Sub‑optimal knowledge with positive attitude and belief of frontline health workers toward the use of information technologies: A mixed‑method study from rural Haryana, India

Information technology (IT) can be used by frontline health workers (FLWs) to connect and deliver care to the community. Various studies in India have assessed the beneficial impact of IT usage by FLWs, but for the long‑term sustainability, the attitude and belief toward IT usage have not been adequately studied. We conducted this study to assess the knowledge and attitude and to explore the beliefs of FLWs toward the use of IT in a rural area of Haryana.

We conducted a mixed‑method study (qualitative and quantitative approach) in a rural setting of Haryana, India. We included FLWs of two primary health centers (PHCs). Data were collected from October 19, 2020 to December 31, 2020. We collected data from 75 accredited social health activists (ASHAs), 37 Anganwadi workers (AWWs), 28 multi‑purpose workers (MPWs), two information assistants, and two medical officers using a semi‑structured interview schedule. Their knowledge about the benefits of IT use, past use of IT applications and devices, and self‑rating of knowledge regarding computers or laptops were collected. We used 14 attitude statements, each with a five‑point Likert scale to assess the attitude; a total score ≥35 was considered a positive attitude. We conducted eight focus group discussions (FGDs) to explore the beliefs regarding IT usage (four FGDs with ASHAs, two FGDs with AWWs, and two FGDs with MPWs). A descriptive analysis was performed for the quantitative data, and a thematic analysis was performed for qualitative data.

Knowledge about the benefits of IT use was present among 77.8% of FLWs. Among the FLWs, 79.2% self‑rated their knowledge of computers/laptops as ‘do not have knowledge’, 16% self‑rated as ‘low knowledge’, and 4.8% self‑rated as ‘good knowledge’. The median total score for attitude statements among all the FLWs (n = 144) was 54 [inter‑quartile range – 48–59]. Four themes emerged for beliefs toward IT usage, namely, positive beliefs, negative beliefs, challenges anticipated in adopting IT use, and facilitation factors. The positive beliefs were related to improvement in work efficiency and social status, less paperwork, timely report generation, and better learning. The negative beliefs were related to an increase in working hours, close monitoring, and feeling over‑burdened.

We found that FLWs had knowledge regarding the benefits of IT use, but they lacked knowledge regarding laptop/computer use. They had a satisfactory level of confidence in using smartphones, and most of them were using mobile applications. The majority of the FLWs had a positive attitude and beliefs toward IT use and wanted to use it in the future.