Provider perspectives on usability, trust, and adoption of digital health tools under India's Ayushman Bharat Digital Mission: A qualitative analysis

Background India's Ayushman Bharat Digital Mission (ABDM) is building a national digital health ecosystem. Uptake by health care providers remains uneven. Paper records often persist alongside digital tools, suggesting a gap between tool design and frontline care. Objectives To explore how health care providers and other stakeholders in two Indian states experience the usability of digital health tools under ABDM, how far they trust these tools, and what shapes their adoption in routine practice. Methods We analysed 42 in-depth interviews with state and district officials, frontline health workers, clinicians and implementation partners in Karnataka and Andhra Pradesh. Interviews were collected under the provider adoption objective of the parent Digital Health Exemplars: India study. We used template analysis, with Cognitive Load Theory and Human Factors Engineering as a priori lenses. The themes were then mapped to the Consolidated Framework for Implementation Research (CFIR). Results We identified six mismatches between tool design and clinical reality. These were (1) rigid interfaces that clash with nonlinear clinical reasoning, (2) separate portals that force repeated data entry, (3) fears of surveillance and unclear data use by AI tools, (4) reliance on paper and WhatsApp as practical workarounds, (5) unreliable networks, devices and power, and (6) one-time, generic training. In some settings, use appeared to depend on incentives and partner support. Conclusion Providers in this study did not avoid digital tools because of low digital literacy alone. They avoided tools that added work without clinical value. Sustained adoption under ABDM is likely to need interoperable, offline-capable tools, clear data-use safeguards and cadre-specific training, addressed in national implementation guidance alongside enrolment targets.