| dc.description.abstract | Routinization is the process by which practices, procedures or a technology becomes
standardized or routinized into daily workflows (no longer questioned, becomes norm).
The incorporation of e-Health into healthcare has the capacity to revolutionize service
delivery by enhancing quality, which encompasses safety, timeliness, efficacy, efficiency,
patient-centeredness, and equity. Nonetheless, the adoption and utilization of these
systems continue to pose challenges, especially in developing nations. Despite substantial
expenditures in e-Health by the Kenyan government and its partners, the deployment and
integration of these technologies have not yet realized their full primary potential. The
research was motivated by the effective implementation of e-Health systems in
industrialized nations, which have markedly enhanced healthcare service provision. This
study aimed to develop a routinization architecture for e-Health implementations in public
healthcare facilities in Kenya, focusing on Kakamega County. The goal was to enhance
the daily use of implemented technologies, improve data accuracy, ensure consistency in
care delivery, increase efficiency, and support better decision-making. Despite substantial
investments by the Kenyan government and development partners, the full potential of e
Health systems remains unrealized. Drawing inspiration from successful e-Health
adoption in developed countries, this study sought to assess the current status of e-Health
systems, identify factors influencing routinization and design a proposed routinization
architecture to support sustained use. The study was guided by the Unified Theory of
Acceptance and Use of Technology, Normalization Process Theory and Task-Technology
Fit. An exploratory research design was employed; data was collected from a sample of
328 healthcare workers across seven selected public healthcare facilities level 3 to 5
through a quantitative approach through structured questionnaires and non-participatory
observation using stratified simple random sampling. Reliability test confirmed using
Cronbach’s alpha of 0.871 which was calculated to assess internal consistency of the scales
used in the questionnaire, validity was assessed using the Kaiser-Meyer-Olkin (KMO)
measure of 0.812 and Bartlett’s test of sphericity value of p < 0.001 confirming to sampling
adequacy. Data was analysed using SPSS v26 for both descriptive and inferential statistics.
Exploratory factor analysis was conducted using principal component analysis with
rotation to identify and group underlying constructs influencing e-Health routinization
such as system usability, organizational support and technology availability. Inferential
statistics using Pearson correlation was also applied to explore relationships and to test
predictive strength of key independent variables on the routinization outcome. The study
established that successful routinization of e-Health systems requires a comprehensive
architecture addressing strategic, technical, organizational support and user-related
factors. Key barriers identified include data management, insufficient IT training,
infrastructural limitations, limited user involvement and leadership, absence of supportive
policies and standard operating procedures. These findings underscore the need for a
comprehensive routinization architecture that addresses technical, organizational support
and user related factors to support the sustainable routinization of e-Health into daily
routine use to enhance healthcare service delivery. Addressing these challenges through
targeted intervention such as training in IT programs, infrastructure upgrade, clear policies
and strong leadership can enhance system use, data quality and healthcare delivery
efficiency. Findings were integrated into a context-specific routinization architecture to
guide a sustained e-Health integration into public healthcare settings workflows. | en_US |
