Appropriation and perceived effectiveness of the eSanteCoM digital tool among Community Health Workers in Burkina Faso: a convergent parallel mixed-methods cross-sectional study

Abstract Background. The digitalization of community health is increasingly presented as a lever to strengthen health systems in resource-limited settings, provided that the tools deployed are genuinely appropriated by their users. Within the Minimal Digital Ecosystem (MDE) initiative, Burkina Faso deployed the eSanteCoM mHealth tool among Community Health Workers (CHWs). This study assessed its level of appropriation, perceived effectiveness, and associated factors. Methods. We conducted a convergent parallel mixed-methods cross-sectional study in May 2025 among 135 CHWs utilizing eSanteCoM across the Ziniaré and Manga health districts. Two binary outcomes were modeled via multivariable logistic regression to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI): perceived effectiveness (improved data speed and reliability) and regular data utilization for local decision-making. Qualitative responses to open-ended questions underwent thematic content analysis and were integrated with quantitative findings via triangulation. Results. Most participants were female (52.6%), and literate (97.8%), with 83.5% reporting over five years of service. Perceptions of tool appropriation were high: 98.5% considered it useful, 96.3% deemed it user-friendly, 89.6% felt at ease using it, and 100% expressed overall satisfaction. While perceived effectiveness was high at 79.4%, regular data use for decision-making concerned only 21.6% of CHWs. Perceived effectiveness was independently associated with possessing a suitable smartphone (aOR = 4.88; 95% CI [1.53 to 15.57]), higher digital self-efficacy (aOR = 4.14; 95% CI [1.22 to 14.09]), regular administrative feedback (aOR = 2.97; 95% CI [1.00 to 8.79]), and the Manga health district (aOR = 3.13; 95% CI [1.07 to 9.18]). Regular data use for decision-making was significantly associated with digital self-efficacy (aOR = 3.49; 95% CI [1.22 to 9.97]), the Manga district (aOR = 3.88; 95% CI [1.27 to 11.81]), and material resources (aOR = 3.93; 95% CI [0.81 to 18.98]). Qualitative data highlighted critical needs for reliable device charging, continuous refresher training, and stable financial incentives. Conclusion. The eSanteCoM tool achieved excellent user acceptability, but a substantial implementation bottleneck restricts routine data utilization for local decision-making. Transitioning from passive adoption to decision-oriented integration requires a multi-pronged strategy addressing hardware security, digital self-efficacy, formative feedback loops, and sustainable CHWs incentives.