Perception of Female Primary Healthcare Providers on Acceptability, Perceived Ease of Use, and Perceived Quality of Care of Digital Decision Support Systems embedded within a large tele-Primary Healthcare Setting in Sindh, Pakistan (Preprint)

BACKGROUND Primary healthcare (PHC) in Pakistan faces a critical workforce shortage, exacerbated by the attrition of women physicians, an estimated 35% leave practice post-marriage or childbirth. Sehat Kahani, a private telehealth network, addresses this gap by enabling these “doctor-brides” to offer remote consultations from home. Recently, it piloted a Digital Decision Support System (DDSS) for febrile illnesses. This study explores female PHC providers’ perceptions of DDSS acceptability, perceived ease of use, and perceived quality of care in a large-scale telehealth setting in Sindh, Pakistan. OBJECTIVE This study is designed to explore the acceptance, perceived ease of use and perceived quality of care among female primary health providers, implementing DDSS in a large-scale tele-health setting in Sindh, Pakistan. METHODS A mixed-method sequential explanatory design was used. An online survey (n=30) across 5 telehealth clinics assessed healthcare providers' perceptions across seven domains, including utilization, peer influence, technical facilitation, behavioral intention, satisfaction, ease of use, and trust in diagnostic accuracy. This was followed by focus group discussions (FGDs) to explore facilitators and barriers to DDSS use. Descriptive statistics were applied to survey data and thematic analysis to FGD transcripts. RESULTS In survey, most PHC providers used DDSS regularly, 43.3% using it multiple times a day. 50% expressed trust in DDSS accuracy, 46.7% occasionally re-evaluated its suggestions. 50% of providers were moderately satisfied with system usability and 46.7% found the interface easy to use. In FGDs, PHC providers valued DDSS for enhancing decision-making. It was viewed as user-friendly and supportive in unfamiliar clinical domains. However, concerns included incomplete algorithms, increased documentation and limited disease coverage which contributed to mistrust, especially in complex cases with overlapping symptoms. CONCLUSIONS DDSS-integrated telehealth offers a viable strategy to re-engage female providers in, but success depends on addressing technical limitations and expanding clinical applicability.