic regression performed provided adjusted odds ratio. Statistical significance was assessed at p<0.05. Out of the 220 respondents, most were aged between 20-30 years (69.7%), male was 62%, a majority (69.6%) had Diploma with nurses making up 56.0%. Chi-Square test revealed statistically significant associations between EHR sustainability and staff attributes, regular training (χ² = 9.676, p = 0.002), training frequency (χ² = 11.908, p = 0.003), training satisfaction (χ² = 6.814, p = 0.009), reduced medical errors (2 =7.869, p=0.005), improved communication, and reduced duplication (2 = 21.902, = 0.001). Logistic regression with EHR sustainability as the dependent variable yielded the adjusted odds ratio for regular training as 2.575 (p = 0.004), thrice-weekly training as 4.778 (p = 0.014), improved communication was 2.516 (p= 0.015), and reduced duplication was 3.093 (p= 0.0003). Accessing more than five computers, (χ² = 10.516, p = 0.005), and stable internet (χ² = 33.200, p = 0.001), were linked to EHR sustainable use under infrastructure. In the regression, >5 computers (AOR= 7.130, p= 0.007), and stable internet (AOR= 5.255, p= 0.001) maintained the association. Flexibility to IT changes (χ² = 13.506, p = 0.001), presence of data policy (χ² = 4.978, p = 0.026) and staff leaving (χ² = 22.546, p = 0.001) highly predicted EHR sustainability. Logistic regression, flexibility to change, (AOR 2.015 P = 0.046), data policy (AOR= 2.352, p= 0.012) and staff exit (AOR= 3.657, 95% CI, (1.845 – 7.248), p-value= 0.001) all contributed significantly too. This study recommends comprehensive, inclusive EHR training, communicating tangible benefits to foster system ownership. Stakeholders to invest in modern infrastructure, including functional computers, stable internet, power and dedicated technical support. Adaptive leadership, strong data privacy policies and strategic staff retention are also critical for the continuity of the EHR system. | en_US |
