Adoption of an Electronic Decision Support Tool for Capacity Building of Community Health Workers: Mixed Methods Study

Our findings show that acceptability does not guarantee sustained use and that adoption cannot be captured fully by log-in counts. UpToDate's value for CHWs lay in how it was domesticated as a tool for building capacity and professional credibility, not in its intended function as a decision aid used at the point of care. Therefore, evaluations of digital health tools should incorporate indicators of learning and social capital alongside use metrics. Policymakers should recognize that infrastructural fragility and communal adaptation shape digital health uptake. Embedding tools into ongoing training and peer learning structures, providing offline and multilingual support, and investing in resilience planning will be crucial for meaningful scale-up and sustainability.