Abstract
BACKGROUND: Kenya lags behind other countries in adoption of mobile health (m-health) applications. Understanding factors affecting adoption of m-health by hospitals is required to inform strategic scale up and leverage m-health for sustainable development goals. This study investigated the moderating effects of Top Executives' (TEs) traits, namely sex, level of education and knowledge of m-health, on adoption of Patient Centered (PC) and Facility-Centered (FC) m-health applications. METHODS: This study applied the Technological, Organizational and Environmental (TOE) framework and the Diffusion of Innovation (DOI) theory to test hypotheses that TEs' traits individually or combined had no statistically significant moderating effect on adoption of PC and FC m-health applications. Primary data were collected through a self-administered questionnaire from a representative sample size of 211 TEs from level 4 to 6 hospitals. The Logit Regression Model was used to determine the significance of each predictor. RESULTS: Most TEs of hospitals are predominantly male (75.3%). Most TEs (65%) rated their knowledge of m-health at medium level. Most TEs reported having completed undergraduate (46%) or post-graduate (38.4%) degrees. At 5% level of significance, the study found that being a male TE (p=0.041) and having higher level of knowledge of m-health (p=0.009) were statistically significant moderators of adoption of PC m-health applications by hospitals in Kenya. However, all TEs' traits combined or individually were not statistically significant moderators of FC m-health applications. The moderating effect of TEs' traits is thus affected by the focus, level of complexity of the technology, and by the required organizational change management. For PC scale-up, there is an urgent need to integrate digital health training in the medical education curricula and in the professional development programs and to develop policy incentives that remove any gender-related barriers to adoption of m-health. However, scale up of FC m-health may require other strategies such as pre-existence of systems and infrastructure and a cohesive change management strategy. CONCLUSION: This study recommends a differentiated approach to introduction, scale up, and investigation of PC and FC m-health applications.