Adoption, Utilization and Challenges of Digital Health Technologies for Monitoring and Evaluation of Primary Health Care Programs in Rivers State, Nigeria

Background: Digital health technologies are increasingly integrated into primary health care (PHC) systems to strengthen routine data collection, reporting, programme monitoring and evidence-informed decision-making. Effective implementation depends on health-personnel adoption, routine utilization, supportive infrastructure and organisational capacity. In Nigeria, evidence on their adoption and use for monitoring and evaluation (M&E) at PHC level remains limited, particularly in Rivers State. Methods: A cross-sectional study was conducted among 602 PHC personnel involved in healthdata collection, reporting, supervision and programme monitoring. Participants were recruited through multistage sampling, and data were collected using a structured questionnaire developed from the study objectives. Descriptive statistics, Spearman’s rank-order correlation, group-comparison tests, Chi-square tests and multivariable regression were used; significance was set at p<0.05 Results: DHIS2 was most commonly used (84.7%), followed by NHLMIS (73.1%), electronic data-capture/reporting tools (65.8%), ODK (62.1%), NDARS (59.5%) and OpenMRS (42.0%). Mean adoption breadth was 4.34±1.25 technology categories; 75.6% used at least four categories. Routine utilization was extensive, averaging 8.95±1.10 of 10 M&E activities, while 38.4% reported frequent or very frequent digital use across all ten activities. Perceived M&E contribution was high (mean=3.61), with 99.2% positive endorsement. However, implementation challenges remained evident (mean=3.09). Adoption breadth was not significantly associated with perceived M&E contribution (ρ=−0.006, p=0.882), and UTAUT-related factors did not significantly predict adoption or continued use (R²=0.008; F (4,597) =1.150; p=0.332) Conclusion: Digital health technologies are widely adopted and routinely used for PHC M&E in Rivers State and are perceived to contribute substantially to routine information processes. However, greater adoption alone did not improve perceived M&E contribution, and technologyacceptance factors did not independently explain utilization. Recommendation: Strengthening interoperability, infrastructure, workforce development, technical support, sustainable financing and institutional ownership is essential for resilient, scalable and effective PHC M&E systems.