Perceived value but persistent barriers: A qualitative study of healthcare worker experiences with the Impilo electronic health record system in rural Zimbabwe
- 1Department of Environmental Health, Faculty of Environmental Science, National University of Science and Technology, Bulawayo, Zimbabwe
Abstract
Electronic Health Records (EHRs) are pivotal for improving healthcare data quality and service delivery. Despite the introduction of the Impilo EHR system at St Anne’s Mission Hospital in Brunapeg, utilisation remains low. This study aimed to explore healthcare workers’ (HCWs) experiences and identify the key barriers and facilitators to Impilo’s utilisation. A descriptive qualitative study was conducted at St Anne’s Mission Hospital. In-depth interviews were conducted with 20 HCWs authorised to use Impilo, selected via purposive sampling until thematic saturation was achieved. Thematic analysis, following the Braun and Clarke approach, was used to analyse the data. Trustworthiness was ensured through multi-coder analysis, the maintenance of an audit trail, and thick descriptive reporting. HCWs reported positive experiences related to ease of data access, improved communication, and better inventory management. However, significant barriers undermine utilisation. The analysis revealed three key themes: (1) Benefits of Impilo, (2) Multifaceted Challenges, and (3) Suggested Improvements. Challenges included pervasive technical and infrastructural issues (e.g., frequent network downtime, lack of offline functionality), human resource constraints leading to dual documentation and increased workload, and subsequent compromised data quality due to inconsistent entry. The underutilisation of the Impilo system is not due to a lack of perceived value but is primarily driven by remediable barriers related to infrastructure, training, and workflow design issues. For successful implementation, interventions must be multifaceted, addressing technical reliability (e.g., offline functionality), human capacity (continuous training and support), and organisational processes (dedicated data clerks and inclusive system redesign). This study provides a framework for improving EHR adoption in similar low-resource rural settings. Author summary: In this study, we spoke with healthcare workers at a rural hospital in Zimbabwe to understand their experiences using a new digital health record system called Impilo. We discovered that while staff see great value in the system, it makes finding patient information faster, reduces errors, and helps manage medical supplies; its potential is largely untapped. The primary reasons for this are not a rejection of the technology, but rather solvable, real-world problems. Frequent internet outages, a lack of training, and the exhausting burden of having to record the same information on both paper and the digital system are the main hurdles. The findings suggest that for digital health tools to succeed in rural and low-resource settings, the focus must extend beyond the software itself. Success depends on creating a supportive environment, which includes reliable infrastructure like offline functionality, ongoing staff training and support, and a fundamental redesign of workflows to reduce the double burden on healthcare workers. We believe that by addressing these practical barriers, our work can help guide the successful adoption of digital health systems not only in Zimbabwe but in similar communities worldwide, ultimately strengthening healthcare delivery for all.
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BibTeX
@article{dube2026perceived,
title = {{Perceived value but persistent barriers: A qualitative study of healthcare worker experiences with the Impilo electronic health record system in rural Zimbabwe}},
author = {Shalom Rudorwashe Dube and Perez Livias Moyo and Methembe Yotamu Khozah},
journal = {PLOS Digital Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pdig.0001765},
url = {https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001765},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Perceived value but persistent barriers: A qualitative study of healthcare worker experiences with the Impilo electronic health record system in rural Zimbabwe
AU - Shalom Rudorwashe Dube
AU - Perez Livias Moyo
AU - Methembe Yotamu Khozah
PY - 2026
DA - 2026/10/08
JO - PLOS Digital Health
DO - 10.1371/journal.pdig.0001765
UR - https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001765
AB - Electronic Health Records (EHRs) are pivotal for improving healthcare data quality and service delivery. Despite the introduction of the Impilo EHR system at St Anne’s Mission Hospital in Brunapeg, utilisation remains low. This study aimed to explore healthcare workers’ (HCWs) experiences and identify the key barriers and facilitators to Impilo’s utilisation. A descriptive qualitative study was conducted at St Anne’s Mission Hospital. In-depth interviews were conducted with 20 HCWs authorised to use Impilo, selected via purposive sampling until thematic saturation was achieved. Thematic analysis, following the Braun and Clarke approach, was used to analyse the data. Trustworthiness was ensured through multi-coder analysis, the maintenance of an audit trail, and thick descriptive reporting. HCWs reported positive experiences related to ease of data access, improved communication, and better inventory management. However, significant barriers undermine utilisation. The analysis revealed three key themes: (1) Benefits of Impilo, (2) Multifaceted Challenges, and (3) Suggested Improvements. Challenges included pervasive technical and infrastructural issues (e.g., frequent network downtime, lack of offline functionality), human resource constraints leading to dual documentation and increased workload, and subsequent compromised data quality due to inconsistent entry. The underutilisation of the Impilo system is not due to a lack of perceived value but is primarily driven by remediable barriers related to infrastructure, training, and workflow design issues. For successful implementation, interventions must be multifaceted, addressing technical reliability (e.g., offline functionality), human capacity (continuous training and support), and organisational processes (dedicated data clerks and inclusive system redesign). This study provides a framework for improving EHR adoption in similar low-resource rural settings. Author summary: In this study, we spoke with healthcare workers at a rural hospital in Zimbabwe to understand their experiences using a new digital health record system called Impilo. We discovered that while staff see great value in the system, it makes finding patient information faster, reduces errors, and helps manage medical supplies; its potential is largely untapped. The primary reasons for this are not a rejection of the technology, but rather solvable, real-world problems. Frequent internet outages, a lack of training, and the exhausting burden of having to record the same information on both paper and the digital system are the main hurdles. The findings suggest that for digital health tools to succeed in rural and low-resource settings, the focus must extend beyond the software itself. Success depends on creating a supportive environment, which includes reliable infrastructure like offline functionality, ongoing staff training and support, and a fundamental redesign of workflows to reduce the double burden on healthcare workers. We believe that by addressing these practical barriers, our work can help guide the successful adoption of digital health systems not only in Zimbabwe but in similar communities worldwide, ultimately strengthening healthcare delivery for all.
SN - 2767-3170
ER -