Abstract
Background: Digital health adoption in primary health care remains poorly understood in Rivers State, Nigeria, where Public Health Nurses (PHNs) serve as the frontline health workforce. Most prior Nigerian studies have not measured infrastructure availability as an independent variable, limiting the accuracy of findings on adoption barriers.
Objective: To assess knowledge, attitudes, availability, and utilisation of digital health tools among PHNs in Rivers State and identify independent predictors of utilisation.
Methods: A descriptive cross-sectional survey was conducted among 232 PHNs from all 23 Local Government Areas of Rivers State, Nigeria, selected by stratified random sampling between October and December 2025. A validated self-administered questionnaire (Cronbach α = 0.83) and facility observation checklists were used for data collection. Data were analysed with descriptive statistics, chi-square tests, and binary logistic regression using SPSS version 25. Analysis of variance (ANOVA) was used to compare mean scores across facility types and locations (F = 12.45, p < 0.001).
Results: Functional computers were available in 24.1% of facilities, internet connectivity in 19.0%, electronic health record systems in 12.1%, and telemedicine platforms in only 5.2%. Rural facilities had significantly lower availability scores than urban facilities (mean 2.1 vs. 3.8; p < 0.001). The mean knowledge score was 6.2/10; 33.6% demonstrated good knowledge, 45.7% moderate, and 20.7% poor. Positive attitudes were held by 53.4% of PHNs, and 76.8% were willing to adopt digital tools with training. High utilisation was reported by 37.9%. Availability (OR = 2.44; 95% CI: 1.44–4.13), attitude (OR = 2.50; 95% CI: 1.46–4.28), knowledge (OR = 2.10; 95% CI: 1.28–3.42), and urban location (OR = 2.27; 95% CI: 1.41–3.65) independently predicted high utilisation (χ² = 52.38, p < 0.001; Nagelkerke R² = 0.42).
Conclusion: PHNs in Rivers State possess moderate knowledge and positive attitudes toward digital health, but absent infrastructure — particularly in rural areas — remains the dominant barrier to utilisation. The data demonstrate that infrastructure investment, targeted training, and technical support are prerequisites for effective digital health integration in primary health care.