Abstract Introduction The rapid growth of digital health initiatives has heightened dependence on frontline health workers (FLHWs) to deliver, document, and manage services via digital tools, especially in low- and middle-income countries. In India, widespread adoption of platforms under the Ayushman Bharat Digital Mission (ABDM) lacks a standardized digital health competency framework for FLHWs, hindering systematic skill development, assessment, and integration. This study designed, developed, and evaluated a theory-driven, evidence-based, scalable Digital Health Competency Framework (DHCF) for India’s health workforce, framed as a feasibility and proof-of-concept study, piloted among FLHWs in Uttar Pradesh. Methods We used a three-stage approach: design, implementation, and evaluation. Development drew from a systematic literature review and the Government of India’s Framework for Roles, Activities, and Competencies (FRAC). A cadre-agnostic competency dictionary was created, covering functional, behavioral, domain-specific, and intervention-specific skills at graded proficiency levels. Competencies were mapped to FLHW roles, with aligned training materials and assessments developed. The framework was piloted via in-person, instructor-led sessions for Auxiliary Nurse Midwives (ANMs) in two districts (n=70), plus baseline evaluations for Accredited Social Health Activists (ASHAs; n=32). Results The DHCF comprises a three-component package: (i) a cadre-agnostic competency dictionary with progressive proficiency levels, (ii) systematic role-to-competency mapping via the FRAC methodology, and (iii) integrated training content and assessment scaffolding designed for institutional embedding. The DHCF defined ten core competencies, enabling role-specific mapping across cadres. Feasibility testing showed significant gains in ANMs’ knowledge and digital skills (Wilcoxon signed-rank test showed significant gains in two of four competency levels (C1L1 and C2L1, both p0.001), with the largest effect in data collection basics (r=0.84)); ASHA baselines exposed major foundational literacy gaps (mean total score 11.97/30, 39.9%; data collection competency weakest at 32.5%, with no ASHA scoring above 60% on C2L1). Stakeholders affirmed the framework’s relevance, feasibility, and adaptability, but noted needs for hybrid training and better institutional embedding. Conclusion The DHCF offers a structured, scalable method to standardize digital health training for FLHWs, enhancing workforce preparedness in resource-limited settings during India’s digital health evolution. This feasibility study demonstrates the framework’s relevance and applicability, with future work needed to assess effectiveness at scale, long-term competency retention, and linkage to service delivery outcomes. Parallel attention to digital tool design and usability is essential to complement competency-building efforts.
Bariya et al. (2026) studied this question.