Factors Influencing Nurses’ Comfort Using Electronic Health Records in Botswana’s Resource-Limited Settings

Electronic health records (EHRs) can improve data access, care coordination, data integrity, and protections for privacy and confidentiality, yet adoption in resource-constrained settings is uneven. This cross-sectional mixed-methods study examined factors associated with nurses' comfort using EHRs in Botswana's clinics and health posts. We surveyed 193 nurses across 53 facilities within 8 district health management teams. Closed-ended survey responses were analyzed descriptively in SPSS 26, while responses to one open-ended question were analyzed in NVivo 15 as an exploratory qualitative component. Individual factors reported in relation to comfort using EHRs included computer self-efficacy, EHR knowledge, familiarity, frequency of use, and prior technology-related training. Technology characteristics linked to comfort using EHRs were perceived accessibility, usability, efficiency, and enhancements to privacy and confidentiality, whereas limited access, software and hardware issues, difficulty of use, and workflow inefficiencies were linked to discomfort using EHRs. At the organizational level, availability of training was the only factor that fostered comfort using EHRs, while lack of institutional training, weak EHR support and maintenance, inadequate infrastructure, and understaffing were prominent sources of discomfort using EHRs. These findings highlight the need for continuous training, reliable infrastructure, and sufficient staffing to reduce discomfort using EHRs and strengthen nurses' comfort using EHRs and sustained EHR use in resource-constrained settings.